LEVEL 2

OPTOMETRY TRAINING 1
MODULE 2

INSTRUMENTS AND EQUIPMENT

THE OBJECTIVE IS TO FAMILIARIZE WITH THE INSTRUMENTS AND
OPTOMETRIC USE EQUIPMENT.

PUPILOMETER
TEST BOX
TEST FRAME
OPTOTYPE CHART
PROJECTOR
RETINOSCOPE
DIRECT OPHTHALMOSCOPE
INDIRECT OPHTHALMOSCOPE
FOROPTER
SLIT LAMP
Javal Keratometer
HELLOMTZ KERATOMETER
LENSOMETER
TONOMETER
 PUPILOMETER

4 3
5
1
2

Convergence distance selector

2. Convergence distance
3. Mobile reticle control OD
4. Interpupillary distance (IPD)
5. Pupillary distance OD (DNP)
6. Mobile platelets
Frontal support
Measurement of inter-pupillary distances.
. Use the pupillometer well supported on the client's nose.
(as if it were the mount) and in contact with the forehead.

. Proceed to measure each eye with both eyes open.

. In case of double vision, proceed with the measurement in monocular.

using the occluder of the pupillometer.

. Measure the naso-pupillary distances (right and left eye)

in long vision (to infinity).

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 TEST BOX

Portable briefcase with a series of crystals that comprise the possible

refractive corrections, to conduct a visual examination.

Negative spherical lenses (0.25D......20.00D)

2. Positive spherical lenses (0.25D......20.00D)

3. Negative cylindrical lenses (0.25.....6.00D)

4. Positive cylindrical lenses (0.25.....6.00D)

5. Prismatic lenses (1º.....10º)

6. Accessories:

Occluder
Pinhole
Pinhole slit
- x crossed reticulums
R red filter
- G green filter
It's frosted glass
- N neutral lens
M Maddux rod

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 TEST FRAME

It is a frame with rotating rings that allows the optometrist to change

glasses for conducting a vision exam.

Adjustable length rod

2. Controller nut for the inclination of the rod

3. Vertex distance indicator plate

Fixed protractor with scale in degrees

5. Mobile supports capable of holding three lenses

Nut to rotate the mobile support

7. Fixed rear support, with capacity for one lens

8. Millimeter rule to indicate the pupillary distance

Screw to position the DNP

10. Bridge lock nut

11. Screw to raise or lower the glasses

12. Bridge

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 OPTOTYPE CHART
The visual acuity of a person is determined by what we call optotypes. Optotypes are a series of
of panels or cards that the patient must look at from a certain distance, first with one eye and then
with the other. The most commonly used chart or optotype is the Snellen; in it, each line may consist of
numbers, letters or figures (similar to the letters C or E in different positions).

The Snellen chart is a visual acuity chart created by the Dutch ophthalmologist Hermann.
Snellen in the year 1862. After several studies, Snellen came to define good vision as that which
it allows to distinguish patterns of 1' (1 arc minute) of amplitude. To that person who can distinguish
those patterns are commonly said to have a visual acuity (at a distance) of 20/20. It simply means
that at 20 ft, the optotypes of the line marked as 20/20 should be clearly seen.

The Snellen chart exists in various forms and distances. In Great Britain, the metric chart is used.
(6/6), in some European countries, in Japan, and very likely in other countries, the decimal booklet is used.
In the American continent, the imperial system (English, royal, British, etc.) is used, and recently
A chart with logarithmic progression (logMAR 1.0, 0.9, 0.8, 0.7) has been recommended, as
The difference in the size of optotypes between each row compared to the previous one is constant throughout the
leaflet.

The following shows the equivalences between the metric, imperial, decimal, and logarithmic systems.
 In small children, there are other optotypes, generally adapted, which include children's drawings.
to gain their cooperation and be able to determine visual acuity.

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 PROJECTOR
The mission of the optotype projector is to project figures.
standardized to subjectively evaluate the refraction of the eye.

With this method, when using a system of

lighting for the object can be achieved
a good uniformity in the image, being
possible also, to use a large number of
optotypes according to the needs and
demands of the optometrist.

The tests are optotypes of different

sizes, located on circular discs that
rotates by a motor. Attached to the disk of
optotypes are found another disk that contains
rectangular diaphragms and filters. The filters,
red and green each occupy half of the
Optotype, and can be used in any
Diaphragms have the mission of isolating
a horizontal or vertical line of the Optotype.

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 RETINOSCOPE
Optometric instrument for the objective determination of the
refraction of an eye.

The retinoscope consists of the following

elements:
L
1.- Light source B

2.- Condensation system formed

D
through one or more converging lenses

3.- Semitransparent sheet L, which

the purpose is to direct the beam of C
lighting towards the patient's eye,
time that transmits the light that comes from B
of the

4.- Diaphragm for conducting the observation

D

All this set is incorporated within the so-called head. Likewise, the
the instrument has an interchangeable handle on which the source is located
power supply with a rheostat to provide variable power to the source of
lighting.

