Keratometry is a technique used to measure the curvature of the anterior surface of the cornea. It works by reflecting light off the cornea's convex surface and measuring the size of the reflected image to calculate the radius of curvature. The cornea acts as a convex mirror. Keratometry is important for assessing corneal astigmatism, estimating refractive error, monitoring conditions like keratoconus, and calculating intraocular lens power. Factors like improper calibration, positioning, focusing, or corneal irregularities can introduce errors in keratometry measurements.
Keratometry is a technique used to measure the curvature of the anterior surface of the cornea. It works by reflecting light off the cornea and using the size of the reflected image to calculate the radius of curvature based on principles of optics for convex mirrors. The keratometer utilizes doubling prisms and fixed or variable image sizes to measure the curvature in two principal meridians of the cornea. Automated keratometers have made the technique faster and easier by focusing a reflected corneal image electronically rather than using doubling prisms. Keratometry is useful for estimating refractive error, contact lens fitting, and monitoring conditions like keratoconus. Limitations include assumptions of symmetrical corneal curvature and inaccuracy for very steep or
This document discusses the history and principles of autorefractors. It explains that autorefractors use infrared light and meridional refractometry to objectively determine a patient's refractive error without needing subjective feedback. Modern autorefractors are more accurate and efficient than older subjective methods due to advances in electronics. They provide speed, accuracy, and repeatability in clinical and research settings.
This document discusses the history and principles of autorefractors. It explains that autorefractors use infrared light and meridional refractometry to objectively determine a patient's refractive error without needing subjective feedback. Modern autorefractors are more accurate and efficient than older subjective methods due to advances in electronics. They work by projecting an infrared fixation target and using a Badal optometer and fogging technique to relax accommodation and obtain refractive measurements.
Retinoscopy is the primary objective method for determining a patient's refractive error. It involves using a retinoscope to illuminate the retina and observe the movement of the reflected light. For myopic patients, the light moves in the opposite direction of the retinoscope's movement, while for hyperopic patients it moves in the same direction. The goal is to find the neutralization point where no movement is seen, indicating the proper refractive correction. Factors like the working distance, type of mirror used, and patient's fixation can impact results. Retinoscopy is useful for initial refractive estimates and screening for ocular conditions.
REFRACTION: OBJECTIVE RETINOSCOPY AND SUBJECTIVE ACCEPTANCEAnandTrivedi24
Retinoscopy is an objective method to determine refractive error using neutralization. During retinoscopy, the examiner observes the movement of the light reflex in the patient's eye to determine the type and amount of refractive error. Various techniques are used, including streak retinoscopy. The subjective refraction process involves the patient to find the best refractive correction. Steps include determining the starting point lenses, refining the sphere and cylinder powers and axes through techniques like binary comparison and the astigmatic clock dial. Both objective and subjective methods are needed to obtain an accurate refractive prescription.
The document discusses the optics and use of a lensometer. A lensometer is a device used to measure the refractive power of lenses. It works using the Badal principle, where the eye is placed at the focal point of a lens and the image always subtends the same visual angle. There are manual and automated lensometers. A manual lensometer uses a telescope, target, and power drum to measure spherical and cylindrical lens powers by bringing lines of the target into focus. An automated lensometer uses an LCD monitor, lens plate, and memory buttons to electronically measure lens parameters. Correct use requires focusing the eyepiece and centering lenses to determine their optical power.
This presentation discusses retinoscopy, which is an objective method of determining refractive error by neutralizing the movement of light reflected from the retina. The history, theory, procedure, and types of retinoscopy are explained. Static retinoscopy finds the far point, while dynamic retinoscopy assesses accommodation. Observations of the retinoscopic reflex indicate refractive errors, and neutralization with lenses determines the prescription. Potential sources of error and techniques to confirm astigmatism are also reviewed.
Optometry instruments is a presentation to describe instrument in a beautiful way. use this tool to improve your knowledge. stay blessed. Regards Muhammad Akbar Rashid Qadri.
