21 VISUAL TEST

VT#1: OPHTHALMOSCOPY
PURPOSE:
 To determine the presence or absence of pathological or structural conditions, which would either
prevent the attainment of or indicate the potential loss of normal vision. If evidence of pathology if
found, the patient must be referred to the proper practitioner for proper diagnosis and treatment.
 Since the eye is part of the brain, neurological retinal structure visible may reflect developments which
are simultaneously occurring in the cranium.
 Many systematic diseases exhibit phenomenon in the ocular fundus which confirm or indicate the
existence of the general disorder.
 Approximation of the refractive state of the eye.
 Detect the presence of opacity (seen as shadow cast on the fundus)

INSTRUMENT USED: Ophthalmoscope

TARGET DISTANCE: 20/200 Snellen Chart
LENSES IN PLACE: None
TEST DISTANCE : 20ft
ILLUMINATION : Dim
INTENSITY OF ILLUMINATION : Mimimum
INDIRECT OPHTHALMOSCOPY: use +10.00 to +20.00 D sph lens
THINGS TO BE OBSERVED : disc, macula, blood vessels, fundus background
NORMAL FINDINGS : Cup disc ratio - 0.3 to 0.5
Foveal reflex - sharp/clear
A/V ratio - 2:3
Macula - NSF/normal
Vessels - normal
Vitreous - NSF/normal
Venous pulsation - present
Periphery - NSF/normal

PROCEDURES
DIRECT:
1. The method of examination is OD and OS.
2. To examine the right eye, the ophthalmoscope is held in the right hand with the index finger in the proper
position to turn the lens wheel attached to the eyepiece of the instrument and views with his right eye. Similarly,
to examine the left eye, the instrument is held by the left hand and the left eye is used for observation.
3. When peeping through the right eye of patient, use your right eye to observe and vice versa.
4. At a distance approximately 20” (arms length) and patient is looking at 20/200 of Snellen Chart, look for a
red-orange reflex and or the presence of any opacities which is seen black.
5. Then slowly move forward as close as possible to the patient’s eye to observe the interior part of the eye.
6. By starting the maximum plus, slowly reduce plus until you reach the clearest possible image that you can
observe.
7. Observe the four important landmarks in the fundus: OPTIC DISC, VESSELS, MACULAR AREA,
FUNDUS BACKGROUND.

INDIRECT:
1. Same procedure as in direct method, but with the use of high plus (+) sphere lens (+10.00D-+20.00D.
2. By placing the lens in front of one eye, observe the eye 20” distance (arms length).
VT#2: KERATOMETRY / OPHTHALMOMETRY
PURPOSE
 An objective method of determining the corneal curvature, the amount and direction of regular corneal
astigmatism.
 Determining the nature of the corneal refracting surface and the presence of any irregular astigmatism in
patients who have corneal abnormalities/injuries.
 Measures the base curve of the contact lens.
 Determine the nature of anisometropia.
 Evaluating the following cases / determining the ocular refraction / quality of refraction:
a. Stability of the corneal refracting surface in progressive myopia, keratoconus, other degenerative
anomalies affecting the cornea.
b. Are to be fitted with contact lenses and following the wear of contact lens.
c. Cataract / opacities in the ocular media.
d. Following cataract extraction, radial keratotomy, keratoplasty, epikeratophakia and other corneal
surgery
e. Poor retinoscopic reflex / aphakia / high ametropia.
f. Can’t manifest reaction during refraction.

