clinical refraction procedure presented by t.muthuramalingam
TRANSCRIPT
Clinical Refraction Procedure
Presented by
T.Muthuramalingam
Introduction
It is a combination of adequate examination and correction of vision .
According to eye care system clinical refraction is used to described the process of measuring a patients refractive error and determining the optical correction needed to provide patients with clear vision.
History taking Usually the optometry history should included
the following:- Chief complaint History of comfort ness with glass.
( if any) Family history of ocular disorder
(myopic , blindness,squint) Occupation
General Information Are essential facts that should be noted Include patient Name,Address,Age and
occupation Any allergy to drugs
Complaints related with vision Chief complaint should be noted first for which
patients has come to hospital. Vision related complaints can be pain ,loss of vision,
eye fatigue and blurred vision. For all these question ask the duration, date of
unset,sudden or gradual loss.
History of using glass
Duration of glass used. About of type of lens(glass or plastics) Present problem with glass(if any) Note the condition of glass like frame
alignment, scratches in lens etc.
Preliminary eye examination It is done to record any gross abnormality by using
torch light Position and size of eye balls and orbital socket. Position and size of eye lids and its margins and
lashes. Surface of cornea, its shape,size, opacities. Position and color of Iris. Ocular movement. Pupillary action, size-dilated or not dilated. Lens clear or opacity,aphakia or pseudophakia.
Preliminary vision assessment
It is done for finding out the existing vision . Check vision monocularly unaided and aided. Make sure whether patients is comfortable with
present glass or not. Decide whether the refraction is needed or not
Objective refraction It is done by streak retinoscope To determine objectively the actual refractive error
of patients. It is done monocularly by trial lens method It include following steps
Positioning and alignment of patients. Maintained the proper working distance Observing the retinal reflex (with or against movement. Finding the neutrality point using the appropriate lens.
Indication for Auto refraction
One who suspected to have high power in retinoscopy
The uncooperative patients while doing retinoscopy
One who comes for glass first time particularly children
All astigmatic patients having above 1D cylinder
Subjective refraction
Verification of findings obtained from retinoscopy with patients.
Always proceed the subjective refraction monocularly and also check the binocular comfortness.
Confirm the unaided vision first and proceed the lens accordingly
Find out the spherical improvement first to avoid unwanted cylinder
Add cylinder to correct the remaining. Apply supplementary test to confirm the final prescription
Indication of Cycloplegic refraction
All hypropes having the age group. One who complains of Asthenopic symptoms. Who come for glass for first time Accommodation is abnormally active.
Near vision assessment The near vision test is preferably done at 40cm by aging
method It is done with distance vision correction that is with
patients emmetropic level. Determine the correction depend upon the comfortness,
working distance, visual need of patients along with aging method.
Always check the unaided improvement first to find better correction. E.g. if pt’s with good reading speed indicates the under
correction.
.
Prescription writing
It should be clearly written regarding the sign and cylinder axis.
Transpose the prescription with plus cylinder to provide comfortness to patients.
Measure and write the IPD properly. Mention the advice given to patients
regarding lens design.
Advice to patient
Advice properly Instruct the patients how to use the glass
(dist. Near,constantly) Counsel the patients about the difficulties and
limitation of lenses. E.g: slow adaptation in PAL, jumping effect in
bifocal.
Instruction to optician
Recommended only flat top bifocal for constant uses.
Advice only the plastics lens for safety reasons specially for children.