After general practitioners complete their preparation for an ophthalmic exam, gross inspection, and vision inspection, it is time to evaluate the pupils, examine the anterior structure, and use ophthalmoscopy. As general practitioners prepare to provide the final pieces of their exam, they may need some extra tips and tricks to make sure the exam is smooth and less stressful for veterinary professionals.

 based on Ron Ofri’s, DVM, PhD, DECVO, Hebrew University of Jerusalem, lecture 

 presented at the Veterinary Meeting & Expo Conference in Orlando, Florida, here are the final steps in Ofri’s process that are designed to make ophthalmic exams less complicated for general practitioners.

During the exam, once the team has dimmed the lights in the exam room the patient’s pupils should be dilated and evaluated. First, use a dim light and stand a short distance away from the patient so you can see both pupils at once through a tapetal reflection, which can also serve to highlight any ocular opacities by means of retroillumination, particularly in the vitreous or lens.

Next, a bright light is used to evaluate the Pupillary Light Reflex (PLR), which is a subcortical reflex. Ofri explained this does not test vision, and a cortically blind animal can present with a normal PLR. The PLR is usually presented in animals suffering from outer retinal degeneration, cataracts, and any other causes of subcortical blindness, though it could potentially be diminished or slow. This test is crucial to the examinationƒ because it can help the veterinary team localize the lesion causing the patient's vision loss. To help, Ofri offered this tip to attendees.

“Another very important point when testing the dazzle or the PLR, please use a fully charged trans illuminator. Use a strong source of light, not a cheap LED that you [buy] when filling up your gas tank at the station. Believe me, the most common cause for lack of PLR is the practitioner not using a strong enough source of light. It is very, very embarrassing when we get dogs referred to us for lack of PLR and it turns out that they have proper PLR,” Ofri said.

When it comes to the patients’ pupils, if one does not react to the light or cannot be visualized, the consensual PLR should be checked, or alternatively, the dazzle reflex. The dazzle reflex is also a subcortical reflex that manifests as a bilateral, partial blink in response to a bright light, he explained.

Examine the anterior structures of the eye

As veterinary professionals continue to this stage, the rest of the examination will be done in the dark with a focal light source and magnification to examine the anterior structures of the eye, in anatomical order.

First, the eyelids and eyelashes. Ofri explained the first step is to evaluate the size of the palpebral fissures to look for a narrowed or enlarged fissure. Then, carefully examine the skin and look for any signs of dermatological disorders or discharge. Veterinary professionals should pay extra attention to the eyelid margin because, in a normal animal, the veterinarian should be able to see the entire margin in close contact with the globe. If there is a lack of contact, it could be due to the ectropion but if you cannot see the margin or even parts of it, the lid could be everted.

A tip from Ofri for professionals is if there are any eyelash abnormalities, it may be better to see if the lid is slightly retracted.

“Our next tissue in this anatomical journey is the conjunctiva. And I guess you all know what normal mucus conjunctiva looks like, but if it's abnormal, you ask yourself whether there is edema or chemosis, whether there are congested vessels or other signs of inflammation, or, as I've said earlier, it may be a sign of systemic disease, such as a pale conjunctiva in the case of anemia icterus,” Ofri continued.

And then the third eyelid, which is an extra fold of the conjunctiva, will also need to be examined. Ofri explained that sometimes a foreign body could get stuck behind the inner aspect of the third eyelid. When it comes to the third eyelid, it should be hardly visible and mostly retracted at rest and the outer aspect can be examined by pressing on the globe, causing the third eyelid elevation. Veterinarians can examine the inner aspect of the 3rd eyelid after applying a topical anesthetic and eversion of the lid with fine forceps.

The cornea and sclera follow the examination of the conjunctiva and third eyelid. A normal cornea should be smooth and transparent, so any deviation from that represents a pathological change. Veterinary teams should look for a loss of transparency caused by edema, pigmentation, cellular infiltration, vascularization, lipid or mineral deposition, or fibrosis. Ofri explained that surface irregularities should also be looked for and can be caused by ulceration, iris prolapse, granulation tissue, perforation, or keratoconus. The corneal diameter should be evaluated, with a larger diameter indicating glaucoma and a reduced diameter potentially meaning micro-phthalic or phthisical eye.

The next step of the exam is to assess the depths of the anterior chamber, which is best visualized from the side according to Ofri. The anterior chamber may increase or decrease due to various intraocular diseases. The aqueous filling within the chamber should be clear, and opacities or masses such as fibrin, hypopyon, luxated lens, persistent pupillary membranes, iris cysts, or vitreous. Another cause could be a phenomenon called aqueous flare, which Ofri explained to attendees.

