Loading...
Loading...
Fundus photography is an increasingly important skill for paraoptometric professionals. Retinal cameras—ranging from traditional dilated systems to modern non-mydriatic widefield cameras—allow documentation of the retina, optic disc, and macula for disease detection, monitoring, and treatment planning. Paraoptometrics who can perform high-quality fundus photography contribute directly to better patient care in diabetic retinopathy, glaucoma, AMD, and other conditions.
Free CPO and CPOA exam prep on Opterio—including fundus photography and diagnostic imaging.
Optical coherence tomography—cross-sectional retinal and optic nerve imaging.
Diabetic retinopathy stages and screening—where fundus photography is essential.
Dilation drops used before dilated fundus photography.
Browse all CPO and CPOA study topics by category.
A fundus camera (also called a retinal camera) is a specialized microscope-camera system designed to photograph the posterior segment of the eye—the fundus. It captures images of the retina, optic disc, macula, retinal vessels, and choroid. Most fundus cameras have a 30°–50° field of view. Widefield cameras can capture 100°–200° with or without dilation. The camera uses a ring-shaped illumination system that enters and exits the pupil through different zones, avoiding corneal reflections. Modern cameras produce high-resolution color images, red-free images, fluorescein angiography images, and can connect to electronic health records.
Traditional fundus cameras typically require a pupil of at least 3–4 mm for adequate image quality, making pharmacologic dilation (typically with tropicamide and phenylephrine) necessary for patients with small or poorly dilating pupils. Modern non-mydriatic cameras (also called NMC or non-dilated cameras) can capture images through undilated pupils as small as 2–3 mm using flash illumination that avoids the constriction reflex. Non-mydriatic cameras are widely used for diabetic retinopathy screening programs because they eliminate the need for dilation, reduce chair time, and avoid the 4–6 hours of blurred near vision associated with dilation. However, image quality is generally better with dilation, and undilated wide-angle images may miss peripheral pathology.
The standard fundus photo protocol typically includes: (1) Optic disc-centered photograph—centers the camera on the optic nerve head to show the disc, cup, and peripapillary RNFL. (2) Macula-centered photograph—centers the camera on the fovea to show the macula and surrounding retina. (3) Combined field showing both the disc and macula when a single image can capture both (may require a widefield camera). Some protocols also include superior, inferior, nasal, and temporal field photographs for a 7-field ETDRS protocol (used in diabetic retinopathy grading). For each eye, images should be labeled correctly: OD (right) and OS (left).
A high-quality fundus photograph should have: (1) Sharp focus across the entire image—the optic disc and macular vessels should be in crisp focus. (2) Adequate and even illumination—no dark zones at the edges (vignetting) or overexposed areas. (3) No corneal reflex or flash artifact obscuring the image center. (4) Correct centering on the target structure (disc or macula). If quality is poor, paraoptometrics can: ask the patient to fixate on a specific target, instill a lubricating drop to improve tear film, dim the exam room lighting to allow natural pupil dilation, adjust joystick position to minimize corneal reflex, or schedule a dilated appointment if persistent quality issues occur.
Fundus photography is the primary method for screening and grading diabetic retinopathy. Regular retinal photographs allow: (1) Detection of early non-proliferative diabetic retinopathy (NPDR) including microaneurysms, dot/blot hemorrhages, hard exudates, and cotton-wool spots. (2) Documentation of macular edema risk (clinically significant macular edema requires OCT for confirmation). (3) Detection of high-risk proliferative diabetic retinopathy (PDR) including neovascularization of the disc (NVD) and elsewhere (NVE). (4) Longitudinal comparison—photographs from sequential visits show whether retinopathy is stable, improving (after treatment), or progressing. In many diabetic retinopathy screening programs, paraoptometrics perform the photography and trained graders or AI algorithms analyze the images.
Practice with free weekly questions tailored for CPO and CPOA certification candidates.