Direct versus indirect ophthalmoscopy: Medical student assessment of retinal pathology

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Fundoscopy by non Ophthalmic specialists is typically performed by direct ophthalmoscopy. This challenging skill gives a magnified, monocular image. In contrast, indirect ophthalmoscopy as regularly used by Ophthalmologists allows a wide field, binocular view. The aim of the study was to test the hypothesis that compared to direct ophthalmoscopy, indirect ophthalmoscopy is an easier technique to learn and that the correct diagnosis of fundus pathology is more readily achieved.


The design was a prospective cohort study, conducted on 50 third year medical students, at a large inner city hospital. Participants attended a practical teaching session on both techniques. Students were then randomly allocated to either ophthalmoscopy technique and scored on their ability to recognise common fundus pathology in a group of patients. Student perception of the technique was also ascertained.


The number of surveys filled out for first and second session was 98% and 86% respectively. After the initial teaching session, the majority of students reported being ‘moderately’ confident in using both techniques (direct 52%; indirect 35%), but overall 59% preferred direct ophthalmoscopy. When asked to identify common retinal pathology, it was found that students allocated to direct ophthalmoscopy were more likely to correctly identify the pathology although not statistically significant (U value 9.5, p≤0.05).


Although indirect ophthalmoscopy provides better views of the retina, students are more confident using direct ophthalmoscopy. Furthermore, there is no significant difference in ability to diagnosis retinal pathology between either techniques.

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