4. in case of Welsch Allen retinoscope
when the lens is pushed down the
mirror acts like a plane mirror and the
rays are divergent.
Plane Mirror Retinoscopy
5. When the lens is pushed up the mirror
acts like a concave mirror so the rays are
convergent.
Practical importance : in plane mirror
retinoscopy a with movement will need +
lenses but in concave mirror retinoscopy
a with movement will need – lenses.
Concave Mirror Retinoscopy
13. Break :
Width : Narrowest when
allingned with true axis
Intensity : Brightest when
along with true axis
Skew : When axis is not
assigned reflex breaking
into two
14. Low Errors High Errors
Speed High Low
Brilliance Bright Dull
Width Wide Narrow
Neutralization point : complete illumination of entire
pupillary area.
Swirl
15. Checking axis : Swirl
2.00DC @ 80
Add 45 degrees = 125
Minus 45 degrees = 35
Keep the streak at 125 and 35
Note the width : should be equal
Side that is less : change axis
slowly towards wider side.
WAKE UP
16. GROSS NET
Power of lens
that is held in
front of the
examined eye
at which
neutralization
occurs
Following
subtraction of
distance and
cycloplegic
drops
17. Distance Subtraction Cycloplegic
1 mt = 1 D
2/3 mt = 1.50 D
Atropine = -1.00 D
Homatropine = -0.50 D
Cyclopentolate = -0.75 D
Example Distance (lm) Atropine
+6.00 DS +5.00 DS +4.00 DS
18. Few Algebraic rules for signs of Cylinders
- - = + - 6.00 - 4.00 = - 2.00
- + = + - 6.00 + 4.00 = - 10.00
19. Practice Situations
Net + 6.00
+ 4.00
Lower Value = Sphere = +4.00
Difference = Cylinder = +2.00
+ 4.00 - +6.00 = - Sign of cylinder
Axis at lower value = 180°
+ 4.00 DS / -2.00 DC @ 180° Axis
20. Net - 6.00 DS
- 4.00 DS
90° Axis
180° Axis
* Lower value here is – 6.00 DS
The rest is the same
- - = +
- 6.00 DS / +2.00 DC x 90° Axis
21. - 8.00 DS
- 10.00 DS
- 10.00 / +2.00 DC x 180° Axis
Sample Transpositions
- 2.00 DS / -4.00 DC x 180° Axis
1. Allegebric sum of the sphere and cylinder
- 6.00 DS
2. Change the sign of the cylinder
- 6.00 DS / +4.00 DC
3. Change the axis if above 90° = minus 90
if below 90° = add 90
- 6.00 DS / +4.00 DC @ 90 ° Axis
WAKE UP
23. Methods
Easiest : fogging. Over refraction,
over retinoscopy
Duchrome testing
Jackson cross cylinder
Astigmatic dial
Astigmatic fan and block
24. Jackson Cross Cylinder
Components: sphere
Cylinder
Power: ½ that of cylinder
Axis of Cylinder : 2 are
perpendicular to each other
Handle: 45 degrees always.
25. How it works?
Axis first: handle in direction of
the cylinder in the frame already.
Eg) 2.00DC at 180 then keep
handle at 180
Va chart 2 lines above least visible.
eg)6/12 if BCVA is 6/6.
Flip + 0.50 or – in front of patient.
At best vision point, rotate the DC
by 10 degrees towards the red
mark in case of – and towards
white mark in +.
26. E.g.) DC in trial frame= +2.00DC @
180
BCVA CLEAR when +0.50 DC is in
front
Rotate 10 degrees towards white
mark
+2.00 DC@ 170.
27. Power of DC. This is easy.
Keeping the correct axis. Flip the
JC by + or – and then add or
subtract the correct power.
E.g.) DC in trial frame = +2.00,Va
better at +0.50 DC then final
value= +2.50 DC.
If equal Va at 2 flips: correct
power.
How it works?
WAKE UP
28. Summary
Most plus or least minus sphere:
BCVA
Va chart 2 lines above least visible.
eg)6/12 if BCVA is 6/6.
No cylinder, still flip at
90,180,45,135.
Axis first : Why?
Lower powers 0.25 for 20/30 Va
.Flip + 0.50 or 1.00 for lower
30. Duchrome
Normal : both equal
Start with Red slightly better
Focus on the letters
31. Hyperope of +5.00 sees green
better, increase to +5.25 D so sees
red better.
