Podcast
Questions and Answers
What is the primary objective of binocular balancing in routine refraction?
What is the primary objective of binocular balancing in routine refraction?
- To ensure each eye has a different prescription.
- To prevent any interaction between the two eyes during testing.
- To achieve an even distribution of accommodation between the eyes. (correct)
- To maintain equal visual acuity between both eyes.
Which statement is true regarding latent hyperopia?
Which statement is true regarding latent hyperopia?
- It only occurs in one eye and does not affect binocular vision.
- It is completely invisible and cannot be detected in a routine examination.
- It results solely from age-related changes in the eye.
- It can lead to unbalanced accommodation if not addressed appropriately. (correct)
What is a common consequence of unbalanced accommodation between the eyes during refraction?
What is a common consequence of unbalanced accommodation between the eyes during refraction?
- Asthenopia, or eye strain, may occur. (correct)
- A complete failure of the visual system.
- Increased visual acuity in one eye.
- Enhanced depth perception in the affected eye.
Why is the procedure for monocular refraction significant in routine eye examinations?
Why is the procedure for monocular refraction significant in routine eye examinations?
Which element is NOT part of the basic mini routine of BR-TY-RN for eye examination?
Which element is NOT part of the basic mini routine of BR-TY-RN for eye examination?
What is the significance of a retinoscopy result of R+1.25/-1.00 x 180 for Mr. Abdul Khan?
What is the significance of a retinoscopy result of R+1.25/-1.00 x 180 for Mr. Abdul Khan?
How does age affect the ability to accommodate in hyperopes?
How does age affect the ability to accommodate in hyperopes?
What is one characteristic of hyperopia in children mentioned in the content?
What is one characteristic of hyperopia in children mentioned in the content?
What condition is Ms. Sara Kalique likely experiencing based on her provided details?
What condition is Ms. Sara Kalique likely experiencing based on her provided details?
What is one reason for low tolerance or understanding of hyperopia in early presbyopes?
What is one reason for low tolerance or understanding of hyperopia in early presbyopes?
What is the purpose of occluding one eye during retinoscopy?
What is the purpose of occluding one eye during retinoscopy?
Which technique is typically used when fusional vergence is present during monocular subjective refraction?
Which technique is typically used when fusional vergence is present during monocular subjective refraction?
What should be added to the right eye after occluding the left eye for retinoscopy for 1-2 seconds?
What should be added to the right eye after occluding the left eye for retinoscopy for 1-2 seconds?
When performing binocular balance, which method utilizes a polarized chart?
When performing binocular balance, which method utilizes a polarized chart?
Which of the following combinations effectively refines the spherical component during refraction?
Which of the following combinations effectively refines the spherical component during refraction?
What characteristic is unique to the Turville Infinity Balance method?
What characteristic is unique to the Turville Infinity Balance method?
What occurs to the central vision of the left eye during the occlusion process?
What occurs to the central vision of the left eye during the occlusion process?
During binocular fogging, which technique is employed to create visual blur?
During binocular fogging, which technique is employed to create visual blur?
What is the purpose of binocular addition in retinoscopy?
What is the purpose of binocular addition in retinoscopy?
Which of the following steps is performed after binocular balancing?
Which of the following steps is performed after binocular balancing?
What is the initial fogging prescribed for the left eye during binocular refraction?
What is the initial fogging prescribed for the left eye during binocular refraction?
What is the final requirement after performing the refraction stage in retinoscopy?
What is the final requirement after performing the refraction stage in retinoscopy?
How does monocular fogging contribute to accommodation relaxation?
How does monocular fogging contribute to accommodation relaxation?
What is the role of the binocular vision status (BVS) during the procedure?
What is the role of the binocular vision status (BVS) during the procedure?
In the context of binocular addition, why might it be unnecessary to perform this step?
In the context of binocular addition, why might it be unnecessary to perform this step?
What should be done after fogging the left eye during the binocular refraction procedure?
What should be done after fogging the left eye during the binocular refraction procedure?
What characterizes latent hyperopia?
What characterizes latent hyperopia?
Which type of hyperopia is uncorrectable by the ciliary muscle's effort?
Which type of hyperopia is uncorrectable by the ciliary muscle's effort?
What is a common management strategy for latent hyperopia?
What is a common management strategy for latent hyperopia?
What is the first action to take after checking the end visual acuity (VA)?
