Ophthalmic Refraction Techniques
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Questions and Answers

What should be done if the cylinder axis has a DC of 1.00 or less?

  • Move the axis 10˚
  • Leave the axis unchanged
  • Move the axis 20˚ (correct)
  • Move the axis 30˚
  • What is the correct endpoint when refining the cylindrical axis?

  • When both choices look the same (correct)
  • When both choices appear different
  • When one choice is clearer than the other
  • When both choices seem brighter
  • If a patient reports that letters look better when the red dots are parallel to the axis, what adjustment should be made?

  • Remove -0.25 DC
  • Decrease the sphere power
  • Add +0.25 DC
  • Add -0.25 DC (correct)
  • How much sphere adjustment should be made for every two clicks of cylindrical power added?

    <p>Add +0.25 D sphere (A)</p> Signup and view all the answers

    What is the next step after refining cylinder axis?

    <p>Determine the Cylinder Power (A)</p> Signup and view all the answers

    When refining cylinder power, how should one adjust if letters look better when white dots are parallel to the axis?

    <p>Remove -0.25 DC (D)</p> Signup and view all the answers

    What precedes the determination of binocular balance in the sequence of refraction?

    <p>JCC to Refine Sphere Power (C)</p> Signup and view all the answers

    What must be done to maintain the circle of least confusion when adding cylindrical power?

    <p>Increase sphere power (D)</p> Signup and view all the answers

    What should a patient be able to read to indicate improvement after adding -0.50 DS?

    <p>20/20 line (D)</p> Signup and view all the answers

    What occurs when a patient is over-minused during refraction?

    <p>Letters appear smaller (C)</p> Signup and view all the answers

    If +0.25 DS does not worsen the letters, what is the next step?

    <p>Try more plus power (C)</p> Signup and view all the answers

    What is the first step in the Manifest Refraction Sequence?

    <p>Determine Sphere Power Starting Point (C)</p> Signup and view all the answers

    What is the purpose of Binocular Balance in subjective refraction?

    <p>To balance out visual stimulus to accommodate (C)</p> Signup and view all the answers

    What does a patient need to demonstrate to receive extra minus during refraction?

    <p>Improved visual acuity (B)</p> Signup and view all the answers

    What principle should be followed to ensure correct refraction results?

    <p>Avoiding over-minusing (C)</p> Signup and view all the answers

    What should be the approach if a patient presents unequal acuity in each eye?

    <p>Refine cylinder axis and power (D)</p> Signup and view all the answers

    What does the midpoint of break indicate in the context of vertical phoria interpretation?

    <p>The presence of hypophoria or hyperphoria (A)</p> Signup and view all the answers

    In the provided example, what is the effective way to determine the midpoint when given different supravergence and infravergence readings?

    <p>Subtract the smaller range from the larger range and then divide by two (B)</p> Signup and view all the answers

    What does the notation '4pd BU/2pd BU' signify in the vertical vergence findings?

    <p>The degree of infravergence related to the right eye (C)</p> Signup and view all the answers

    What is the purpose of introducing BU prism during infravergence testing?

    <p>To assess recovery from vertical deviation (C)</p> Signup and view all the answers

    How should the horizontal vergence ranges be set according to the guidelines?

    <p>To calibrate both prisms to zero (C)</p> Signup and view all the answers

    If a patient has Right Supravergence = 3pd BD and Right Infravergence = 5pd BU, what is the midpoint of break?

    <p>1pd BU (D)</p> Signup and view all the answers

    Asymmetric supra and infra vergence findings can confirm what condition?

    <p>A vertical phoria (A)</p> Signup and view all the answers

    What is the primary goal when refining sphere power during retinoscopy?

    <p>To adjust the location of the Circle of Least Confusion (C)</p> Signup and view all the answers

    What does a reading of '1pd BU OD' suggest in regards to patient's binocular vision?

    <p>Weakness in vertical muscle function (C)</p> Signup and view all the answers

    What should be done to the room lighting during a visual acuity check post-retinoscopy?

    <p>Keep it dark or very dim (B)</p> Signup and view all the answers

    What is the correct approach if a patient’s monocular acuity is 20/20 during retinoscopy?

    <p>Add plus sphere in 0.50 DS steps until the patient loses letters (C)</p> Signup and view all the answers

    If the monocular acuity is between 20/25 and 20/30, what should be added during the examination?

    <p>Plus 0.50 DS steps (C)</p> Signup and view all the answers

    What action is advised if a patient reports that their vision looks worse but can still read the same size letters?

    <p>Have the patient re-read the lowest line possible (B)</p> Signup and view all the answers

    What should be done if the patient loses some letters after the first plus DS step?

