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Questions and Answers
What should be done if the cylinder axis has a DC of 1.00 or less?
What should be done if the cylinder axis has a DC of 1.00 or less?
What is the correct endpoint when refining the cylindrical axis?
What is the correct endpoint when refining the cylindrical axis?
If a patient reports that letters look better when the red dots are parallel to the axis, what adjustment should be made?
If a patient reports that letters look better when the red dots are parallel to the axis, what adjustment should be made?
How much sphere adjustment should be made for every two clicks of cylindrical power added?
How much sphere adjustment should be made for every two clicks of cylindrical power added?
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What is the next step after refining cylinder axis?
What is the next step after refining cylinder axis?
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When refining cylinder power, how should one adjust if letters look better when white dots are parallel to the axis?
When refining cylinder power, how should one adjust if letters look better when white dots are parallel to the axis?
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What precedes the determination of binocular balance in the sequence of refraction?
What precedes the determination of binocular balance in the sequence of refraction?
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What must be done to maintain the circle of least confusion when adding cylindrical power?
What must be done to maintain the circle of least confusion when adding cylindrical power?
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What should a patient be able to read to indicate improvement after adding -0.50 DS?
What should a patient be able to read to indicate improvement after adding -0.50 DS?
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What occurs when a patient is over-minused during refraction?
What occurs when a patient is over-minused during refraction?
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If +0.25 DS does not worsen the letters, what is the next step?
If +0.25 DS does not worsen the letters, what is the next step?
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What is the first step in the Manifest Refraction Sequence?
What is the first step in the Manifest Refraction Sequence?
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What is the purpose of Binocular Balance in subjective refraction?
What is the purpose of Binocular Balance in subjective refraction?
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What does a patient need to demonstrate to receive extra minus during refraction?
What does a patient need to demonstrate to receive extra minus during refraction?
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What principle should be followed to ensure correct refraction results?
What principle should be followed to ensure correct refraction results?
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What should be the approach if a patient presents unequal acuity in each eye?
What should be the approach if a patient presents unequal acuity in each eye?
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What does the midpoint of break indicate in the context of vertical phoria interpretation?
What does the midpoint of break indicate in the context of vertical phoria interpretation?
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In the provided example, what is the effective way to determine the midpoint when given different supravergence and infravergence readings?
In the provided example, what is the effective way to determine the midpoint when given different supravergence and infravergence readings?
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What does the notation '4pd BU/2pd BU' signify in the vertical vergence findings?
What does the notation '4pd BU/2pd BU' signify in the vertical vergence findings?
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What is the purpose of introducing BU prism during infravergence testing?
What is the purpose of introducing BU prism during infravergence testing?
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How should the horizontal vergence ranges be set according to the guidelines?
How should the horizontal vergence ranges be set according to the guidelines?
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If a patient has Right Supravergence = 3pd BD and Right Infravergence = 5pd BU, what is the midpoint of break?
If a patient has Right Supravergence = 3pd BD and Right Infravergence = 5pd BU, what is the midpoint of break?
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Asymmetric supra and infra vergence findings can confirm what condition?
Asymmetric supra and infra vergence findings can confirm what condition?
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What is the primary goal when refining sphere power during retinoscopy?
What is the primary goal when refining sphere power during retinoscopy?
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What does a reading of '1pd BU OD' suggest in regards to patient's binocular vision?
What does a reading of '1pd BU OD' suggest in regards to patient's binocular vision?
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What should be done to the room lighting during a visual acuity check post-retinoscopy?
What should be done to the room lighting during a visual acuity check post-retinoscopy?
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What is the correct approach if a patient’s monocular acuity is 20/20 during retinoscopy?
What is the correct approach if a patient’s monocular acuity is 20/20 during retinoscopy?
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If the monocular acuity is between 20/25 and 20/30, what should be added during the examination?
If the monocular acuity is between 20/25 and 20/30, what should be added during the examination?
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What action is advised if a patient reports that their vision looks worse but can still read the same size letters?
What action is advised if a patient reports that their vision looks worse but can still read the same size letters?
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What should be done if the patient loses some letters after the first plus DS step?
What should be done if the patient loses some letters after the first plus DS step?
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What is the importance of occluding one eye during the visual acuity test?
What is the importance of occluding one eye during the visual acuity test?
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What measurement should be taken if a patient cannot read the lowest line displayed?
What measurement should be taken if a patient cannot read the lowest line displayed?
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What is the primary goal of manifest refraction?
What is the primary goal of manifest refraction?
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Which sequence is proper for the monocular subjective refraction process?
