 Hi, my name is Tanya Puriakandi, I'm a fourth year medical student and today we'll be going over how to use the Direct Up Thmoscope. The key learning objectives for this video are to understand the utility of the Direct Up Thmoscope, to identify key anatomical structures visible with a Direct Up Thmoscope, to learn the parts and settings of the Direct Up Thmoscope, and to learn the exam technique of the Direct Up Thmoscope. The Direct Up Thmoscope allows you to look at the health of the retina, including the optic nerve, the veins and arteries, the macula, and the fovea. It produces an upright image of about 15 times magnification. In order to use the Direct Up Thmoscope correctly, it's important to know the different parts and settings of the instrument. Let's begin by looking at the practitioner side. This is the side that will be facing your eyes. The first thing you're going to want to do is turn on the instrument. In order to do this, you'll need to depress down on the green button and turn. This is called the rheostat and it controls the brightness of your light. This is the eyebrow rest. This is the viewing window. This is the diopter dial. And this is the diopter display. The far-sided eye requires more green numbers and the near-sided eye requires more red numbers. If you do not wear glasses or contact lenses, set the diopter to zero. If you do wear glasses or contact lenses, you can adjust it by looking at an image about 10 feet away, adjusting the dial until the image comes into focus. The patient side includes the viewing window, the filter switch. This switch allows you to change the color of the light. The red-free light allows you to look more closely at the vasculature. The aperture switch allows you to change the size of the light. The small aperture allows you to look at a constricted pupil in a well-lit room. The blue light allows you to look at corneal abrasions or ulcers with the use of fluorescing dye. The slit allows you to look at contour abnormalities. The grid allows you to measure distances between lesions. The large light allows you to look at a dilated pupil after using miedrotic drops. And the medium light allows you to look at an undilated pupil in a dark room. Now that you know the different parts and settings of the direct ophthalmoscope, we can learn the exam technique. The first thing you need to do is wash your hands and introduce yourself to the patient. We will be examining Kevin today. And the most important part of this exam is to position the patient correctly. You are going to want to have the position's eyes at the level of the instrument. So we will be moving you up, Kevin. So now that he's in the correct position, we can begin the exam. The reason why the position is so important is because it's going to allow you to visualize the optic disc more easily. Some textbooks do say you can go in and follow the vessels until you reach the optic nerve. However, positioning the patient is the easiest way to do it. So now that he's in the correct position, Kevin I'm going to ask you to look at an object on the wall directly ahead and then you'll want to turn the instrument on. And at this point you would want to dim the light so that you could get a better view. However, for this video we will be leaving the lights on. So since we're in a well-lit room and his pupils are constricted, I'm going to start with the small aperture and now you're going to want to place your hand on the patient's head and your thumb on the patient's eyebrow. Placing your thumb on the patient's eyebrow allows you to get as close as possible without running into the patient's eye. We're examining his left eye so we're wanting to use our left hand and our left eye to examine the patient's left eye. So you want to start at about 6 inches from the patient's eye and then about 15 degrees from the center. Now that you're in position, look for the red reflex. Get closer until you have the optic nerve in sight. You can change the diopter settings to focus on the optic nerve. Once you see the optic nerve, look at the cup to disc ratio. You can move slightly up or down to look at the vessels. Move temporarily to look at the macula and the fovea. Now you can repeat the same technique on the other eye. Thank you for watching this educational video. Please join us at the following Moran Core website for more information on basic eye exam techniques and other ophthalmology topics.