Equipment review: ophthalmoscope
Dr Tonia Myers gives her verdict on this new piece of equipment after trying it out
WelchAllyn PanOptic Ophthalmoscope Model 11820 – with additional cobalt blue filter (and add-on magnifying lens for corneal examination). Catalogue price for head only (without handle) £467.
For those of you, like myself, who are lucky to get a fleeting glimpse of the optic disc if the wind is blowing in the right direction, then this is the ophthalmoscope for you.
Using patented new technology known as 'axial PointSource optics', the PanOptic gives a five times larger view of the fundus than standard ophthalmoscopes in an undilated eye and a 25-degree field of vision compared with the usual five degrees.
These claims are not exaggerated. After just a few minutes' demonstration I had the best view of the fundus I have ever seen outside of a slide show. The PanOptic has a much bigger head than traditional ophthalmoscopes and the rubber cup comes into direct contact with the patient. So there is a much greater 'comfort zone' between doctor and patient – a great selling point if your patients favour garlic bread!
The downside is that patients should be warned that the device is going to make contact and that you need to stabilise their forehead with your hand.
I soon discovered, when I was testing the PanOptic, how rarely I actually use my ophthalmoscope in my day-to-day practice and several surgeries went by without my reaching for it.
With the advent of screening programmes in diabetes, the need for skilled GP ophthalmoscopy seems less pressing. Nevertheless the PanOptic would come in very handy for those patients with severe headaches whose discs always seem to elude me.
Ease of use
After my two-week trial I was still not totally proficient using the PanOptic and I certainly did not have a 100 per cent hit rate in viewing the optic disc. Nevertheless, it is easier to get a good view of the retina than when using a standard ophthalmoscope, and I am sure that with more practice I may actually have seen a macula.
Another big plus point for someone like me who has one very dominant eye is that the operator can use either eye when viewing the fundus. Focusing is smooth with the dynamic focusing wheel with a range from
-20 to +20 diopters.
The model I tested also has a cobalt blue filter giving a blue light, which fluoresced beautifully after I instilled fluorescein drops into the eye of a patient with a corneal abrasion. The removable rubber cup can be easily disinfected with antiseptic wipes, but I would be very hesitant to use the PanOptic if the patient had any eye condition that could potentially be infectious.
Value for money
The PanOptic comes with or without a 'handle' and in various diagnostic set combinations. The head is compatible with other WelchAllyn battery rechargeable handles – so savings are possible if you can use your existing wall or desk set.
I think the PanOptic is an expensive piece of kit, so it is probably a bit of a luxury item unless you use your ophthalmoscope more frequently than I do.
On balance I think it would be a good
investment to have one PanOptic shared
per practice, or to replace worn-out or
lost equipment rather than to rush out and upgrade.
Overall I feel the PanOptic is a great innovation and potentially very useful. I will be sad to see my loan one go, just when I was getting the hang of it.
Tonia Myers is a GP in Highams Park, east London
Manufacturer's comment We are very pleased with the review. With regards to the infection control issue, the eye cups can be cold sterilised. They come in packs of five.