Roger H Armour

Manufacture and use of home made ophthalmoscopes: a 150th anniversary tribute to Helmholtz.

Abstract Objective: To produce a simple, effective, and inexpensive training ophthalmoscope. Design: Case study. Setting: A coffee table in a sitting room and an eye clinic. Participants: 10 friends and relatives, several patients, and a cooperative Persian cat. Interventions: Direct ophthalmoscopy with instrument made with easily available material and tools from art and office equipment shops. Main outcome measures: Efficiency, clarity of view, and price of ophthalmoscope. Results: The instrument was readily made; of the 50 manufactured two thirds gave a good view; and each cost less than £1 to make. Conclusion: The ophthalmoscope is fun to make, works well, and anyone can make one.

Recurrent severe haemorrhage from false aneurysm following fracture of the femur.

A case of traumatic false aneurysm presenting as recurrent exsanguinating haemorrhage from a surgical wound of the thigh is described. A plate, inserted to maintain reduction of a fracture of the femur, was removed during the third attempt to control the bleeding and only then was the source revealed. Diagnostic difficulty delayed definitive treatment.

Patients are mismanaged when they are well investigated but not well examined

Patel seems to be playing devil’s advocate in arguing that clinical examination is dead, but he does not go far enough.1 Why not programme robots to take a history, order a vast array of scans to avoid missing anything, and print out evidence …

Comment on: Diagnosing central nervous system trypanosomiasis: two stage or not to stage.

In his scholarly review, Kennedy highlights both the therapeutic importance and the difficulty of differentiating the early or haemolymphatic stage of sleeping sickness from the late or encephalitic stage on clinical grounds.1 Similar difficulties were encountered in the case of cerebral malaria, especially in children in endemic areas, where parasitaemia is so common that it is not in itself diagnostic. And then Lewallen et al. described an unusual retinopathy seen on direct and indirect ophthalmoscopy in 57% of the patients.2 It has now been confirmed that retinal whitening, especially of the macula, and white or orange discoloration of retinal vessels are specific to malaria.3 Has fundoscopy through dilated pupils by trained practitioners been the subject of a clinical trial in patients with sleeping sickness? Might it help in the diagnosis of the encephalitic stage of the illness? Ophthalmologists and neurologists apart, most practitioners are not confident in the use of ophthalmoscopes, and fundoscopy is a muchneglected clinical method. As Denniston (2001) remarks, ‘‘Ophthalmoscopy is many a physician’s ‘blind spot’ . . .’’4

Auto-ophthalmoscopy: a novel way to practice retinal examination

Proficiency at retinal examination takes a long time to acquire. The authors investigated auto-ophthalmoscopy — the examination of ones own retina — as a way of helping the student or practitioner. They report the first pilot study in the 145-year history of the method. Auto-ophthalmoscopy is best taught by demonstration and is best learnt under supervision. It takes practice, which is in itself useful in learning how to use a direct ophthalmoscope. Of 20 participants in the pilot study, 11 saw their retinae. One of the authors, who has type 2 diabetes, has seen and sketched his own micro-aneurysms.