“Inflammatory material may be seen in the aqueous as a phenomenon that we call aqueous flare. The best example I can give you, or the best analogy I can give you, of what is aqueous flare is when you go to see a movie. You were sitting in a dark movie house. The lights went down. It's completely black. And then the propeller comes on at the back of the room, and you see all of these dust particles floating in the cinema house right? Same thing in the eye,” he continued.

The final step in the examination is the iris and pupil. General practitioners should look for alterations in the pupil shape, which could be caused by adhesions, iris atrophy, hypoplasia, or coloboma. If the patient is presenting with changes to the pupil color, it could be a sign of cataract, retinal detachment, or hemorrhage. For the size of the pupil changing, this could be caused by glaucoma, uveitis, or other diseases of the retina or nervous system.

Ofri explained that the surface of the iris should be examined for changes in color or masses, caused by inflammation, hemorrhage, or neoplasia.

According to Ofri, this is the portion of the examination that clinicians dread the most. He believes it is partly because there is a large range of normal variations in the appearance of canine and feline fundus, although they are to a lesser extent when it comes to feline patients. This can make it difficult to diagnose abnormalities if veterinarians are not in the habit of performing the examination, which is why Ofri recommends performing these on every patient. The clients will not only be happy with the extra effort, but it gives veterinary professionals practice.

The exam should be conducted once the pupil is dilated in a dark room. First, the tapetal reflection should be evaluated to detect any opacities of the lens or vitreous. When approaching the patient, Ofri explained to focus on successively more posterior structures, the cornea, iris, lens, and vitreous, until becoming focused on the fundus. It is important to carefully inspect the complete fundus, evaluating changes in the tapetum, non-tapetum, blood vessels, and optic disc. 

“If you are to remember one slide from everything I said up till now, it's this one, please do an ophthalmoscopic exam on every patient that walks into your clinic, not just on blind patients…on every patient that walks into your clinic, be it for vaccination or flea control or dietary consultation or whatever. The reason I say that is that...number 1, the technique is challenging to learn. There is a steep learning curve in order to become good in ophthalmoscopy,” he explained.

“Number 2, there are lots and lots of normal variations in the appearance of a normal fundus, especially in dogs. If you haven't done an ophthalmoscopy and you haven't practiced the technique and you haven't learned all the normal variations, you have no hope in hell of diagnosing a fundus with abnormalities or looking at the fundus of a blind animal,” Ofri concluded.

Ofri R. Ophthalmic Exam Made Easy! Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Articles

Ron Ofri, DVM, PhD, DECVO, provided veterinary professionals at the Veterinary Meeting & Expo conference ways to make ophthalmic exams less intimidating for general practitioners 

Making ophthalmic exams easier for general practitioners 

At the 2025 Veterinary Meeting & Expo (VMX) in Orlando, Florida, January 25-29, Hill’s Pet Nutrition showcased a handful of new and improved Prescription Diet and Science Diet products. The products, according to Hill’s, will be launching this year.

The new products build on the success and technology in products like Hill’s Prescription Diet Gastrointestinal Biome, the company said in a news release.

Additionally, many of the new products will contain the company’s ActivBiome+ technology, which used information from the collection and processing of thousands of fecal, oral, skin, and urinary microbiome samples for its development.

“At Hill’s, we have a real focus on continuing to innovate, thinking about how we can push the envelope around how we can use nutrition to help support animals, both in healthy pets and with sick pets,” said Karen Shenoy, DVM, chief veterinary officer for Hill’s US, in an interview with 

at VMX. “And through that focus on the microbiome, we've been focusing on something called ActivBiome+ technology. And there's actually a few different forms of that.”

Currently company has 3 ActivBiome+ blends

ActivBiome+ Digestion: A Hill’s blend of prebiotics that quickly “activate the gut microbiome to support digestive health and wellbeing.”

ActivBiome+ Kidney Defense: “Activates” the gut microbiome to decrease harmful waste products.

ActivBiome+ Multi-Benefit: A mixture of prebiotic fibers and antioxidants that lay the groundwork for long-term health by helping digestion, the immune system, and organ health.

