be due to hydrocephalus, benign intracranial hypertension (aka pseudotumor cerebri) or brain tumor, amongst other conditions. Cupped optic discs are seen in glaucoma. In patients with diabetes mellitus, regular ophthalmoscopic eye examinations (once every 6 months to 1 year) are important to screen for diabetic retinopathy as visual loss due to diabetes can be prevented by retinal laser treatment if retinopathy is spotted early. In arterial hypertension, hypertensive changes of the retina closely mimic those in the brain and may predict cerebrovascular accidents (strokes). Dilation of the pupil To allow for better inspection through the pupil, which constricts because of light from the ophthalmoscope, it is often desirable to dilate the pupil by application of a mydriatic agent, for instance tropicamide, or simply reducing the brightness of the ophthalmoscope, which may slightly increase natural mydriasis, allowing a better view of the posterior eye. It is primarily considered ophthalmologist or optometrist equipment, but is used by other specialists as well, including neurology and internal medicine. Recent developments like scanning laser ophthalmoscopy can make good quality images through pupils as small as 2 millimeters, so dilating pupils is no longer needed with these devices. History Dr. William Cumming in 1846 at the Royal London Ophthalmic Hospital (later Moorfields Eye Hospital), of his pioneering work wrote "every eye could be made luminous if the axis from a source of illumination directed towards a person's eye and the line of vision of the observer were coincident". Although some credit the invention of the ophthalmoscope to Charles Babbage in 1847, it was not until it was independently reinvented by Hermann von Helmholtz in 1851 that its usefulness was recognized - it was to revolutionize ophthalmology. While training in France, Andreas Anagnostakis, MD, an ophthalmologist from Greece, came up with the idea of making the instrument hand-held by adding a concave mirror. Austin Barnett created a model for Anagnostakis, which he used in his practice and subsequently when presented at the first Ophthalmological Conference in Brussels in 1857, the instrument became very popular among ophthalmologists. In 1915, Francis A. Welch and William Noah Allyn invented the world's first hand-held direct illuminating ophthalmoscope, precursor to the device now used by clinicians around the world. This refinement and updating of von Helmholtz's invention enabled ophthalmoscopy to become one of the most ubiquitous medical screening techniques in the world today. The company Welch Allyn started as a result of