Unit 3
Refraction & Vision Testing
Instruments
Unit 4
Ophthalmic Diagnostic
Procedures
Krunal [Link]
Lecturer, Biomedical Department
[Link] Technical Institute, Rajkot
Contents
• Refractive Instruments: Trial Set, Slit Lamp
• OCT
• Visual Acuity
Refractive Instruments
Trial Set
Slit Lamp
Visual Acuity Charts
Refractive Power
Trial Set
Trial Set - Definition
Find the exact corrective lens
Determine refractive errors
power
A Trial Set is a collection
of optical lenses and
accessories used by
optometrists and
ophthalmologists to:
It is a diagnostic tool, not a
Prescribe spectacles
treatment device.
Trial Set - Components
Trial Set Lenses Trial Frame
Components
Accessories of Trial Set
Spherical Lens
Trial Set Lens Cylindrical Lens
Prism Lens
Trial Set Occluder
Trial Frame
Components
Pinhole Disc
Accessories Stenopic slit
Maddox Rod
Near Vision
Chart
Trial Set – Spherical Lenses
Trial Set – Cylindrical Lenses
Trial Set – Prism Lenses
Accessories - Occluder
How does an Occluder look?
What is an Occluder?
✓ Flat, round or oval
An occluder is a solid black plate used to
✓ Black in color
cover one eye completely during eye
✓ No power (0 D)
testing.
✓ Made of plastic or metal
It blocks light from entering the eye.
✓ Fits into the trial frame like a lens
Why is an Occluder used? 3. Used in many eye tests
• Visual acuity test
1. To test one eye at a time • refraction
• Covers the non-tested eye & • Binocular vision test
ensures only test eye is working • squint evaluation
2. To check vision accurately
• If both eyes are open:
• Brain combines images
• Test results become wrong
Accessories - Pinhole
Definition How does Pinhole look?
A pinhole is a black disc with a very • Black circular disc
small hole in the center, used to check • Small central hole ( 1 to 1.2 mm)
whether poor vision is due to refractive • No lens power (O D)
error. It allows only a thin beam of light • Fits into trial frame
to enter the eye.
Why is a Pinhole used? • Blocks unwanted rays
• Allows only central rays
1. To find the cause of blurred vision • This reduces: Blur &distortion
• If vision improves with pinhole → 3. To increase depth of focus
problem is refractive error • Pinhole increases clarity &
• If vision does not improve → sharpness
problem is eye disease
2. To reduce light scattering
Accessories – Maddox Rod
How does Maddox Rod look?
Definition
• Red-colored lens (commonly)
A Maddox rod is a special lens made of
• Made of multiple fine cylindrical rods)
many tiny parallel cylinders used to
• All rods are parallel
detect eye misalignment (heterophoria).
• Fits into trial frame
It converts a point of light into a line.
Why is a Maddox Rod used? 2. To reduce light scattering
• Blocks unwanted rays
1. To detect eye alignment problems • Allows only central rays
• This reduces: Blur &distortion
• Esophoria (eye turns inward)
• Exophoria (eye turns outward) 3. To increase depth of focus
• Hyperphoria (vertical • Pinhole increases clarity &
misalignment) sharpness
Accessories – Maddox Rod Test Interpretation
Accessories – Stenopic Slit
Definition Working Principle
A stenopic slit is a thin narrow rectangular • Slit blocks most peripheral rays
opening mounted on a handle and kept in the • Allows the light to enter the eye
trial set box. It allows light to pass only
through one meridian at a time
through a very narrow slit , Similar to pinhole,
but line-shaped, not circular. It is mainly used
• Reduces effect of irregular refraction
to detect and analyse astigmatism.
Why is a Stenopic Slit used? How It Is Used in Eye Testing
1. Identify presence of astigmatism • Patient looks at vision chart
2. Find the principal meridians of the • Examiner places stenopic slit in front of
eye eye
3. Determine the axis of the eye • Slit is rotated slowly (0°–180°)
• Patient reports position of maximum
What Does Improvement Indicate? clarity
❖ That angle indicates the axis of
If vision improves at a particular angle →
astigmatism.