The products launching in 2025, which were created to also help veterinary professionals manage patients with more than one condition, include

Prescription Diet z/d for dogs and cats with ActivBiome+ Digestion: 

A therapeutic diet with hydrolyzed proteins designed to help lower skin irritation, scratching, and digestive issues caused by adverse food reactions

Prescription Diet i/d for cats with ActivBiome+ Digestion

: A nutrition designed to activate the gut microbiome and help settle digestive upsets

New Prescription Diet i/d for puppies and kittens with ActivBiome+ Digestion: 

A “highly digestible” nutrition developed to activate the gut microbiome and help settle digestive upsets

New Prescription Diet Brain Care + j/d for dogs and cats: 

A clinical diet created for pets with cognitive dysfunction and compromised mobility

Hill’s is also launching a New Prescription Diet Multi-Organ for dogs and cats with ActivBiome+ Kidney Defense, which is designed to feed pets that may have conflicting nutritional needs.

 “We're really not only thinking about microbiome health, but some of those challenging cases where you might have multiple issues going on in the same pet, and it can be a little challenging sometimes to decipher which nutrition is the best for them. So, it's a good diet that can help in multiple situations where there may be different disease processes going on in that same pet,” explained Shenoy of the upcoming early 2025 product launch, in an interview with 

“The new Hill’s Prescription Diet Multi-Organ for dogs is designed to help with dogs that might have fat sensitivities or have liver disease, cardiac disease, renal disease. And the cat product is designed for cats that may have issues with the heart, kidney, liver or the urinary tract,” she continued. 

Speaking of the upcoming new Prescription Diet i/d for puppies and kittens, Shenoy told 

, “We have an existing product, Hill’s Prescription Diet i/d that's been one of our flagship products that we've had for a really long time, and we're continuing to innovate with that diet as well. [We] have a new option where we'll have a puppy-kitten formula as well as an adult formula, and…both of those formulas will contain ActivBiome+, so [it will] really help with easy to digest formulas, and that technology that helps with the gut microbiome at the same time.”

In addition to releasing their "new and enhanced" Prescription Diet products, Hill’s is improving select Science Diet life stage dry dog and cat foods. These products, according to Hill’s, will now contain ActivBiome+ Multi-Benefit.

"Every meal is an opportunity to enhance the health and well-being of pets," Karen Shenoy, DVM, chief veterinary officer for Hill’s US, said in a news release.

 "At Hill's, veterinary professionals are at the heart of all we do, and we stand as their partners in pioneering new and improved, innovative nutrition that helps them best meet their patients' evolving needs. Our newest advancements in microbiome science, support for pets with concurrent conditions, and lifestage nutrition are extensions of our commitment to enriching pets' health, every step of the way."

At VMX, Hill’s was also recognized as a 

 The company received the North American Veterinary Community (NAVC) Spotlight Award for the “Hill’s Prescription Diet–Silent Sufferers” campaign, which was developed by Hill’s and VML, a partner agency.

Kristen Coppock Crossley, MA contributed to this article.

Hill's Pet Nutrition leads the way in microbiome science at VMX 2025, unveiling breakthrough product innovations. News release. Hill’s Pet Nutrition. January 24, 2025. Accessed February 5, 2025. 

https://prnmedia.prnewswire.com/news-releases/hills-pet-nutrition-leads-the-way-in-microbiome-science-at-vmx-2025-unveiling-breakthrough-product-innovations-302359972.html

Coppock Crossley K. NAVC presented VETTY Awards at VMX 2025.

. February 5, 2025. Accessed February 5, 2025. 

https://www.dvm360.com/view/navc-presents-vetty-awards-at-vmx-2025

Hill’s Pet Nutrition announced improved Prescription Diet and Science Diet products will be launched early this year

Upcoming microbiome-based nutrition products announced at VMX

Mount Laurel Animal Hospital (MLAH) in New Jersey is now accredited by the American Animal Hospital Association (AAHA) in recognition of the practice’s commitment to providing exceptional veterinary care. This new accreditation is in addition to the hospital's recently acquired certifications by Fear Free and the Veterinary Emergency and Critical Care Society (VECCS).

The AAHA accreditation is a mark of excellence that reflects the highest standards in veterinary medicine, and assures pet owners that they are choosing a veterinary facility that prioritizes their pets' health and well-being, according to MLAH. Accredited hospitals are required to meet rigorous criteria in areas such as patient care, diagnostic services, and hospital facilities.

