Objective To analyze the results from ophthalmic B-scan ultrasonography for consistency, sensitivity and specificity in the diagnosis of fundus disease. All data from clinical analysis and ultrasonography were compared to support the use of B-scan as a reference for assessing refractive media opacity in fundus disease. Methods One thousand ninety-two eyes with refractive media opacity were examined with conventional B-scan ultrasonography from June 2006 to September 2008, and the data were reviewed and analyzed to evaluate for consistency, sensitivity, specificity,and the positive and negative predictive values between the B-scan ultrasonography results and the final diagnosis of fundus disease. The results of the B-scan ultrasonography were evaluated for consistency, reliability, and authentic assessment. Results The coincidence rate of B-scan ultrasonography for fundus disease was 85.07%, and the adjusted agreement was 84.15%; the Kappa index was 0.6802; The sensitivity was 84.51%, the specificity was 85.37%, and the Youden index was 0.70; the positive likelihood ratio was 5.78, and the negative likelihood ratio was 0.18. Fundus disease found out by B-scan most were diabetic retinopathy, trauma, and age related degeneration;the disease misdiagnosed easiest were retinopathy, optic neuropathy, and retina edema; the disease missed diagnosed easiest were age related degeneration and diabetic retinopathy. Conclusion Ophthalmic B-scan ultrasonography used in eyes with refractive media opacity has a high clinical coincidence rate in diagnosing fundus disease, and can be used as a guide for therapy and prognosis.