Retinoscopy is a technique used to objectively measure the refractive error of the eye. Light is directed into the patient's eye to illuminate the retina, and the observer views the resulting reflex to determine the refractive state. There are different types of retinoscopes and techniques used. By observing properties of the fundal reflex such as direction and speed of motion, the observer can determine if the eye is emmetropic, hyperopic, or myopic, and approximately how much refractive error is present. Further testing is done to refine the prescription and determine any astigmatism. Retinoscopy provides an efficient initial objective refraction.
Techniques of refraction is the process of calculation of glass power.drbrijeshbhu
Refractive errors are most common cause of ocular morbidity. It affects all age groups, and ethnic profiles. There is no g nder discrimination. Most common symptoms are blur vission along with pain in eye ,headache and tiredness. Refraction is process of determination of eye and currect it with power glass power or contact lens power. It can subjective or objective.
This document discusses biometry and intraocular lens (IOL) power calculation. It begins by defining biometry as the analysis of biological data using mathematical and statistical methods. It then describes various biometry techniques including A-scan ultrasound to measure axial length, keratometry to measure corneal curvature, and different formulas used to calculate IOL power. Over generations, the formulas have evolved from theoretical to regression-based approaches using parameters like axial length, keratometry readings, and A-constants specific to IOL designs. Proper technique and quality checks are important for accurate biometry and IOL power calculation to achieve the desired refractive outcome.
Retinoscopy is an objective method used to measure the refractive power of the eye by illuminating the retina and observing how the reflected light changes as it passes through the eye's optical components. This allows the examiner to determine the refractive error by how the emerging rays change when viewed through a retinoscope. It involves using a light source and mirror incorporated into a device called a retinoscope to project light into the patient's eye and observe the movement of the reflected light to neutralize the red reflex. The patient is instructed to fixate on a distant target while the examiner views movement of the reflex through the retinoscope to determine the refractive error.
An autorefractor or automated refractor is a computer-controlled machine used during an eye examination to provide an objective measurement of a person's refractive error and prescription for glasses or contact lenses. This is achieved by measuring how light is changed as it enters a person's eye. Autorefractometer is a Instruement which is using in optometrist and Opthalmologist clinic for objective refraction.
Now a days autorefractometer is very usefull Instruement for the refraction than retinoscope
these slides explain the objective refraction in optometry , and describes its types and its measurement , and it gives you in details the types of Retinoscopy.
The document discusses intraocular lens (IOL) power calculation and selection. Precise calculations are important for optimal outcomes after cataract surgery. Various formulas are now used that require accurate measurement of corneal power and axial length. The most commonly used regression formula is the SRK formula, which relates IOL power to axial length and corneal curvature. Modifications like SRK-II adjust the formula for shorter or longer eyes. Proper technique is described for taking keratometry and axial length measurements, which are input into formulas to determine the appropriate IOL power.
The document discusses lensometry, which is the process of using a lensometer or lensmeter to measure the optical properties of lenses. A lensometer projects lines that allow optometrists to determine information like the sphere, cylinder, and axis measurements specified in a prescription. It can also verify the accuracy of lenses and detect their type (spherical, astigmatic, prismatic). Lensometers are used to properly fit lenses into frames and ensure prescriptions are correct. The document outlines the history of the lensometer's invention and provides details on its use, parts, manual operation, and the measurements it can obtain for different lens types like bifocals.
Optometers are subjective if the patient judges the clarity of the retinal image or objective when the machine or examiner does it.
Subjective optometers control the focus of the retinal image and are used to determine when a target is conjugate to the retina.
Objective optometers measure the defocus or disconjugacy of the retinal image and the stimulus target.
There are also measures of accommodation that measure characteristics of the crystalline lens such as front surface curvature via the third Purkinje image.
SIMPLE OPTOMETER:
The simple optometer is a plus lens placed in the anterior focal plane or spectacle plane of the eye.
The virtual image of objects placed before the lens can be imaged from infinity to close to the spectacle plane, simply by moving the target from the anterior focal plane of the lens to the lens plane respectively.