INSTRUMENT : Keratometer / Ophthalmometer

LENSES IN PLACE : None
ILLUMINATION : Dim
NORMAL FINDINGS: 43 to 44N; 90º apart meridians
EXCESSIVE CURVATURE MYOPIA (steep): decrease base curve
LESS CURVATURE HYPEROPIA (flat) : increase base curve
WITH THE RULE: 0-30; 150-180
AGAINST THE RULE: 60-120
OBLIQUE : 31-59; 121-149

JAVAL’S RULE:
WITH THE RULE : decrease by 0.50D
AGAINST THE RULE : increase by 0.50D
OBLIQUE : physiologic astigmatism is ignored

PROCEDURE:
1.From outside the instrument, roughly align the barrel with the patient’s eye by raising or lowering the
instrument and by moving it to the left or right until a reflection of the mires is seen on the patient’s cornea.
2.Instruct the patient to look at the reflection of his own eye in the keratometer barrel.
3.Look into the keratometer and refine the alignment of the image of the mires on the patient’s cornea.
4.Focus the mires and adjust the instrument so that the reticle is centered in the lower right hand circle.
5.Lock the instrument in place. Adjust the horizontal and vertical power wheels until the mires are in close
apposition.
6.To locate the 2 principal meridians of the patient’s cornea, rotate the telescope until the 2 horizontal spurs on
the mires are perfectly continuous with one another.
7.Adjust the horizontal power wheel until the horizontal mires are coincident.
8.Adjust the vertical power wheel until the vertical mires are coincident.
9.If the corneal astigmatism is irregular, the 2 principal meridians will not be 90º apart. The examiner must
readjust the barrel of the instrument to align the horizontal components of the mires before adjusting the power
wheel.
10.Observe the integrity of the cornea by observing the condition of the mires
RECORDING:
1.Record for each eye separately.
2.Record for the power and the meridian for the horizontal meridian first.
3.Write a slash mark after the primary meridian and record the power and meridian for the vertical meridian.
4.Record for the amount of corneal astigmatism in diopters.
5.Record the type of astigmatism:
WR - with the rule (more power in the vertical meridian)
AR - against the rule (more power in the horizontal meridian)
OBL - oblique
Irregular - the two principal meridians are not 90º apart
6.Record the conditions of the mires:
NORMAL: mires are clear and regular
ABNORMAL: mires are irregular and distorted
Example:
OD 43.00 x 95º / 44.00 x 5 º
-1.00 D x 5 º WR (corneal astigmatism)
OD 41.75 x 180º / 43.75 x 90 º
-6.00 D x 90 º AR (corneal astigmatism)

VT#3: HABITUAL PHORIA AT FAR

 Measures the magnitude of the deviation present with the old correction or without any correction in
place (objective angle of deviation/corneal reflex).
 Measures the subjective angle deviation and compared to the objective angle of deviation.
 Helps/directs in the optical management of patient.
 By suspending convergence, it allows the examiner to see the presence of muscular imbalance.
 Determine the status of accommodation and convergence (they should be equal).

TEST DISTANCE : 6m or 20ft

TEST TARGET : 20/20 of Snellen (one line above the best line)
LENSES IN PLACE : Habitual distance correction / Plano
P.D. ADJUSTMENT : P.D. at far
PRISM IN PLACE: 6 prism Base Up (BU) over OS (Dissociating prism)
12 prism Base In (BI) over OD (measuring prism)
ILLUMINATION : Target should be well illuminated/bright/normal-20ft candle
ENDPOINT : Vertical alignment of targets
EXPECTED VALUE : ½ Exophoria
RECORDING : 0 (zero) - orthophoria
BI remaining – exophoria ( compensation test VT9 &VT10)
BO remaining – esophoria (compensation test VT11)
 BI^ in VT3: inhibition of convergence.

PROCEDURE: (take first the patient’s P.D)

1.Place habitual correction or plano.
2.The patient is directed to observe the distant fixation target.
3.Adjust the phoropter properly to the patient’s eye.
4.You can occlude the eye when the prisms are placed or you can position one prism first, then the other.
Normally, the dissociating prism 96^ BU) and place to the left eye. (non-dominant eye)
5.Instruct the patient what he will see when the prisms are placed. Patient is told to close his eyes and the prisms
are positioned. OS: 6 prism BU; OD: 12 prism BI.
6.Place the 12^BI to the right eye (dominant eye), then slowly adjusting the BI^ towards zero until vertical
alignment is obtained.
VT#4: STATIC RETINOSCOPY
PURPOSE
 It is used to determine the error of refraction objectively. (accurate in determining error of refraction)
 Useful for infants, illiterate and uncooperative patients.
 Confirming the subjective finding.

