Objectives of teaching direct ophthalmoscopy to medical students

Jochanan Benbassat, Bettine C P Polak, Jonathan C. Javitt

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Purpose: To propose the objectives of undergraduate training in direct ophthalmoscopy (DO). Method: Narrative review of the literature on (i) opinions about the expected proficiency from students in DO, and (ii) estimates of its diagnostic value. Results: (i) Authorities disagree on the proficiency in DO that they expect from students. Textbooks of physical diagnosis differ in their coverage of DO. Surveys have indicated that US physicians expect students to be able to detect optic nerve head abnormalities. The Association of American Medical Colleges expects students to perform ophthalmoscopic examination and describe observations. The International Council of Ophthalmology expects students to recognize also diabetic and hypertensive retinopathies. The Association of University Professors in Ophthalmology requires that students recognize papilloedema, cholesterol emboli, glaucomatous cupping and macular degeneration. (ii) There is evidence that DO, even by ophthalmologists, is inadequate for screening for glaucoma, diabetic and hypertensive retinopathies. Two studies have suggested a limited value of DO in detecting clinical emergencies. Conclusions: The evidence that DO, even by ophthalmologists, is sub-optimal in detecting common abnormalities challenges existing the notions of training medical students. On pending the results of additional studies of the value of DO in detecting emergencies, we suggest that undergraduate teaching of DO should impart the following: (i) an ability to identify the red fundus reflex and optic disc; (ii) an ability to recognize signs of clinical emergencies in patients, mannequins or fundus photographs; and (iii) knowledge about, but not an ability to detect, other retinopathies.

Original languageEnglish (US)
Pages (from-to)503-507
Number of pages5
JournalActa Ophthalmologica
Issue number6
StatePublished - Sep 2012


  • direct ophthalmoscopy
  • medical education
  • ophthalmology
  • physical examination
  • undergraduate

ASJC Scopus subject areas

  • Ophthalmology


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