• Increasing the converging power so that
“STRONGEST + LENSES “ are given.
P O
N F
T E
A K
32. Myope: - 5.00D sees red better leave
him alone
-5.00 D sees green then – 4.75 D get
the rays in front.
• “WEAKEST (– )LENSES”
P O
N F
T E
A K
34. Fogging
Indications : Young
: Recurrent Asthenopia
: H/O Squeezing / frowning
: Difficulty in near work
(E.g.) Needle work, Microscope
Reference Chart :
If we start pt +20.00 DS upto +16 D: Decrease in lens in strengths of +2.00 DS
(E.g.) +20.00 D = Next lens + 18.00 DS
+16 D TO +12/10 D: Decrease in strengths of 1.00 DS
(E.g.) +10.00 +9.00 DS, +8.00 etc
Upto (+6.00 DS. From then upto +4.00 DS : +0.50 DS decrease
+5.50, +5.00, +4.50 etc
36. Giving Glasses
Hyperopia
Age
Fogging
Refinement methods
1) Less than 3 years = Full retinoscopic correction
Eg; +4.00 DS = Give + 4.00 DS
2) 3 to 8 years
Presence of tropia
Presence of phoria
Esotropia = Full gross value subjective to AC/A ratio
Phoria = Full net optimal, under correction
Eg. Net Value
+4.00 D in phoria = +3.50 / +3.75 which is accepted
3) Adults follow : rule of strongest +
38. Giving Glasses : MYOPIA
Thumb rules
Normal patients
1) From -1.00 to -6.00 DS : Full correction
2) Above -6.00 DS : Under correct to meet subjectiveness
Esotropia
High presence of -6.00 DS and above are under corrected
meet acceptance followed by optimal to full correction
Exotropia
Over correct in intermittent EXOTROPIAS
39. Giving Glasses : Astigmatism
Normal patients
: In a child less than 3 years = 1.25 DC,
Regular
: Older than 3 years = all astigmatism to
be corrected
• Child : follow-up 6 months
• Adult yearly
• Frequent change : over correct (0.25 D)
WAKE UP
40. Giving glasses: child
Ideal frame: large, sturdy, well
balanced
Ideal lenses: plastic,
polycarbonates
Ideal refraction:
Less than 3 years: solely on
retinoscopy
All strabismus : retinoscopy
Beyond 3 years: myopes do not
need
41. Cycloplegic studies
Rosenbaum and associates: atropine
estimation of hyperopia 0.34 D more
as compared to homatropine
Hurol et al: no difference between 2
and 3 days of cycloplegia
Stolovich: 8 instillations vs 4
instillations.
43. Bifocals
Working distance
0.2 m wide or smallest test
type
Blurred/ not readable = near
point
No doubling
Keep 1/3rd
reserve
44. Tips on bifocals
Keep 1/3rd
reserve
Undercorrect
Full correction 23 mm of near
point max (3.5D)
Prisms for convergence thereafter
45. Practical Tips
Do Don't
Read Previous prescription
Bifocal to progressive
Adjust sphere first
E.g.) +1.25 DS / -0.75 DC
Change to +1.75 to +1.50
Don’t make drastic glass
changes from past
“Suspicion”
progressive to Bifocals
Do not try to change to
higher astigmatism
+1.25 DS / -1.25 DC
46. Practical Tips
Do Don't
4. Try to correct the axis
rather than the number
Eg) -0.75 DC @ 90° Ax
change to -0.75 DC @ 100°
Ax rather than -1.00 DC @
90° Ax
Final Example
-1.25 DS / -0.75 @ 80° Ax
(a) -1.50 DS / -1.75 DS with -0.75 DC @ 80° Ax
(b) -1.25 DS / -0.75 DC @ 90° Ax
(c) -1.25 DS / -1.00 DC @ 80° Ax
-1.50 DS / -1.50 DC @ 80° Ax
47. Make the right choice
Low powers : smile and
bye bye
High plus: think!
Chromatic aberrations
prismatic aberrations
High index lenses:
1.6 and 1.74
Thinner, flatter, lighter
+4.00 D = high index
48. Gets higher : plastic lenticular
lenses
Aspheric lenses : curves that
flatten away from the center.
Prismatic effects
Myopes: higher powers -4.00
above 1.6 high index
49. Power refraction you are now armed
Retinoscopy
Interpretation of numbers
Giving glasses
Refinement of numbers
What not to do