    <p>Remove the last plus DS step and try minus DS (D)</p> Signup and view all the answers

    What is the importance of occluding one eye during the visual acuity test?

    <p>To ensure only one eye is assessed at a time (C)</p> Signup and view all the answers

    What measurement should be taken if a patient cannot read the lowest line displayed?

    <p>Document the highest line they read and conclude (B)</p> Signup and view all the answers

    What is the primary goal of manifest refraction?

    <p>To create artificial emmetropia using corrective lenses (C)</p> Signup and view all the answers

    Which sequence is proper for the monocular subjective refraction process?

    <p>Determine Sphere Power, JCC to Refine Cylinder Axis, JCC to Refine Cylinder Power (A)</p> Signup and view all the answers

    In retinoscopy, what does an increase in positive sphere indicate?

    <p>The patient experiences blur (C)</p> Signup and view all the answers

    What is the purpose of using a cobalt blue filter during examination?

    <p>To illuminate corneal defects with vital dye (C)</p> Signup and view all the answers

    What happens when a patient cannot relax accommodation during a vision exam?

    <p>The retinal image may be blurred (B)</p> Signup and view all the answers

    What is the function of the 'Circle of Least Confusion' in refraction?

    <p>To ensure light focuses on the retina (D)</p> Signup and view all the answers

    What is a typical initial step in the manifest refraction sequence?

    <p>Determine Sphere Power Starting Point (A)</p> Signup and view all the answers

    Which option is considered an auxiliary feature to improve visibility in eye examinations?

    <p>Red free filter (D)</p> Signup and view all the answers

    When using the JCC in the refraction process, what is the main objective?

    <p>To refine the cylinder axis and power (A)</p> Signup and view all the answers

    What effect does a negative sphere power have on visual acuity when over the distance BVA?

    <p>It can create additional blur (C)</p> Signup and view all the answers

    What symptom may indicate that a patient has been over-minused?

    <p>Presence of blur on BI vergence ranges at distance (A)</p> Signup and view all the answers

    Which near target chart is used for measuring near acuity?

    <p>Reduced Snellen (20/50 to 20/20) (C)</p> Signup and view all the answers

    What is the main use of the Cross cylinder grid?

    <p>Conduct fused cross cylinder test for near add determination (C)</p> Signup and view all the answers

    What indicates that a patient's NRA finding is greater than normal?

    <p>Greater than +2.50 D (C)</p> Signup and view all the answers

    What is NOT a reliable measure of visual acuity?

    <p>Reading chart (20/60 to 20/20) (A)</p> Signup and view all the answers

    What is the purpose of the sunburst dial in optometry?

    <p>Determine cylinder axis (D)</p> Signup and view all the answers

    The horizontal line of words is used to evaluate which of the following?

    <p>Break and recovery of vertical vergence amplitudes (D)</p> Signup and view all the answers

    What condition is the Cross Cylinder grid NOT reliable for?

    <p>Presbyopia evaluation (D)</p> Signup and view all the answers

    Which near target chart is specifically focused on measuring accuracy of accommodation?

    <p>Cross cylinder grid (C)</p> Signup and view all the answers

    What is the primary function of NRA/PRA in optometry?

    <p>Determine the amount of near add required (D)</p> Signup and view all the answers

    Flashcards

    Discoloration

    A change in the color of a part of the eye or skin.

    Cobalt Blue Filter

    A tool used to enhance visibility of corneal defects.

    Sodium Fluorescein

    A vital dye used to illuminate eye defects.

    Manifest Refraction

    A method to determine the eye's need for corrective lenses.

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    Emmetropia

    The condition where light focuses perfectly on the retina.

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    Monocular Subjective Refraction

    Testing one eye's refraction independently.

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    JCC (Jackson Cross Cylinder)

    A test to refine cylinder axis and power in refraction.

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    Circle of Least Confusion

    Point where vision is clearest during astigmatism testing.

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    Interval of Sturm

    The distance between two lines of focus in astigmatism.

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    Binocular Balance

    Adjusting vision in both eyes for even clarity.

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    JCC

    A technique to refine cylinder axis and power in vision correction.

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    Refine Cyl Axis

    Adjusting the cylinder axis using the JCC method to achieve optimal vision clarity.

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    Chase the red dots

    A method to determine the correct axis by seeing which orientation looks clearer.

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    DC (Diopter Change)

    Measurement of the amount of lens power change needed to correct vision.

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    Endpoint

    The point in testing when no further improvements can be noticed by the patient.

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    Sphere Power Adjustment

    Changing sphere power to maintain clarity when modifying cylinder power.

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    Dioptic midpoint

    The ideal point on the retina where optical clarity is achieved.

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    Retinoscopy

    A technique used to determine eye prescriptions by evaluating the reflection of light off the retina.

