• Fundoscopy

Neurological diagnosis is based upon the clinical assessment, the history and examination. How can we make an appropriate diagnosis without an adequate clinical assessment? “Fundoscopy—discs not seen”, “ophthalmoscope not available”, or simply a blank space where the ophthalmoscopy findings should appear, are commonly seen in the notes of patients admitted with neurological problems across the world. One recent study found that only 30% of such patients recalled being examined with an ophthalmoscope.1 This unsatisfactory situation must be putting patients at risk. A ‘what if’ game brings out the critical importance of ophthalmoscopy: consider the differential diagnosis and management (and urgency of investigations) if the same patient had bilateral papilloedema, unilateral optic atrophy, etc. Despite its readily demonstrable importance in clinical assessment, ophthalmoscopy risks being dropped—along with many a departmental ophthalmoscope—as a routine part of examination. All doctors own a stethoscope—and most an expensive mobile phone—but only neurologists seem to own an …