Kerala Journal of Ophthalmology

PG CORNER
Year
: 2019  |  Volume : 31  |  Issue : 3  |  Page : 251--254

Retinal drawing


Shahnas Valappil, Anupama Jayan 
 Department of Ophthalmology, Little Flower Hospital and Research Centre, Ernakulam, Kerala, India

Correspondence Address:
Anupama Jayan
Little Flower Hospital and Research Centre, Ernakulam, Kerala
India
Dr. Shahnas Valappil
Little Flower Hospital and Research Eentre, Ernakulam, Kerala
India

Abstract

Retinal drawings are important to document pathology, which help to compare the changes in pathology in follow-up visits, help in better communication when more than one physician is dealing the case, and help in easy follow-up of disease course with a glance. In retinal drawings, the instructor can monitor students – areas of omission and confusion can be detected. They are advantageous over photographs – they are less expensive, provide immediate record, and highlight details that are difficult to photograph and finally help you medicolegally.



How to cite this article:
Valappil S, Jayan A. Retinal drawing.Kerala J Ophthalmol 2019;31:251-254


How to cite this URL:
Valappil S, Jayan A. Retinal drawing. Kerala J Ophthalmol [serial online] 2019 [cited 2020 Nov 23 ];31:251-254
Available from: http://www.kjophthal.com/text.asp?2019/31/3/251/274591


Full Text



 Introduction



Retinal drawings are rarely ever used by practitioners although many of us has been trained well to draw the fundus.[1]

Requisites for drawing

Examination table, indirect ophthalmoscope, 20 D lens, scleral depressor, colored pencils (red, blue, green, yellow, brown, and black), fundus drawing chart, and eraser.

The patient should be lying down comfortably with a well-dilated pupil. The periphery should be examined first as it is less sensitive to light than the posterior pole. To trace the lesion, observe the disc and follow a vessel to the periphery.

Fundus evaluation include:

Optic disc evaluation:[2] Size, shape, and color of the disc; vertical cup-to-disc ratio; neuroretinal rim; disc margins: distinct/blurred and peripapillary changesRetinal vasculature changes: attenuation, tortuosity, dilatation, and nicking, and ratio of artery size compared to vein size (A/V ratio) should be checked after the 1st bifurcation. The normal A/V ratio is 2:3Macula: Flat/intact and uniformly pigmented, yellowish foveal reflex. Look for any abnormal pigment/blood or fluidVitreous and retinal periphery: Vitreous for clear/cells, posterior vitreous detachment. Periphery: complete 360° examination needed and look for retinal holes/breaks/blood.

Fundus drawings are made on a standard fundus chart, Amsler–Dubois chart, which contains three concentric circles – the innermost circle represents the equator, the middle circle represents the ora serrata, and the outer one is the junction between the pars plana and plicata [Figure 1]. The radial numbered in Roman numerical is used to designate the location and extent of the lesions in clock hours. The macula is drawn centrally, and the optic nerve head is located nasal to the macula.{Figure 1}

Image observed in indirect ophthalmoscopy is inverted and reversed; hence, to overcome this, you may invert the paper and draw anomaly as it appears inside the condensing lens, in the same location as you are observing [Figure 2].{Figure 2}

 Color Coding



Red color

Following are represented in [Figure 3] and [Figure 4]{Figure 3}{Figure 4}

Hemorrhages (preretinal and intraretinal)[3],[4]Attached retinaRetinal arteriolesNeovascularizationVascular abnormalities/anomaliesVascular tumorsOpen interior of conventional retinal breaks (tears, holes)Open interior of outer layer holes in retinoschisisOpen portion of retinal holes in the inner layer of retinoschisisOpen portion of Giant retinal tear (GRT) or large dialysesInner portion of thin areas of retinaElevated neovascularizationSubhyaloid hemorrhageMacular edema.

Blue color

Following are represented in [Figure 5] and [Figure 6]{Figure 5}{Figure 6}

Detached retinaRetinal veinsOutlines of retinal breaksInner layer of retinoschisisOutline of lattice degeneration (inner “x”)Outline of thin areas of retinaOutlines of ora serrata (some authors mentioned brown color)Outline of change in area or folds of detached retina because of shifting fluidDetached pars plana epithelium anterior to the separation of ora serrateWhite with or without pressureRolled edges of retinal tears (curved lines)Cystoid degenerationOutline of flat neovascularization.

Green color

Following are represented in [Figure 7]{Figure 7}

Opacities in the mediaVitreous hemorrhageVitreous membranesHyaloid ringIntraocular foreign body (IOFB)Asteroid hyalosisFrosting or snowflakes on cystoid degenerationsRetinoschisis or lattice degenerationOutline of elevated Neovascularisation (NV).

Brown color

Following are represented in [Figure 8]{Figure 8}

Uveal tissuePigment beneath detached retinaPigment epithelial detachmentMalignant choroidal melanomasChoroidal detachmentOutline of posterior staphyloma.

Yellow

Following are represented in [Figure 9]{Figure 9}

Intraretinal subretinal hard yellow exudateDeposits in the retinal pigment epitheliumPost cryo/laser retinal edemaDrusenVenous sheathing.

Black

Following are represented in [Figure 10]{Figure 10}

Hyperpigmentation [5] as a result of previous t/t with cryo/diathermySclerosed vesselsPigment in detached retinaPigmented demarcation lines at the attached margin of detached retina or within detached retina.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Dvorak L, Russell SR. Retinal drawing: A lost art of medicine. Perm J 2011;15:74-5.
2Bowling Brad Retinal detachment In: Kanski's clinical ophthalmology, a systematic approach. 8th ed. China: Elsevier; 2016. p. 687.
3Chaudhuri Zia Retina and vitreous. In: Postgraduate ophthalmology. 2012th ed. New Delhi: Jaypee; 2012. p. 1137–9.
4Tandon Radhika Diseases of the retina. In: Parson's diseases of the eye. 22nd ed. New Delhi: Elsevier; 2015. p. 303.
5Majumder P. Fundus Drawing,Documentation and drawing in Ophthalmology [Internet]. Eophtha.com 2008. Available from: http://www.eophtha.com/Must%20Know/drawing.html. [Last cited 2019 Dec 26].