What is the first action to take after checking the end visual acuity (VA)?
At what point should cycloplegia be considered in evaluating hyperopia?
At what point should cycloplegia be considered in evaluating hyperopia?
What might indicate the need for gradual increase in prescriptions for latent hyperopia?
What might indicate the need for gradual increase in prescriptions for latent hyperopia?
When might occluding the left eye be necessary during binocular refraction?
When might occluding the left eye be necessary during binocular refraction?
Which drop percentage is used for cycloplegia in hyperopia assessment?
Which drop percentage is used for cycloplegia in hyperopia assessment?
What should be considered if a patient's pupil size is small during refraction?
What should be considered if a patient's pupil size is small during refraction?
What should be done if there is uncertainty about giving the plus prescription?
What should be done if there is uncertainty about giving the plus prescription?
Which of the following defines facultative hyperopia?
Which of the following defines facultative hyperopia?
In the case of Miss Jenny Peters, what should be checked after retinoscopy with +1.00 blur?
In the case of Miss Jenny Peters, what should be checked after retinoscopy with +1.00 blur?
What is an essential component when dealing with manifest hyperopia?
What is an essential component when dealing with manifest hyperopia?
What is a clinical consideration when a change in prescription exceeds +0.50 DS?
What is a clinical consideration when a change in prescription exceeds +0.50 DS?
During binocular refraction, what is the goal when selecting the lens power?
During binocular refraction, what is the goal when selecting the lens power?
What could increase the difficulty in detecting a 0.25 change during refraction?
What could increase the difficulty in detecting a 0.25 change during refraction?
Flashcards
Routine Refraction
Routine Refraction
A standard examination procedure used to determine the best lens correction for each eye.
Monocular Refraction
Monocular Refraction
Measuring the refractive error of each eye individually.
Binocular Balancing
Binocular Balancing
Adjusting the lens power of each eye to achieve a comfortable visual experience when both eyes are working together.
Latent Hyperopia
Latent Hyperopia
A condition where a person's eye has a tendency to focus on objects that are too far away.
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Occlusion
Occlusion
The act of covering one eye during refraction testing.
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Binocular Addition
Binocular Addition
A technique for refining the refractive error of both eyes simultaneously, commonly used after binocular balancing or fogging.
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Monocular Fogging
Monocular Fogging
A technique used in retinoscopy where the examiner fogs one eye to relax accommodation, while examining the other eye.
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Final Distance Refraction
Final Distance Refraction
A technique used to assess the patient's ability to see clearly at a distance after refining the refractive error.
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Flippers
Flippers
A tool used to focus light onto the retina during retinoscopy, making it easier to see the reflex.
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Plus 1 Blur
Plus 1 Blur
The amount of plus power that is required to bring the patient's eyes to a +1 blur during retinoscopy.
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Binocular Balance
Binocular Balance
A technique for assessing the balance of the eyes when focusing at near, ensuring both eyes work together smoothly.
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Anisometropic Hyperopia
Anisometropic Hyperopia
A type of hyperopia where the refractive error is different in each eye. This can lead to amblyopia (lazy eye) in children.
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Isometropic Hyperopia
Isometropic Hyperopia
A type of hyperopia where the refractive error is the same in each eye. This can also lead to amblyopia, especially when high hyperopia is present.
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Modified Humphriss
Modified Humphriss
A method for subjective refraction that utilizes a polarized chart or duochrome to determine the best lens power for each eye, while simultaneously balancing the eyes' convergence and accommodation.
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Prism Dissociated Balance
Prism Dissociated Balance
A method for subjective refraction that utilizes a prism to separate the visual input from each eye, thus isolating the accommodation of each eye and facilitating the determination of the best lens power for each eye.
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Humphriss Immediate Contrast
Humphriss Immediate Contrast
A subjective refraction technique that uses a special chart with alternating black and white bars to determine the lens power needed to achieve clear vision in each eye. This technique helps to isolate the accommodation of each eye and avoid the interference of fusional vergence.
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Turville Infinity Balance
Turville Infinity Balance
A subjective refraction technique that uses a special chart with alternating black and white bars to determine the lens power needed to achieve clear vision in each eye. This technique helps to isolate the accommodation of each eye and avoid the interference of fusional vergence.
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Polarized Chart
Polarized Chart
A subjective refraction technique that uses a special chart with alternating black and white bars to determine the lens power needed to achieve clear vision in each eye. This technique helps to isolate the accommodation of each eye and avoid the interference of fusional vergence.