1. Self-adhesive test for dynamic retinoscopy

2. Mobile remote;

Vertically:

Flat mirror

Concave mirror

Horizontally:

Rotation of the light strip

 TYPES OF RETINOSCOPES

Point Retinoscope:

Use a point filament halogen lamp as a light source.

the lighting system is fixed and does not allow changing the position of the equivalent source,
which is positioned behind the observer just like in the technique of the flat mirror.

Stripe Retinoscope:

The lighting source used is halogen, with a rectangular filament located with
its vertical dimension perpendicular to the optical axis.

RETINSOCOPY

1.- Static retinoscopy: Determines the objective refraction for distance and its results.
they are the starting point for the subjective refractive examination

*DIP far away

Retinoscopic lens

Fixation point: optotype E 20/400 with red/green filter

Recognize types of shadows

Neutralization of spheres

Cylinder neutralization
2.- Dynamic retinoscopy: It objectively measures the accommodative response to the
close working distance. Diagnosis of binocular anomalies and prediction of the
effectiveness of therapeutic forms.

Binocular technique, with near correction, ambient lighting

Place the MEM card (monocular estimation method) on the retinoscope, the
the stripe must be vertical

Ask the patient to read the letters and determine the type of reflex observed.
neutralize it.

3.- Near Mohindra Retinoscopy: Determines the refractive error using the
retinoscope light as a fixation point.

Lighting in the dark, monocular technique, skiascopic rule

Determine the power of each meridian, calculate the result with a negative cylinder.

Add a sphere of -1.25 to the spherical component (Sph -1.25 = empirical constant
defined

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 DIRECT OPHTHALMOSCOPE
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The ophthalmoscope is an instrument, with several lenses and mirrors that illuminates the

interior of the eye through the pupil and lens, allowing the examination of the retina or of
eye fundus. This device has variations in terms of its components, but its
the functioning is based on la reflectionthrough mirrors of a ray of light that goes to the patient. Its
The main application is the observation of the fundus of the eye, although other areas can also be examined.

the rest of the ocular structures, from the eyelids and the anterior segment of the eye to
the intraocular media and the retina. It has several lenses that the explorer uses
changing depending on the structure of the eye that is to be examined and lto precisionwith
he who wants to see the back of the eye.

Front support rubber

2. Visor
3. Disc for lens selection
4. Power reading window
Power button
6. Optical mirror system
7. Accessory disc
8. Battery body
9. Polarizing filter
7. Accessory disk
7.1 Rectangular diaphragm: For detecting different levels of depth.
7.2 Fixation opening: For the determination of eccentric fixation.
7.3 Cobalt blue filter: Used with fluorescein allowing the observation of lesions.

7.4 Large opening: Standard opening for a general examination with dilated pupil.
7.5 Small aperture: Provides a wide field of view with undilated pupil.
7.6 Anerita Filter: For greater contrast and visualization of the vessels.
OPENINGS OF THE OPHTHALMOSCOPE.

OPENINGS AND FILTERS:

Small opening: facilitates the view of the fundus in non-dilated pupils; thus avoiding the
reflection of the beam of light on the pupillary edge.

Large opening: for eyes with dilated pupils and examination of the ocular structures
previous.
Fixing opening: it has two lines crossed perpendicularly, which allows a
easy diagnosis of eccentric fixation if when making the patient look at the point where
the lines cross, this does not fall directly on the spot.
Notch opening: helps to determine levels in lesions, particularly tumors.
papilledema.
Cobalt filter: if a drop of fluorescein is instilled on the ocular surface, it is possible
evaluate lesions of the external structures of the eye.
Light highlights the spectrum by eliminating the red from the beam.
structures, mainly vascular ones. It can also be used with all types of
opening
Polarizing Filter: decreases abnormal corneal reflections

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 INDIRECT OPHTHALMOSCOPE
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Use a light source directed into the patient's eye through a mirror.
adjustable, whereby the reflected light is gathered by a condenser lens (generally
of a power of +20 diopters or +28) to form an inverted real image of the retina. It has
the advantages of providing high-intensity lighting (the fundus exam can be assessed)
even through murky optical media), stereoscopic vision and a wide field of view, as well as
allow a dynamic assessment of vitreoretinal pathology. Its disadvantages are that the
the image is inverted and its handling requires skill.

The image of the fundus corresponds, in reverse, to the real position of the
anatomical elements. In this way, what is seen above is actually located below, and what
it is seen to the right, it is located to the left. On the other hand, it presents the advantage that the field of

Visualization is much broader than with direct ophthalmoscopy.