INSTRUMENT USED: Retinoscope

TEST DISTANCE : Patient’s fixation distance – 20ft
WORKING DISTANCE : 20 inches
TEST TARGET : Biggest letter of the Snellen Chart
LENSES IN PLACE : Start from plano
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Dim
NEUTRALIZING LENS : (+) lens if with reflex movement;
(-) lens if against reflex movement
ENDPOINT : Neutrality
 Accommodation is inhibited.

PROCEDURE: (done binocularly)

1.The method of examination is OD and OS.
2.When peeping through the right eye of the patient, use your right eye and vice versa.
3.At an arms length distance (20”) and the patient is looking at the biggest letter on the Snellen chart, look for
the reflex.
4.Observe the initial movement in the 2 primary meridians by rotating the focusing sleeve, moving right-left or
up-down, depending on the meridian you are observing or the position of the streak.
5.Use a plano mirror as apparent source of light.
6.Place sphere lenses depending on the initial movement.
a.With initial movement, place (+) lens in 0.25D steps
b.Against initial movement, place (-) lens in 0.25D steps
7.If the eye is sphere, both meridians will be neutralized with the same LIP.
8.If the eye has an astigmatism:
a.If initial movement is with-with: neutralize first the slowest “with”
b.If initial movement is vs-vs: neutralize first the fastest “vs”
c.If initial movement is with-vs: neutralize first the “with”
9.After neutralizing one meridian, neutralize the other meridian by placing (-) cylinder lens to the other
meridian starting at -0.25D sphere and axis is placed to the first neutralized meridian.
10.Record your findings as your gross of VT#4.
11.Compute for the net of VT#4.
COMPUTATION: Gross of VT#4 – (+2.00D sph) = Net of VT#4
12. After computation, letthe patient use the net prescription.

VT#5: DYNAMIC RETINOSCOPY AT 20”

PURPOSE
 To get the ADD correction or near correction.

INSTRUMENT USED: Retinoscope

TEST DISTANCE : Patient’s fixation distance – 20 inches
WORKING DISTANCE : 20 inches
TEST TARGET : Retinoscope head or near the retinoscope head
LENSES IN PLACE : Gross of VT#4
P.D. ADJUSTMENT : P.D. at near
ILLUMINATION : Dim
NEUTRALIZING LENS : Add (+) lens to gross of VT#4 if the initial movement seen is “with”
Add (-) lens to gross of VT#4 if the initial movement seen is “against”
ENDPOINT : Neutrality

PROCEDURE:
1.With gross of VT#4 in place, patient is instructed to fixate at the target near the retinoscope or at the
retinoscope head.
2.Observe the movement of the 2 primary meridians by moving the rotating sleeve right-left and up-down
depending n the meridian you are observing.
3.Use plano mirror as apparent source of light.
4.Place sphere lenses depending on the initial movement:
a. With initial movement, place (+) lens in 0.25D steps
b. Against initial movement, place (-) lens in 0.25D steps
5.If the eye is sphere, both meridians will be neutralized with the same LIP.
6.If the eye as astigmatism:
a. If initial movement is with-with: neutralize first the slowest “with”
b. If initial movement is vs-vs: neutralize first the fastest “vs”
c. If initial movement is with-vs: neutralize first the “with”
7.After neutralizing one meridian, neutralize the other meridian by placing (-) cylinder lens to the other
meridian starting at -0.25D sphere and axis is placed to the first neutralized meridian.
8.Record your findings as your gross of VT#5.

VT#6: DYNAMIC RETINOSCOPY AT 40”

PURPOSE
 To get the INTERMEDIATE distance correction.

