• ophthalmology
• investigative techniques
• neurology
• general practice
• public health

It is acknowledged that direct ophthalmoscopy is underutilised by non-ophthalmic specialists, a view which is frequently supported by research.1–4 Omission of ophthalmoscopy is, of course, perilous as it is may lead to delayed diagnosis and treatment. Clinicians will miss the opportunity to undertake a non-invasive in vivo assessment of retinal integrity, vasculature, and the optic nerve head; thus, potentially limiting the examination of patients with suspected conditions such as malignant hypertension; raised intracranial pressure; secondary metastases; and more common ocular conditions such as diabetic retinopathy or macula degeneration.

The exact reasons for poor ophthalmoscopy uptake remain unclear, but there is indication that medics would be more inclined to embrace ophthalmoscopy if there were easier access to a working instrument.2 5 However, such rationale is somewhat at odds with more recent work where constant provision to an ophthalmoscope failed to stimulate a significant increase in usage.3 Other reasons for not undertaking ophthalmoscopy may include time constraints; an inability to see anything useful,2 which could particularly be the case with elderly patients who may have smaller pupils and hospital wards are generally well-illuminated environments; a belief that the procedure was low priority2 or a lack of confidence using the instrument, especially on undilated pupils.6 The consensus appears to be that more training is required.5 Indeed, adequate ophthalmoscopy training in UK medical students has often been a point of concern.7 8

Successful direct ophthalmoscopy …