 I'm Dr. James Zimmerman, one of the Vitria Retina Fellows at the Moran, and I'm going to be demonstrating how to do indirect ophthalmoscopy with scleral depression. So indirect ophthalmoscopy is a complicated procedure that takes a lifetime to master. However, the basics are put the indirect ophthalmoscope on and make sure that the light is centered in each eye independently, and you can move the eye pieces on either side if you need to. And then you position so that you're facing right at the patient and the light's shining in their eye, and place the lens in front between the eye and your scope, and you should be able to view the retina by just slightly moving. All of the movements are backwards and upside down, so depending on what you see, you have to move in the opposite direction that you think you should, which sometimes can make it very difficult, which is why it's a practiced skill. But a lot of times you can at least get a view and see, and this provides a very wide-angle view of the retina so that you can see a large area and see out into the periphery where you normally can't see when you're doing direct ophthalmoscopy. So the lenses that you use for this procedure, you can use a 20-dipter lens, a 15-dipter lens, or a 28-dipter lens, so they're lower magnification but larger field of view, and they're all free lenses, so you have to hold them between you and the patient at a certain distance. Usually I like to brace on the patient with my finger, which allows you to keep a constant distance, and then you can just kind of adjust, make micro adjustments, but that way you're more stable. If you try to float like this, it's very difficult to maintain a good view. And then we'll show how to do skeletal depression. It's basically a complicated maneuver using both hands when you're doing indirect ophthalmoscopy. So what you'll have the patient do is if I'm going to depress her superior portion of her eye, I'd have her look down and place the depressor in her eyelid and then have her look straight up towards the ceiling and then do the same indirect ophthalmoscopy, and then gently press on the sclera, and you're looking for the edge of your depressor, and that allows you to see some areas that are not visible just due to the optics of the eye, so that you can see the entire retina, including the pars plana. So that is indirect ophthalmoscopy with skeletal depression basics. It takes, like I said, a lot of practice, but making sure that everything's in alignment and then making sure that you're keeping your hand constantly resting on the patient's cheek makes it much easier. I hope you found this tutorial beneficial and helpful to you. Again, I'm Dr. James Zimmerman, the vitro retinal fellow at Moran Eye Institute and demonstrated indirect ophthalmoscopy and skeletal depression.