Direct Ophthalmoscopic Indirect Ophthalmoscopy (DIDO) and Estimation Dynamic Distance Direct Ophthalmoscopy (E-DDDO). The Two Novel Uses of Direct Ophthalmoscope!

Abstract

Aim: To describe two novel uses of a direct ophthalmoscope. 1) Direct ophthalmoscopic indirect ophthalmoscopy (DIDO) for the evaluation of the posterior pole of the eye from a distance using a direct ophthalmoscope and 2) estimation dynamic distance direct ophthalmoscopy (E-DDDO) for the objective measurement of accommodation in children. Subjects and methods: In this prospective observational study, DIDO and E-DDDO were performed on children< 16 years and compared with the current gold standard, the binocular indirect ophthalmoscopy (BIDO) and dynamic retinoscopy (DR), respectively. Results: Of 31 consecutive cases, DIDO identified all 5 patients who had retinal pathology diagnosed by BIDO. Seventeen children, aged 9.6±3.1 years underwent the E-DDDO and DR. The accommodative amplitude with E-DDDO was 8±2.3D, (range 4-11D) and that with DR was 8.5±2.7 D, (range 4-14D). One patient with asthenopia & hypo-accommodation was identified on both DR and E-DDDO. The Pearson r for E-DDDO & DR was 0.9. There was no statistical difference between the values obtained on two different techniques (Paired t test–p=0.6). Conclusion: DIDO and E-DDDO are two valid techniques; DIDO can be used for a rapid screening of the posterior pole of the fundus especially in uncooperative children and E-DDDO can be used to objectively assess the amplitude of accommodation in preverbal children and uncooperative children or adults.