The virtual image distance is calculated from the Gaussian equation
1/u + F = 1/v where: u= object distance, v=image distance, F = focal power
One problem with the simple optometer in the measurement of accommodation is that the image increases in size with proximity so that you have both size and blur cues to accommodation.
BADAL OPTOMETER:
Invented by Jules Badal in 1876, who is French scientist
The Badal optometer utilizes a plus lens placed so that its posterior focal plane is coincident with the anterior focal plane of the eye.
This instrument keeps image size constant while varying target distance and stimulus to accommodation.
The optical system is telecentric in both the object and image space, that is, the rays are parallel.
NAGEL OPTOMETER:
The Nagel optometer is based on a similar concept.
Here ,a plus lens whose posterior focal plane is coincident with the nodal point of the eye. It also keeps image size constant with changing object distance.
SUBJECTIVE OPTOMETERS
For Δz = 0, the light emerging from the lens is collimated (i.e. object at infinity)
For Δz > 0, the light emerging from the lens is diverging. The object appears in front of eye, so will be in focus for myopes.
For Δz < 0, the light emerging from the lens is converging. The virtual image is behind the eye, so will be in focus for hyperopes.
STIGMATOSCOPY:
Combine of Simple and Badal lens optometers with various visual stimuli to enhance the sensitivity of subjective measures by improving sensitivity to blur detection.
The stigmascope enhances blur perception with a small point source as the target viewed through the optometer lens.
When the image of the point source is seen clearly and sharply, it is optically conjugate to the fovea.
At the same time, this image may be introduced so that the eye can be fixating some other target which acts as the stimulus to accommodation such as Snellen chart.
Bracketing the measures of positive and negative blur of the stigma allows you to estimate the accommodative response.
SCHEINER’S PUPIL:
Scheiner developed a double pupil that causes images viewed through it to app
The document discusses preoperative evaluation and measurements for cataract surgery, including biometry. It covers evaluating the general health and ocular history of the patient, performing visual acuity testing, refraction, and other objective tests. It then describes methods of measuring the eye, including A-scan biometry to determine axial length using ultrasound, and optical biometry using light waves. Factors that can influence biometry measurements and techniques like keratometry are also discussed. The document concludes by covering intraocular lens power calculation and selection, noting the importance of accurate measurements and various generation of formulas used.
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2. INTRODUCTION
S Refractometry is the estimation of refractive error
with a machine, called refractometer or optometer.
S Automated Refractometers (AutoRefractors) are
designed to objectively determine the refractive error
& are of various types depending upon the
underlying principle they are based on.
2
3. HISTORY & OPTICAL
PRINCIPLES
S The present day autorefractors are based on the
principles used in earlier attempts for automation of
refraction.
S It is therefore important to understand the underlying
principles on which they function as well as the
difficulties which prevented the successful
automation of refraction in the past.
3
4. 4
The Scheiner Principle
S Scheiner discovered in 1619 that the
point at which an eye was focused could
be precisely determined by placing double
pinhole apertures before the pupil.
S Parallel rays of light from a distant object are
reduced to two small bundles of light by the
Scheiner disc.
S These form a single focus on the retina if the
eye is emmetropic; but if there is any
refractive error two spots fall on the retina
6. 6
Optometer Principle
S The term ‘optometer’ was first used in 1759 by
Porterfield who described an instrument for
‘measuring the limits of distinct vision, and
determining with great exactness the strength and
weakness of sight’.
S It involved a convex lens placed in front of the eye at
its focal length from the eye (or the spectacle plane)
and a movable target is viewed through the lens.
8. 8
S Light from the target on the far side of the lens
enters the eye with vergence of different amounts,
depending on the position of the target.
S If the target lies at the focal point of the lens, light
from the target will be parallel at the spectacle plane,
and focused on the retina of the Emmetropic eye.
S Light from the target when it is within the focal length
of the lens will be divergent in the spectacle plane
while light from a target outside the focal length of
the lens will be convergent.
9. 9
Meridional Refractometry
S In the presence of astigmatism, the axes of the
principal meridians must be found and refraction in
both measured.