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 Phoropter
It is a complex lens portal instrument that allows
streamline the process for perform refraction easily
visual.
External Part:
The phoropter is a symmetrical instrument with respect to the axis
vertical, formed by two movable bodies that contain disks of
glasses and necessary accessories to carry out the graduation of each
eye. The separation between the openings can be varied by which
look at the patient until they match their distance
interpupillary and avoid the prismatic effects that can occur
when using high power lenses. The horizontal alignment of the instrument
it is achieved through a screw and an air bubble
used as a reference test.

At the top, there is a rod 70 cm long.

whose purpose is to position the different tests used in the
close tests. By means of some levers, each body performs
automatically a small convergence turn to maintain
the perpendicularity of each of the visual axes, at the same time that
reduce 2mm from the pupillary distance.

Internal part:

It consists of two disks for spherical lenses, two for

the cylindrical ones and another where the accessories are immersed. The
the position of these discs within each body of the phoropter is the
next:
The disc 1, or closest to the eye, is the one that contains the
accessory elements, The disks 2 and 3, located in position
intermediate, contain spherical lenses. Discs 4 and 5, located in
the outermost part contains the cylindrical lenses that
they present along with the cylindrical power reading disc.
 9. Control handle of the cylinder shaft
Leveling handle
10 Power control of the cylinder
2. Level
11. Quick power selection wheel
3. Interpupillary distance scale
spherical
4. Interpupillary distance adjustment control
12. Auxiliary lens control handle
5. Convergence lever

Device for the placement of the 13. in

stopover Spherical
VP power control ring

7. Crossed cylinder 14. Power lens reading window

Rotary prism spherical

9. Control handle of the cylinder axis 15. Reading window of the cylindrical power

10. Power control remote cylinderAccommodation of auxiliary lenses

17. Front support adjustment control

 Rotary prism belonging to the OI Crossed cylinder

Auxiliary lenses of the phoropter

CONTROL HANDSET FOR AUXILIARY LENSES

O: Open opening GL Green filter

Occluder RMH: Horizontal red Maddox rod
+/-.50 : Crossed cylinder of 0.50 RMV: Maddox red vertical rod
6 prism diopters of superior base WMH: Horizontal white Maddox rod
10 / I: 10 prismatic diopters with a lower base WMV: Vertical white Maddox rod
Pinhole P135º: Polarizing filter, axis 135º
+0.12 : Auxiliary lens of +0.12 D P45º Polarizing filter, 45º axis
RL: Red filter R : Retinoscopic lens, +2.00 D

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 SLOTTED LAMP
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It is a low-power microscope combined with a high light source.

intensity, it is used to examine the external ocular structures and the segment
anterior part of the eye. Necessary for evaluating the adaptation of Contact Lenses

Lamp holders 2. Longitudinal millimetric control of the slit

3. Filter changing device 4. Adjustment of the groove width
5. Angle tilt spring 6. Biomicroscope
7. Magnification change selector 8. Bright Fixation Point
Hruby lens 10. Lifting and focus adjustment device
Transformer and electrical controls 12. Eye height leveler

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 Javal keratometer

Mirrors of the Javal keratometer

Javal keratometer scales

Keratometer readings
2. Scale of measurement of corneal meridians (2a degrees, 2b radius and power)
3. Fixation point
4. Ocular
5. Rotating crank of the astigmatism axis
6. Visual Leveler
Chin support
8. Chin support lift control
9. Occluder
10. Focus adjustment
11. Vertical lift control
12. Eye height mark

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 HELmhOltz KERATOMETER
It is used to determine the curvature, power, and toricity of the cornea, and the
integrity of the corneal surface. Essential for the adaptation of lenses
contact.

Occluder

2. Scale of degrees of the meridians

3. Scale of radii and powers

horizontal

4. Chin lift

5. Adjustment of the instrument height

6. Blocker

7. Approach

Chin support

9. Occluder

MIRROR OF THE KERATOMETER

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 LENSOMETER
The lensometer helps us measure the power of a lens. The lensometer helps us
allows the determination of:

The effective power of positive or negative spherical lenses.

The power of cylindrical lenses
The axis of the cylinders
The prismatic power
The optical center of a lens
The power of addition

Internal parts:
. Reticle for focusing and determining the prismatic power (located within the
ocular

. Perpendicular rays to measure the power

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 TONOMETER
The tonometer is used to measure the degree of tension that has been reached.
sclera and the cornea as a consequence of the ocular pressure to which they are subjected.
From that level of tension, we deduce the value of the force being received. It is about,
therefore, from an indirect measurement of the IOP.

The methods for clinical determination of intraocular pressure are:

a. Digital tonometry.

b. Indentation tonometry.

c. Applanation tonometry.

d. Non-contact or electronic tonometry.

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