The combination of AAHA accreditation, Fear Free certification, and 

emphasizes MLAH’s commitment to a high standard of care while ensuring a comfortable and stress-free environment for pets. The Fear Free certification showcases the hospital's dedication to minimizing fear and anxiety during veterinary visits, and the VECCS certification highlights its capabilities in emergency and critical care situations. This collaborative approach to veterinary medicine ensures that pets receive comprehensive, compassionate care at every stage of their lives, according to MLAH.

Krista McDermott, CVT, CVPM, MLAH’s practice manager, said she was “incredibly proud” of the hospital’s work and dedication that went into achieving the AAHA accreditation, and the 2 recent certifications. “These milestones are a testament to our commitment to excellence and our unwavering focus on providing the highest level of veterinary care to our community. Our team of over 50 doctors and 300 staff members is passionate about animal welfare, and these accolades reinforce our mission to be a trusted resource for pet owners,” McDermott said in a news release.

MLAH is open daily on a 24-hour basis, 365 days a year. It serves its’ community to ensure that every pet receives quality care whenever it is needed, according to the hospital.

MLAH offers a comprehensive range of services, including emergency care, preventive medicine, and specialized behavioral medicine. These services provide care for pet needs in one setting, as primary care veterinarians can seamlessly work with specialists to create tailored treatment plans.

The hospital offers multiple specialty services including ophthalmology, surgery, cardiology, oncology, critical care, and behavioral medicine, among others. The AAHA accreditation makes Mount Laurel Animal Hospital 1 of 5 accredited behavioral medicine services in North America.

Mount Laurel Animal Hospital achieves prestigious AAHA accreditation, elevating veterinary care in the community. News release. Mount Laurel Animal Hospital. 2025.

Mount Laurel Animal Hospital recently earned certifications from Fear Free and VECCS

New Jersey practice achieves AAHA accreditation

Winners of the 2024 VETTY Awards Grand Prize received crystal towers, similar to those shown from a 2023 awards ceremony, in a presentation at the VMX 2025 on January 26..

The North American Veterinary Community (NAVC) recognized the winners of the 2024 VETTY Awards program, during the NAVC’s 2025 Veterinary Meeting & Expo (VMX) in Orlando, Florida. The honorees included 7 grand prize winners.

These awards recognize excellence in advertising, public relations, digital, social media, design, events, promotions, educational materials and other projects aimed at promoting the contributions of the animal health care industry in keeping patients healthy. The winners include 30 Gold, 43 Silver, and 46 Bronze level recognitions, in addition to the grand prize recipients.

Gene O’Neill, CEO of NAVC, noted that the organization is proud to celebrate the work of these professionals across the animal care industry. “They really bring out the heart and science of veterinary medicine with animals at the center of it all,” O’Neill said in a news release.

The 2024 VETTY Awards Grand Prize winners are as follows

Best in Show (For Profit) Award: “Love Forever Home Commercial” by Lap of Love Veterinary Hospice and VETEOS. Category: Television Commercial.

Best In Show (Nonprofit) Award: “Animal Health Corridor Spirit of Service - PawsAbilities” by Animal Health Corridor and JNA Advertising. Category: Public Service Video.

Large Animal Award: “The Equine Practice Company’s Lameness Program” by The Equine Practice Company and Brown Fox Creative House. Category: Large Animal Video.

“Merck Animal Health @ VMX 2024” by Merck Animal Health and Sparks. Category: Tradeshow Booth.

"Zoetis Test for Success in Clinic Activation" by Zoetis & FWD People. Category: In-Clinic Merchandise, Educational

“Pet Parent Journey: A Guide for Brand Managers” by S&A. Category: Agency Self Promotion.

NAVC Spotlight Award: “Hill’s Prescription Diet–Silent Sufferers” by Hill’s Pet Nutrition and VML. Category: Campaign–Consumer.

Karen Shenoy, DVM, chief veterinary officer of Hill’s US, said the grand prize awarded to the “Silent Sufferers” project was a key VMX highlight for its’ team. In an interview with 

she thanked the NAVC for the recognition and discussed the award-winning campaign.

The concept was all around certain conditions that cats or dogs may have where they kind of mask the symptoms and that a pet parent may not realize that their pet is sick, and just raising awareness and helping them recognize that some things that might seem like real subtle differences could actually be signs that the pet is ill and that they need to see their veterinarian,” Shenoy added.

The 2024 awards program began accepting entries this past September. Entries included those submitted by agencies, professional associations, veterinary clinics, and advocacy groups, as well as companies representing pet pharmaceuticals, foods and diagnostic equipment. Leaders in the creative marketing field comprised the panel of judges that reviewed these entries to determine the winners.

