ADNANCE REFRACTION AND VISUAL
SYSTEMS
Course Code: OD-133
Lecture by:
Rabia Saeed (OD, M.Phil. Optometry)
Lecturer, DOVS, FAHS
OBJECTIVE REFRACTION
Learning Objectives:
What is refraction?
C a n it b e measured objectively?
If yes, how?
Refraction
Determination of the focal condition of
the e y e or the refractive state of the e y e .
Objective refraction
Refraction c a n b e d o n e both objectively
a n d subjectively.
Determination of the refractive state
without the active participation of the
patient.
Autorefractometer or retinoscope.
History
O v e r the last 200 years or so attempts
have been made.
The successful autorefractometers
were d e v e l o p e d over the last 30
years.
With the a d v e n t of technology these
equipments h a v e b e c o m e more
sophisticated & increasingly precise.
Need of autorefractometer
With the increasing load of patients in
any optometry practice.
An autorefractometer will increase the
s p e e d of the refraction process.
Autorefractometer
The most a d v a n c e technology of
measuring the refractive state of the
eye.
Provides a quick reliable guideline for the
subjective refraction.
Optical principle
The Scheiner principle
The Optometer principle
Scheiner principle
Scheiner discovered in 1619 that refractive
error of the eye c a n b e precisely
determined by placing double pinhole
apertures before the pupil.
Parallel rays of light from a distant object are
r e d u c e d to two small bundles of light by the
Scheiner disc.
These rays form a single focus on the
retina if the e y e is emmetropic; but if
there is any refractive error two spots fall
on the retina.
By adjusting the position of the object
performed mechanically or optically by
the autorefractor until one focus of light is
seen by the patient, the far point of the
patient’s eye and the refractive error can
b e determined.
In a Myopic Eye:
The two rays bundles cross each other before reaching the retina
and two small spots of light are seen.
In Hyperopic Eye:
In hyperopic eye, the rays bundles intercepted by the
retina before they meet and thus again two small spots of
lights are seen.
Optometer principle
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'.
A convex lens is placed in front of the eye so
that its focus lies in the spectacle plane and a
movable target is viewed through the lens.
The vergence of the light in the plane of the
second principal focus of the lens is linearly
related to the distance of the target from the
first principal focus of the lens.
Emmetropic c a s e
If the target lies at the first principal
focus of the lens, light from the target
will b e parallel at the spectacle plane,
and focused on the retina of the
emmetropic eye.
Hypermetropia
When the target is within the focal length of
the lens, light from it will b e divergent in the
spectacle plane (simulating a c o n c a v e trial
lens).
Myopia
Light from a target outside the focal
length of the lens will b e convergent in
the spectacle plane (simulating a convex
trial lens).
Basic Designs:
Infrared source
Fixation target
Infrared Source:
The patient's eye is refracted using invisible infrared light of
wavelength 800-900nm because it is invisible thus helps in
overcoming the instrument accommodation.
Due to chromatic aberration of the eye and because infrared
light is not reflected by the same layers of the retina as visible
light, the refraction of the eye to infrared differs significantly
from its refraction to visible light.
Fixation Target:
• A separate fixation target must still be provided, and is
designed to encourage relaxation of accommodation.
• All autorefractometers use fogging technique to relax
accommodation prior to objective refraction.
Advantages:
Autorefractors are a valuable tool in determining a
starting point for refraction.
Painless and quick method.
Modern technology has resulted in improvements in
design, size, speed and accuracy.
Limitations:
The instruments do not perform well if the patient has a:
Small pupil or distorted pupil
E.g Broad iredectomy
Ocular media is not clear (media is hazy and VA is less
than 6/18)
Maintenance:
Calibration of the instrument once in a month.
On a daily basis inspect the window with the penlight so
that if any debris is detected should be cleaned.
Clean the chin rest and forehead rest with the alcohol
after its usage.
Learning Outcomes:
Students have learnt about
• Basic principles of Objective refraction
• Advances of autorefractometer
References
Clinical Optics By Elkington
Theory & Practice of Optics & Refraction By
Khurana
Clinical Optics by American Academy of
Ophthalmology
International Journal of Contemporary
Medical Research
