Indiana University School of Medicine.
Department of Neurology.
Curr Opin Neurol. 2019 Feb;32(1):105-110. doi: 10.1097/WCO.0000000000000637.
The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient care.
Medical practitioners are often first taught to examine the ocular fundus using a direct ophthalmoscope, however, this skill requires frequent practice. Nonmydriatic tabletop and portable fundus photography and even smartphone-based photography offer alternative and practical means for approaching examination of the ocular fundus. These alternative tools have been shown to be practical in a variety of settings including ambulatory clinics and emergency departments. Decreased retinal microvascular density detected with fundus photography has been linked to accelerated rates of cognitive decline. Research has also found optic disc pallor and retinopathy detected via fundus photography to be more prevalent in patients with recent stroke or transient ischemic attack.
Alternative methods of funduscopic examination based on fundus photography have the potential to improve the ease of use, portability, and availability of funduscopy. Recognition of changes in retinal microvasculature has the potential to noninvasively identify patients at the highest risk for cognitive impairment and cerebrovascular disease. However, further research is needed to determine the specific utility of measurements of retinal microvascular changes in clinical care. Innovative funduscopy techniques offer neurologists new approaches to this essential facet of the neurological examination.
眼底检查是神经检查中一项技术难度较大且常被忽略的部分，但它对患者的治疗有很大的影响。
医学从业者通常首先学习使用直接检眼镜进行眼底检查，但这项技能需要经常练习。免散瞳台式和便携式眼底照相术，甚至基于智能手机的照相术，为眼底检查提供了替代且实用的方法。这些替代工具已被证明在各种环境中都非常实用，包括门诊和急诊科。眼底照相术检测到的视网膜微血管密度降低与认知能力下降的速度加快有关。研究还发现，通过眼底照相术发现的视盘苍白和视网膜病变在近期发生中风或短暂性脑缺血发作的患者中更为普遍。
基于眼底照相术的眼底检查替代方法有可能提高眼底镜检查的易用性、便携性和可用性。识别视网膜微血管的变化有可能无创地识别出认知障碍和脑血管疾病风险最高的患者。然而，需要进一步的研究来确定视网膜微血管变化测量在临床护理中的具体应用。创新的眼底镜技术为神经科医生提供了一种新的方法来检查神经科检查的这一重要方面。