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Duochrome
Duochrome
A subjective refraction technique that uses a special chart with alternating black and white bars to determine the lens power needed to achieve clear vision in each eye. This technique helps to isolate the accommodation of each eye and avoid the interference of fusional vergence.
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Fusional Vergence
Fusional Vergence
The ability of the eyes to work together to maintain clear and comfortable vision at different distances. It involves the coordinated effort of accommodation (focusing) and convergence (turning the eyes inward).
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Total Hyperopia
Total Hyperopia
The total amount of hyperopia present in the eye, measured when the eye is fully relaxed and not accommodating.
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Facultative Hyperopia
Facultative Hyperopia
The amount of hyperopia that can be corrected by the eye's natural accommodation.
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Absolute Hyperopia
Absolute Hyperopia
The amount of hyperopia that cannot be corrected by the eye's accommodation, even with maximum effort.
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Cycloplegia
Cycloplegia
A technique used to measure and correct hyperopia, especially latent hyperopia, by temporarily paralyzing the eye's ciliary muscle.
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Subjective Refraction
Subjective Refraction
A method of assessing the amount of hyperopia by observing the eye's accommodative effort.
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High Accommodative Tone
High Accommodative Tone
The tendency of the eyes to over-accommodate, leading to a potential increase in latent hyperopia.
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Refine sph
Refine sph
Refine sph stands for refining the spherical power of the lens. It's a step in the refraction process where adjustments are made to the lens power to achieve the best visual acuity for the patient.
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VA
VA
VA refers to Visual Acuity, which is the sharpness of vision measured using a Snellen chart. It describes how clearly a person can see.
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Aim for most plus with best VA
Aim for most plus with best VA
During binocular refraction, it's important to aim for the 'most plus' lens power that provides the best visual acuity. This usually means finding the strongest positive lens power that allows the patient to see clearly.
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Clinical Decision Making
Clinical Decision Making
Clinical decision-making in refraction involves considering factors like patient preference, pupil size, media opacification, and previous glasses to determine the most appropriate lens power. It requires a balance between objective measurements and individual needs.
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Over-plussing and Latent hyperope
Over-plussing and Latent hyperope
Over-plussing refers to prescribing a lens power that is too strong, leading to blurry vision at distance and sometimes near. Latent hyperope is a condition where a person's eyes are naturally more focused for distance vision, and they may need a stronger lens power for near vision.
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Pupil size and over-plussing
Pupil size and over-plussing
Pupil size can affect the ease of over-plussing during refraction. Smaller pupils may lead to a minimal difference in blur circle size with small changes in lens power, making it difficult to determine the optimal lens power. It's important to use larger changes in lens power like ±0.50 to check for clarity when pupils are small.
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Media opacification
Media opacification
Media opacification refers to a clouding of the eye's internal structures like the lens or cornea. In such cases, it can be harder to detect small changes in lens power during refraction because the clouding may affect the clarity of vision.
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NUT-FREE ZONE
- Images show various foods and personal care products.
- A sign warns of a nut-free zone.
LECTURE RECORDING
- The lecture is being recorded.
- The recording will be available on the module DLE pages.
- Students can comment or ask questions.
- Questions may appear on the recording.
- Participants can ask to pause recording if they do not want their questions to be included.
OPT505 LECTURE 14: BUILDING A ROUTINE REFRACTION
- The lecture is about building a routine refraction.
- The lecturer is Ellie Livings.
INTENDED LEARNING OUTCOMES
- Understand 'basic routine'.
- Monocular v binocular refraction.
- Binocular balancing.
- Latent hyperopia.
PRINCIPLES OF EYE EXAMINATION OR SIGHT TEST
- Internal and external examinations are required.
- Additional tests are necessary to detect injury or disease.
- The same optometrist should conduct the entire episode of care, unless transferred.
- Responsible optometrist interprets findings.
- Automated instruments, such as visual field analyzers, are part of examination.
KEY POINTS
- There is a suggested equipment list (Annex 1).
- All clinical findings must be recorded.
- Sufficient time must be allowed for the examination.
- The format and content of the examination are based on professional judgement and legal requirements.
- An 'episode of care' in the context of eye exam encompasses the entire care journey from initial testing to final prescription.
