Acute lymphocytic leukaemia optic nerve infiltrationBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2382 (Published 09 June 2017) Cite this as: BMJ 2017;357:j2382
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Nuno Ferreira and Filipa Teixiera's item in Minerva' page of 9 June 2017 is a timely reminder of the importance of fundus examination (1). Their patient's fundus photograph is excellent. Unfortunately, in many medical schools little time is given to instruction and practice with a direct ophthalmoscope, and I now meet some consultant physicians who have given up fundoscopy on the grounds that it is too specialised. This loss of an invaluable clinical skill is the subject of a recent paper with an alarming title by D D Mackay et al, 'The dermise of direct ophthalmoscopy' (2). Yet most of the ocular signs of serious systemic diseases can be readily seen in the posterior pole and optic disc, and the non-specialist practitioner need not be put off fundoscopy because they believe that the entire retina has to be examined. Among ,many patients in whom the direct ophthalmoscope came to my rescue, I saw patients with papilloedema and retinal haemorrhages due to malignant hypertension, and cotton wool spots that were a red flag pointer to the diagnosis of acute systemic lupus erythematosus in paraplegia.
Educators in medical schools must restore the place of this elegant and powerful diagnostic skill.
(1) Ferreira NP, Teixeira F Acute lymphocytic leukaemia optic nerve infiltration, in Minerva BMJ2017;357:j2677
(2) Mackay DD, Garza,PS, Bruce BB, Newman NJ, Bioussie V. The demise of direct ophthalmoscopy. A modern clinical challenge. Neurol Clin Pract 2015; 5(2):150-157. doi10.1212/CPJ.0000000000000115
Competing interests: No competing interests