S However, the need to identify the principal meridians
of astigmatism stood in the way of truly automated
refraction until the principle of meridional
refractometry was discovered in the 1960s.
S Which stated that if the spherical refraction is
measured in at least three arbitrary meridians, the
position of the principal axes and their refractive
powers can be calculated by mathematical
calculation.
10. 10
S The mathematical calculation is based on what is
called the sine-squared function.
S The three power measurements at the three
respective meridians provide three points on the
sine-squared function graph. From this, the rest of
the curve can be extrapolated in order to calculate
the maximum and minimum power values, i.e. the
principal focal planes.
11. EARLY OPTOMETERS
S The earliest instruments were the subjective
optometers in which the patient had to adjust the
instrument to achieve the best subjective alignment
or focus of the target.
S However they proved unsatisfactory because of 3
main limitations:-
1. Alignment Problems
2. Irregular Astigmatism
3. Instrument Accommodation
11
12. 12
S Alignment Problems: As per the requirements of
Scheiner’s Principle, both pinhole apertures must fit
in within the patient’s pupil. Achieving and
maintaining correct alignment of the instrument
required great skill & patience from the examiner &
good cooperation from the patient.
S Irregular Astigmatism: Instruments using the
Scheiner principle measure only the refraction of two
small portions of the pupillary aperture
corresponding to the apertures on the Scheiner’s
disc. In a patient with irregular astigmatism, the best
refraction over the whole pupil may be different in
contrast to the two small pinhole areas of the pupil.
13. 13
S Instrument Accommodation:- Inappropriate
accommodation often occurs when a target is
viewed which is known to be within an instrument.
This is called instrument accommodation and leads
to errors in the readings obtained.
S Later, the early objective optometers were
developed, but these required the examiner to focus
or align the image of a target on the patient's retina
& failed to come in main stream use because of
alignment difficulties & instrument accommodation.
14. MODERN
REFRACTOMETERS
S With the rapid development in electronics and
microcomputers, a number of innovative methods &
instruments for automated clinical refraction have
appeared since 1960.
S In recent years, the automatic infrared optometers
have come to the fore. These are truly objective
instruments as the instrument itself senses the end
point of refraction.
14
15. BASIC DESIGN OF AN
AUTOREFRACTOR
S Autorefractors basically comprise of an infrared
source, a fixation target and a Badal optometer.
S An infrared light source (around 800-900nm) is used
primarily because it is invisible & helps overcome
instrument accommodation to a certain extent.
15
16. S However, at this wavelength, light is reflected back
from the deeper layers of the retina, and this
together with chromatic aberration of the eye, the
refraction of the eye to infrared differs significantly
from its refraction to visible light.
S This difference is of the order of 0.75D – 1.50D more
hypermetropic to infrared. Manufacturers therefore
calibrate the instruments empirically to correlate with
subjective clinical results.
16
17. 17
FIXATION TARGET:-
S A variety of targets have been
used for fixation ranging from
animations to pictures with
peripheral blur to further relax
accommodation.
S Accommodation is most relaxed
when the patient identifies the
scene as one typically seen at a
distance which can be achieved
by using visual fixation targets
composed of photographs or
animations of outdoor scenes.
19. 19
S All autorefractors now
use the fogging
technique to relax
accommodation prior to
objective refraction.
S This is the reason why
patients state that the
target is blurred prior to
measurements being
taken – this is the effect
of the fogging lens
21. 21
OPTOMETER:-
S Virtually all autorefractors have a Badal optometer
within the measuring head.
S The Badal lens system has main advantage that,
there is a linear relationship between the distance of
the Badal lens to the eye and the ocular refraction
within the meridian being measured.
23. TYPES OF
AUTOREFRACTORS
S Fundamentally, there are three types of
autorefractors which derive objective refraction by:
• Image quality analysis
• Scheiner double pin-hole refraction
• Retinoscopy
23
24. 24
Image Quality Analysis
S This method is not used very much in modern-day
autorefractors. It was originally used in the Dioptron
autorefractor developed in the 1970s.
S Here, the optimal position of the optometer lens was
determined by the output signal of the light sensor.