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    Monocular acuity

    The clarity or sharpness of vision in one eye.

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    VA after ret

    Visual acuity measured after retinoscopy to determine prescription success.

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    Sphere power

    The strength of a lens needed to correct spherical refractive errors.

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    Plus sphere in DS steps

    Incremental adjustments made with positive spherical lenses during vision testing.

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    Supravergence

    A vertical eye movement where one eye moves upward relative to the other.

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    Infravergence

    A vertical eye movement where one eye moves downward relative to the other.

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    Vertical Phoria

    A misalignment of the eyes in the vertical direction, often revealing under or overaction of eye muscles.

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    Midpoint of Break

    The point at which there is equal tilt in eye testing, suggestive of a specific phoria type and direction.

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    Right Hypophoria

    A condition where the right eye is positioned lower than the left eye when the patient is looking straight ahead.

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    Asymmetric Vergence

    Unequal eye movements when tested for both supravergence and infravergence, indicating possible phoria issues.

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    Prism Direction Assignment

    Assigning prism based on the greater range in eye movement testing to correct misalignments.

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    Vergence Ranges Review

    Assessment of horizontal and vertical eye movements to determine visual efficiency and alignment.

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    Over-Minusing Indicators

    Blur in BI vergence ranges at distance and NRA > +2.50 D.

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    Reading Chart #1

    Used for visual acuity; not precise, speed decreases nearing threshold.

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    Reduced Snellen Chart

    Measures near acuity with sizes from 20/50 to 20/20.

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    Cross Cylinder Grid

    Used for FCC/BCC tests; not reliable for non-presbyopes.

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    Vertical Vergence Amplitudes

    Measured with horizontal lines; assesses break and recovery.

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    NRA/PRA Chart

    Single row chart used in refraction tests; specifics to be covered later.

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    Sunburst Dial

    Determines cylinder axis for irregular astigmatism and mild keratoconus.

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    Clock Dial Example

    A method where patients identify clearer lines for vision assessments.

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    Presbyopia Indicators

    Characteristics indicating difficulty adjusting focus at near distances.

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    Monocular Subjective Sphere

    A vision test method for each eye separately to refine lens power.

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    Amblyopia

    A condition where vision in one eye is reduced because it is not used normally during early childhood development.

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    Overminus

    Providing excessive minus lens power, leading to smaller and less clear letters in a vision test.

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    Subjective Refraction

    A method of determining eyeglass prescriptions based on patient feedback and preferences.

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    Visual Acuity (VA)

    The clarity or sharpness of vision, often tested using an eye chart.

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    Study Notes

    Optometry II - Opto 5272

    • Course introduction and spherocylindrical retinoscopy were covered on January 3, 2024
    • Lucy Kehinde Darnell, OD, PhD, FAAO was the instructor

    Refractive Error Review

    • Spherical refractive error possibilities include myopia, emmetropia, and hyperopia.
    • Myopia: The eye is longer than it should be, causing light rays to focus in front of the retina.
    • Emmetropia: The eye is the correct shape, so light rays focus correctly on the retina.
    • Hyperopia: The eye is shorter than it should be, causing light rays to focus behind the retina.
    • Spherocylindrical classifications include simple astigmatism, compound astigmatism, and mixed astigmatism.
    • Simple astigmatism: One emmetropic meridian, one hyperopic or myopic meridian
    • Compound astigmatism: Both principal meridians are hyperopic or myopic.
    • Mixed astigmatism: One hyperopic meridian and one myopic meridian.

    Spherocylindrical Retinoscopy Steps

    • Align Purkinje images
    • Scope all meridians and determine the two major (principal) meridians; get rid of all motion.
    • Neutralize the MOST PLUS (least minus) meridian FIRST.
    • Set the cyl axis of the phoropter and scope the MOST MINUS (least plus) meridian.
    • Add minus cylinder power until you have neutralized the against motion
    • Take out your working distance

    Astigmatism Classifications

    • With-the-rule: meridian of greatest refractive power is within 30° of vertical
    • Against-the-rule: meridian of greatest refractive power is within 30° of horizontal
    • Oblique: meridian of greatest refractive power is oblique with respect to the vertical or horizontal meridians

    Astigmatism Classifications (cont.)

    • Symmetrical astigmatism: weakest/strongest meridians of both eyes sum up to 180°.
      • Homologous/heterologous symmetrical
    • Asymmetrical astigmatism: weakest/strongest meridians of both eyes do not sum up to 180°.
      • Homonymous/heteronymous

    Astigmatism Classifications (cont.)

    • Total manifest astigmatism: measured in subjective refraction.
    • Corneal astigmatism: results from variation in refractive power of the cornea.
    • Internal/residual/physiological astigmatism: in posterior cornea or crystalline lens (approximately 0.50 DC).