Which sequence is proper for the monocular subjective refraction process?
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In retinoscopy, what does an increase in positive sphere indicate?
In retinoscopy, what does an increase in positive sphere indicate?
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What is the purpose of using a cobalt blue filter during examination?
What is the purpose of using a cobalt blue filter during examination?
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What happens when a patient cannot relax accommodation during a vision exam?
What happens when a patient cannot relax accommodation during a vision exam?
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What is the function of the 'Circle of Least Confusion' in refraction?
What is the function of the 'Circle of Least Confusion' in refraction?
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What is a typical initial step in the manifest refraction sequence?
What is a typical initial step in the manifest refraction sequence?
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Which option is considered an auxiliary feature to improve visibility in eye examinations?
Which option is considered an auxiliary feature to improve visibility in eye examinations?
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When using the JCC in the refraction process, what is the main objective?
When using the JCC in the refraction process, what is the main objective?
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What effect does a negative sphere power have on visual acuity when over the distance BVA?
What effect does a negative sphere power have on visual acuity when over the distance BVA?
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What symptom may indicate that a patient has been over-minused?
What symptom may indicate that a patient has been over-minused?
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Which near target chart is used for measuring near acuity?
Which near target chart is used for measuring near acuity?
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What is the main use of the Cross cylinder grid?
What is the main use of the Cross cylinder grid?
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What indicates that a patient's NRA finding is greater than normal?
What indicates that a patient's NRA finding is greater than normal?
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What is NOT a reliable measure of visual acuity?
What is NOT a reliable measure of visual acuity?
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What is the purpose of the sunburst dial in optometry?
What is the purpose of the sunburst dial in optometry?
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The horizontal line of words is used to evaluate which of the following?
The horizontal line of words is used to evaluate which of the following?
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What condition is the Cross Cylinder grid NOT reliable for?
What condition is the Cross Cylinder grid NOT reliable for?
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Which near target chart is specifically focused on measuring accuracy of accommodation?
Which near target chart is specifically focused on measuring accuracy of accommodation?
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What is the primary function of NRA/PRA in optometry?
What is the primary function of NRA/PRA in optometry?
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Flashcards
Discoloration
Discoloration
A change in the color of a part of the eye or skin.
Cobalt Blue Filter
Cobalt Blue Filter
A tool used to enhance visibility of corneal defects.
Sodium Fluorescein
Sodium Fluorescein
A vital dye used to illuminate eye defects.
Manifest Refraction
Manifest Refraction
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Emmetropia
Emmetropia
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Monocular Subjective Refraction
Monocular Subjective Refraction
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JCC (Jackson Cross Cylinder)
JCC (Jackson Cross Cylinder)
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Circle of Least Confusion
Circle of Least Confusion
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Interval of Sturm
Interval of Sturm
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Binocular Balance
Binocular Balance
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JCC
JCC
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Refine Cyl Axis
Refine Cyl Axis
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Chase the red dots
Chase the red dots
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DC (Diopter Change)
DC (Diopter Change)
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Endpoint
Endpoint
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Sphere Power Adjustment
Sphere Power Adjustment
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Dioptic midpoint
Dioptic midpoint
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Retinoscopy
Retinoscopy
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Monocular acuity
Monocular acuity
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VA after ret
VA after ret
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Sphere power
Sphere power
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Plus sphere in DS steps
Plus sphere in DS steps
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Supravergence
Supravergence
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Infravergence
Infravergence
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Vertical Phoria
Vertical Phoria
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Midpoint of Break
Midpoint of Break
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Right Hypophoria
Right Hypophoria
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Asymmetric Vergence
Asymmetric Vergence
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Prism Direction Assignment
Prism Direction Assignment
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Vergence Ranges Review
Vergence Ranges Review
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Over-Minusing Indicators
Over-Minusing Indicators
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Reading Chart #1
Reading Chart #1
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Reduced Snellen Chart
Reduced Snellen Chart
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Cross Cylinder Grid
Cross Cylinder Grid
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Vertical Vergence Amplitudes
Vertical Vergence Amplitudes
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NRA/PRA Chart
NRA/PRA Chart
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Sunburst Dial
Sunburst Dial
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Clock Dial Example
Clock Dial Example
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Presbyopia Indicators
Presbyopia Indicators
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Monocular Subjective Sphere
Monocular Subjective Sphere
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Amblyopia
Amblyopia
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Overminus
Overminus
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Subjective Refraction
Subjective Refraction
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Visual Acuity (VA)
Visual Acuity (VA)
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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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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.