The light sensor matches the intensity profile of the
incoming light from the eye, to the light intensity
pattern from the rotating slit drum.
25. Autorefractors based on the
Scheiner Principle
S Most of the latest autorefractors used in practice
today use the Scheiner principle.
S Implementation of this technology in autorefractors is
somewhat different to that used by Scheiner in his
double pin-hole experiment.
25
27. Autorefractors based on
Retinoscopy Principle
S Some autorefractors (eg. Welch Allen Suresight and
Power Refractor II) use infra-red videorefraction
S A grating, or slit, is produced by a rotating drum.
S Similar principles to retinoscopy are used where the
speed of the reflex is used as an indicator of the
patient’s refraction.
27
28. 28
S It is also referred to as ‘The Knife Edge Principle’.
S Knife-edge refractors use the concept of optical
reciprocity such that radiation from the fundus reflex
is returned to the primary source.
S The slit or ‘knife’ is used to determine the refractive
power of the eye
S The speed and direction of the movement of the
reflex is detected by photodetectors and computed
to derive the meridional power
30. 30
S The time difference from the slit reaching each of the
detectors allows the autorefractor to detect the
meridian under investigation.
31. 31
S The vertical slit calculates the refraction of the
vertical meridian. The system detects that the
vertical meridian is measured by the way each
detector senses the slit as it passes over the pupil.
S The oblique slit will like wise initiate a different time
dependent response from the detectors, and thus
derive the power within the oblique meridian.
32. Portable Autorefractors
S Since the autorefractor is
stationary, examining light
refraction in children has
remained somewhat challenging.
To address the problem, scientists
developed a portable autorefractor
that is particularly helpful in
examining children as they can
easily adjust themselves
according to different positions of
the patient.
32
33. 33
Advantages of automated refraction systems vs. manual
refraction equipment are:
S less manual labour by the practitioner or technician
S more automation of repetitive and iterative tasks in the
refraction
S ability to present former and new values quickly for
validation
S reduced risk of human error
S direct transmission of results to Electronic Medical
Record(EMR) software
S Improved efficiency of practice
34. 34
S Additionally, some variations on the traditional
autorefractor have been developed.
S The aberrometer is an advanced form of
autorefractor that examines light refraction from
multiple sites on the eye.
S Aberrometry measures the way a wavefront of light
passes through the cornea & crystalline lens, which
are the refractive components of the eye. Distortions
that occur as light travels through the eye are called
aberrations, representing specific vision errors.
Wavefront technology in Refraction
The parallel rays of light entering the eye from a distant object are normally focused on a point on the retina in an emmetropic patient.
They are limited to 2 small bundles when double pinhole apertures or a scheiner’s disc is placed in front of the pupil
In a myopic eye, the 2 ray bundles cross each other before reaching the retina, and 2 small spots of light are seen.
In a hypermetropic eye, the ray bundles are intercepted by the retina before they meet & thus again 2 small spots of light are seen.
Light from the target when it is within the focal length of the lens will be divergent in the spectacle plane while light from a target outside the focal length of the lens will be convergent.
Certain autorefractors use an open view to allow patients an unrestricted binocular view of a distance target
Infrared light is collimated & passes through rectangular masks present in a rotating drum. The light passes through a beam splitter to the optometer system & is projected on the retina & a slit image is formed. The polarising beam splitter effectively removes reflected light from the cornea whereas the slit image from the retina passes through the polarised beam splitter and falls on the light sensor. The optometer lens system moves laterally to find the optimal focus of the slit on the retina. Optimal focus is achieved when a peak signal is received from the light sensor.
Knife edge test for myopic eye. The motion of the reflex across the detector provides information on the nature of the refractive error. The speed of the reflex describes the magnitude of refraction.
Knife edge test for an emmetropic eye. The reflex on the detector moves over most of the surface
A thin laser beam enters the eye and is focused on the retina. As the emerging rays reflect off the macula and refracts out of the eye through each part of the optical media, they are focused onto n lens array & are captured by a CCD-camera which quantifies their deviation, and creates the wavefront pattern from the recorded deviation.