Astigmatism present
If no improvement → blur may be due to
other causes
Slit Lamp - Definition
Slit Lamp - Parts
Illumination System
Observation System
Mechanical System
Patient Support System
Test for Visual Acuity
• Acuity of vision is tested for distant vision as well near vision.
If there is any difficulty in seeing the distant object or near
object, the defect is known as error of refraction.
Distant Vision
• Snellen Chart is used to test the acuity of vision for distant
vision in the diagnosis of refractive errors of the eye.
Near Vision
• Jaeger Chart is used to test the visual acuity for near vision.
Purpose of the test:
• You may need an eye exam if you feel you’re experiencing a
vision problem or your vision has changed. A visual acuity test
is one part of a comprehensive eye exam.
• Children frequently take visual acuity tests. Early testing and
detection of vision problems can prevent issues from getting
worse.
• Optometrists, driver’s license bureaus, and many other
organizations use this test to check your ability to see.
Snellen Chart
• The fact that two distant points can be visible as separate only
when they subtend an angle of 1 minute at the nodal point of
the eye, forms the basis of Snellen’s test-types.
• It consists of a series of black capital letters on a white board,
arranged in lines, each progressively diminishing in size. The
lines comprising the letters have such a breadth that they will
subtend an angle of 1 min at the nodal point.
• Each letter of the chart is so designed that it fits in a square,
the sides of which are five times the breadth of the
constituent lines. Thus, at the given distance, each letter
subtends an angle of 5 min at the nodal point of the eye.
• The letters of the top line of Snellen’s chart should be read
clearly at a distance of 60 m.
• Similarly, the letters in the subsequent lines should be read
from a distance of 36, 24, 18, 12, 9, 6, 5 and 4m, respectively.
• Principle of Snellen’s Test Type:
Procedure for Test
• For testing distant visual acuity, the patient is seated at a
distance of 6m from the Snellen’s chart, so that the rays of
light are practically parallel and the patient exerts minimal
accommodation. The chart should be properly illuminated
(not less than 20 ft candles).
• The patient is asked to read the chart with each eye
separately and the visual acuity is recorded as a fraction, the
numerator being the distance of the patient from the letters,
and the denominator being the smallest letters accurately
read. When the patient is able to read up to 6 m line, the
visual acuity is recorded as 6/6, which is normal.
• Similarly, depending upon the smallest line which the patient
can read from the distance of 6 m, his vision is recorded as
6/9, 6/12, 6/18, 6/24, 6/36 and 6/60, respectively.
• If he cannot see the top line from 6 m, he is asked to slowly
walk towards the chart till he can read the top line. Depending
upon the distance at which he can read the top line, his vision
is recorded as 5/60, 4/60, 3/60, 2/60 and 1/60, respectively.
• If the patient is unable to read the top line even from 1 m, he
is asked to count fingers (CF) of the examiner. His vision is
recorded as CF-3’, CF-2’, CF-1’ or CF close to face, depending
upon the distance at which the patient is able to count
fingers.
• When the patient fails to count fingers, the examiner moves
his hand close to the patient’s face. If he can appreciate the
hand movements (HM), visual acuity is recorded as HM
positive.
• When the patient cannot distinguish the hand movements, he
is taken into the dark room and a light is focused on his eye
and he is asked to say when the light is on and when it is off. If
he succeeds in doing this, V= PL (the examiner notes whether
the patient can perceive light (PL) or not). If yes, vision is
recorded as PL +ve and if not it is recorded as PL –ve.
• Also when examiner throws light, he may be able to give some
indication of the four directions from which the light is
directed—up, down, right and left. This is recorded as
projection of light, accurate or inaccurate in each quadrant. If
he fails to see the light the vision is recorded as V=no
Projection of light.
E Chart or Tumbling E Chart
Broken Ring Chart