BASIC MINIMUM ROUTINE
- Introduction (Intro), health & safety (H&S), prelims.
- Objective refraction.
- Subjective refraction.
- Supplementary tests.
- Health assessment.
- Record management.
- Time estimate per section in minutes.
PROCEDURE FOR MONOCULAR REFRACTION
- Follow red arrows.
- Retinoscopy using occlusion of one eye, followed by un-occlusion.
- Refraction of each eye, including best vision spherical (BVS) and cylinder (x-cyl) measurements.
- Refine spherical values.
- Obtain VA values for each eye.
- Plus 1 blur.
- Un-occlude and Balance both eyes.
- Binocular Add (+0.25DS).
BINOCULAR CONSIDERATIONS
- Most people have binocular vision.
- Accommodation balance between eyes is needed.
- Accommodation is not independent, eyes need to accommodate together.
- Unbalanced accommodation can lead to asthenopia.
WHAT'S THE PROBLEM WITH OCCLUSION?
- Occlusion can dilate the pupil and result in refractive changes from spherical aberration.
- Occlusion can mask latent nystagmus and make subjective refraction difficult.
- Incorrect assessment of astigmatism could result from occlusion.
- Occlusion stimulates accommodation.
ACCOUNTING FOR ACCOMODATION AND BINOCULARITY
- Refraction can be completed separately monocularly, or as a combined binocular process.
- Blurry vision of one eye when refactoring leads to suppression of central vision but peripheral fusion is maintained for binocularity.
PLUS 1 BLUR
- Shows visual acuity (VA) when one eye is blurred by 1 diopter (plus 1).
- Diagram shows visual acuity for each eye on a scale.
ACCOMMODATIVE BALANCE
- Diagram with measurement scales indicating accommodation for each eye.
MONOCULAR V BINOCULAR REFRACTION
- Separated monocular refraction process for each eye.
- Combined binocular refraction process encompassing both eyes.
- Monocular subjective approach required when binocular accommodation is not a concern.
SUBJECTIVE REFRACTION
- Monocular subjective testing method for people with poor binocular vision.
- Binocular subjective method for people with normal binocular vision.
- Pros and cons of each type of subjective testing.
WHO GETS BINOCULAR BALANCING/REFRACTION?
- People with monocular vision.
- People with deep amblyopia.
- People with strabismus.
- People with very poor VA in one eye.
TECHNIQUE 1: MONOCULAR SUBJECTIVE + BINOCULAR BALANCE
- Monocular refraction (RE/LE).
- Binocular balancing.
- Binocular add.
- Record final Rx with final VA values.
- Retinoscopy steps for each eye.
MONOCULAR SUBJECTIVE + BINOCULAR BALANCE: OPTIONS
- Multiple refracting techniques to measure binocular balance.
- Techniques for cases with or without fusional vergence present.
RELAXING ACCOMMODATION EQUALLY IN BOTH EYES
- Methods such as Modified Humphriss, Humphriss Immediate Contrast, and Prism Dissociated Balance for better binocular accomodation.
MODIFIED HUMPHRISS
- Steps to accurately determine appropriate lens power for patient.
- Instructions on what to ask the patient.
CASE SCENARIOS
- Case studies providing specifics such as patient age, eye condition, and retinoscopy results to indicate the need for monocular or binocular refraction.
CYCLOPLEGIC COMPARISON
- Table comparing different cycloplegic drugs based on dose, maximum cycloplegia time, duration of action, tonus allowance, and residual accommodation.
DEALING WITH LATENT HYPEROPIA
- Strategies to manage latent hyperopia focusing on subjective and binocular refraction, prescribing adjustments, monitoring cover tests, and patient communication.
CYCLO
- Issues to consider with unstable ret reflex testing.
- When binocular issues are suspected.
- History of amblyopia/high plus.
- Unequal vision/VA without refractive causes.
WHAT DROPS?
- Cycloplegic eye drops are available to temporarily paralyze the ciliary muscles.
- Description of different drops, including effects, duration and recovery time.
PRESCRIBING POST-CYCLO
- Instructions for referring patients appropriately and measuring visual acuity pre and post procedure, reducing prescription as required, and communicating with parents.
BACKGROUND LEARNING
- Suggested activities for review prior to attending the session on these topics. (Reading specific lab book sections, reviewing Moodle resources, studying and preparing for the full routine procedure, reviewing health, safety, prelims, and management).
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