    Lecture 2 - Retinoscopy on a Patient & Direct Ophthalmoscopy

    • Review of spherocylindrical retinoscopy steps
    • Patient set-up: room lights are off or very dim, patient must be able to view distant target with the unscoped eye, block the eye being scoped with your head.
    • Patient's accommodation: relaxed using cycloplegic eye drops or fogging
    • Additional plus beyond patient's refractive error
    • Oblique observation
    • Retinoscopy on a patient steps: Patient instructions, fog left eye, position yourself, neutralize OD, take out lenses, and document

    Direct Ophthalmoscopy

    • Advantages: Easier to learn, high magnification, allows for evaluation of structures in front of the retina, no image reversal.
    • Disadvantages: Limited field of view, monocular procedure, dim image, close working distance.
    • Procedure: Reduce ambient light, grasp like microphone, give patient fixation point, set power wheel, shine light into pupil from 25 cm slightly temporal. Examine optical media, take out working lenses, record
    • Auxiliary features: slit lamp, half light (hemispot), cobalt blue, red free, grid, polarized filter
    • Further instructions on how to examine the optic disc, vasculature, and macula

    Getting started with EyeSi Simulator

    • Email from VRmNet Web Portal ([email protected])
    • Complete online orientation before Lab 2
    • Set a new password (keep it simple!)

    Lecture 3 - Subjective Refraction Part 1 - Monocular Subjective

    • Manifest refraction sequence
      • JCC
      • determines sphere power starting point
      • refines cylinder axis and power
      • followed by monocular subjective sphere, binocular balance, and binocular subjective sphere
    • Goal of manifest refraction: create artificial emmetropia using corrective lenses
    • Using max plus (least minus) for best visual acuity.

    Lecture 3 - Subjective Refraction Part 2 - Binocular Subjective

    • Binocular subjective: final sphere determination for patient's prescription.
      • Procedure is the same as the monocular subjective, except both eyes are open at the same time.
    • Binocular balance, balancing out stimulus to accommodate for the eyes.
    • Avoiding accommodation during refraction
      • cycloplegic refraction (Tropicamide/Cyclopentolate)
      • binocular refraction technique
    • Techniques:
      • Septum
      • Fogging
      • Polarization (Vectographic Slide, Borish Card)
    • Important: Always change both lenses together.

    Lecture 4 - Subjective Refraction Part 2 - Binocular Balance & Binocular Subjective

    • Binocular Balance: balancing out stimulus to accommodate for the eyes.
    • Binocular Balance Techniques: Prism dissociated balance, Vectographic Balance
    • Procedure: display target and prisms, instruct patient, document
    • Why worry/importance: reduced stereo acuity, central suppression, asthenopia, and a big imbalance.
    • Important: Avoid over-minusing

    Near Testing

    • Follow the same procedures for near testing, but the IPD is set for near and the chart is at 40 cm rather than distance.
    • Use of charts for near testing are included.

    Near Targets and Refractive Error Classifications

    • Chart #1: Reading chart (20/60 to 20/20)
    • Chart #2: Reduced Snellen charts (20/50 to 20/20)
    • Chart #3: Cross-cylinder grid (Fused cross cylinders) BCC
    • Chart #4: Horizontal lines of words (Horizontal vergence ranges)
    • Chart #5: Single row of 20/20 letters (NRA/PRA)
    • Chart #6: Sunburst dial (determining cylinder axis)
    • Chart #7: Reading chart (20/200 to 20/80)
    • Chart #8: Reduced Snellen (20/200 to 20/60)
    • Chart #9: Reduced Snellen (20/200 to 20/20)
    • Chart #10: Vertical column of words (Horizontal vergence ranges)
    • Chart #11: 7-line block of 20/20 letters (Horizontal and Vertical Phoria)
    • Chart #12: Trifocal charts

    Refractive Status Classifications

    • Emmetropia
    • Ametropia
    • Hypermetropia/Hyperopia
    • Types include, Simple, Pathological, and examples such as Microphthalmos, Aphakia, and Ectopia lentis.
    • Classifications for Low, Moderate, and High, based on diopters

    Myopia

    • Types of Myopia include, Low, Moderate, and High, based on diopters.
    • Pathological: Axial elongation.
    • Associated diseases include Retinal tears, Posterior staphyloma, and Macular hole.

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    Optometry II Midterm 1 2024 PDF

    Description

    This quiz focuses on the concepts and procedures involved in ophthalmic refraction. It covers aspects such as cylinder axis adjustments, refining cylinder power, and the sequence of steps in manifest refraction. Test your knowledge on how to achieve optimal vision correction and understand patient responses during the process.

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