“This year’s VETTY Awards winners showcased many of the advancements in animal medicine, a deep understanding of the animal health care audience, technological developments and memorable creative campaigns. We saw a lot of advancement in how marketing messages were delivered, including gamification and the incorporation of AI technology. Through their creative and strategic work, they are really making a difference,” O’Neill said.

The winners were presented with their awards during a reception at the Hyatt Regency Orlando on January 26, 2025. They and their works are also highlighted on 

2024 VETTY Awards recognizes marketing excellence in animal health care worldwide. News release. January 20, 2025. Accessed February 5, 2025. 

https://navc.com/wp-content/uploads/2025/01/01-20-25-FINAL-Press-Release-2024-VETTY-Awards-Winner-Announcement-Jan-20-2025-1.pdf

2024 VETTY Awards Winner. North American Veterinary Community. Accessed February 5, 2025. 

https://thevettys.com/winners/2024-winners/

The program's 2024 winners were recognized in a ceremony in Orlando, Florida, during this year's Veterinary Meeting & Expo

NAVC presented VETTY Awards at VMX 2025

During this interview with Alex Sigmund, DVM, DACVO,he shares common mistakes veterinary professionals assume to be true when treating patients with corneal ulcers

Video interview on corneal ulcer misconceptions with Dr Alex Sigmund

 prior to his lectures at the Veterinary Meeting & Expo (VMX) conference, Alex Sigmund, DVM, DACVO, known as "The Eye Guy" on social media, shared with listeners some of the common misconceptions that he comes across when discussing corneal ulcer treatments, including some surrounding the use of antibiotics and what their impact is on patients. Throughout the interview, Sigmund debunks these common mistaken truths and provides insight into the reality of the treatment.  

I think in general, antibiotics do not heal ulcers. Ulcers will heal themselves. The antibiotic is really just there as a prophylactic therapy to help prevent infection, just because dogs are very, very prone to getting infected ulcers compared to humans, you know, as comparison. And so if that ulcer is again, you know, a week later and it's still there. We don't necessarily have to change our antibiotic because it may still be a superficial maybe now it's an indolent ulcer. There's no infection, so that antibiotic is still doing its job. So we don't need to just keep changing antibiotics just because it's not healing unless we have identified that the current antibiotic did not prevent infection and now we need to switch to one that is going to treat a current infection. 

So I think there's a misconception that just adding an antibiotic isn't going to hurt anything, and it doesn't really matter what type of antibiotic that we choose, but it does in the long term, because we only have so many topical antibiotic choices in veterinary medicine, and resistance is fast coming upon us

Videos

Alex Sigmund, DVM, DACVO, shares fallacies surrounding these eye conditions in pets, including the role of antibiotics in treatment

Corneal ulcers: Common misconceptions

Karen Shenoy, DVM, discusses the importance of a healthy microbiome and the work being done to study more about how it affects pets.

What the microbiome means for pet health

Microbiome science is being explored by researchers and addressed by Hill’s Pet Nutrition in some new and enhanced prescription diet and science diet products including those introduced at the 2025 Veterinary Meeting & Expo (VMX), presented by the North American Veterinary Community, in Orlando, Florida. In an interview with 

0 at VMX, Karen Shenoy, DVM, chief veterinary officer for Hill’s US, discussed the importance of a healthy microbiome and the work being done to study more about how it affects pets and how that knowledge can be applied to their diets.

The following is a transcript of the video:

: The microbiome is a collection of microbes and all kinds of different organisms that are throughout our body. We actually talk the most about the gut microbiome, and you hear about how what's in your gut and how the different microorganisms that live there can affect you system-wide. It can affect all kinds of different organ systems, and is really important in health and disease that we're thinking about keeping the gut microbiome, not just ourselves, but our microbes that live within us and within our pets good and healthy.

The microbiome is so important as we think about new ways that we may be able to help manage pets or keep them healthy. And Hill’s has been looking into the microbiome and doing a ton of research in that space for more than a decade. We're actually really proud of a partnership we have with the Harvard TH Chan School of Public Health, and through that, we're not only sharing knowledge and innovating and thinking about how we can help pets, but actually sharing the information both that that school has, that we have around the microbiome in a public way through this one health microbiome resource, so that we can help get data out there, make sure that we're able to help support both pet and human health, and all the advances that can happen within the microbiome space.

Karen Shenoy, DVM, chief veterinary officer for Hill’s US, provided insights about the link between diet and gut health, in a dvm360 interview at VMX.