TEST DISTANCE : Patient’s fixation distance – 40 inches

WORKING DISTANCE : 40 inches
TEST TARGET : Retinoscope head or near the retinoscope head
LENSES IN PLACE : Gross of VT#5
ILLUMINATION : Dim
NEUTRALIZING LENS : Add (+) lens to gross of VT#5 if the initial movement seen is “with”;
Add (-) lens to gross of VT#5 if the initial movement seen is “against”
ENDPOINT : Neutrality

PROCEDURE:
1.With gross of VT#5 in place, patient is instructed to fixate at the target near the retinoscope or at the
retinoscope head.
2.Observe the movement of the 2 primary meridians by moving the rotating sleeve right-left and up-down
depending n the meridian you are observing.
3.Use plano mirror as apparent source of light.
4.Place sphere lenses depending on the initial movement:
a. With initial movement, place (+) lens in 0.25D steps
b. Against initial movement, place (-) lens in 0.25D steps
5.If the eye is sphere, both meridians will be neutralized with the same LIP.
6.If the eye as astigmatism:
a. If initial movement is with-with: neutralize first the slowest “with”
b. If initial movement is vs-vs: neutralize first the fastest “vs”
c. If initial movement is with-vs: neutralize first the “with”
7.After neutralizing one meridian, neutralize the other meridian by placing (-) cylinder lens to the other
meridian starting at -0.25D sphere and axis is placed to the first neutralized meridian.
8.Record your findings as your gross of VT#6
VT#7: SUBJECTIVE REFRACTION/DRY MANIFEST REFRACTION
PURPOSE:
DISTANCE SUBJECTIVE ROUTINE
 To determine the refractive status of the eye by subjective criteria usually in the form of responses from
the patient to the changes in the lens power relative to appearance of the letters in the test chart.
 It may be used by itself or in comparison with the objective data to provide the patient with a
prescription for corrective lenses.
 May serve as a starting point for such a prescription to be followed by modification.
 May provide a basis for other visual performance tests.
 May prove valuable as a diagnostic indication of ocular disease.

DYNAMIC SUBJECTIVE ROUTINE

 Determining the subjective state of the eye when accommodation is stimulated.
 Done with patient who are hyperope, high myope and presbyope.
 Only done monocularly if patient is antimetropic or strabismus.

DISTANCE SUBJECTIVE ROUTINE

INSTRUMENTS : Phoropter / trial case, Jackson cross-cylinder
TARGET : Snellen Chart
TEST DISTANCE : 20ft
ILLUMINATION : Target should be illuminated
P.D. ADJUSTMENT : P.D. at far
ENDPOINT : Final prescription

PROCEDURE:
1.Fogging technique – to blur out
-Patient is instructed to look at far or at the best line.
a. Then place plus (+) sphere lens, in a +0.25D sph steps until biggest letter (20/200) is totally blur.
- When patient is subnormal, place +1.00D sph to confirm refractive status of the eye. If patient is
subnormally hyperope, more (+) lens is needed. But if patient is subnormally myope, fogging is no
longer needed proceed to unfogging.
b. +2.00D sphere may be place as sudden fog. * unfogging- use minus lens until patient sees best line as
clear
c. Place gross of VT#4

Rules in changing lenses:

(+) lens: place lens before removing previous lens
(-) lens: remove previous lens before placing new lens

2.Unfogging technique – Reduce (+) lens slowly, +0.25D sphere until vision reaches its best line (strongest
plus)
3.Proper fog / Sphere used to fog- place +0.50D sph
4.Determination of astigmatism – letting patient fixate on the fan dial to see if the lines are equally clear.
a. If equally clear, eye is spherical.
b. If not equally clear, eye is astigmatism.
 Ask patient where is the darkest line then get the middle as your power meridian.
 Place (-) cylinder lens, axis opposite to the darkest line (90degrees away).
 (-)0.25D cyl steps until lines are equally clear.
5.Remove the proper fog (+0.50D sph)
6.Refining the cylinder axis – add -0.50D sphere
Jackson cross cylinder: handle parallel to the axis (if cylinder amount is less than 1.00D)
Bracketing method: if cylinder is greater than 1.00D
7. Checking and finalizing cylinder axis and power
Target: one line above the best line
CHECK AXIS:
a. Jackson’s Cross Cylinder Method
 Handle parallel to the axis.
 Flip the cross cylinder and ask the patient which of the two is clearer. If both are the same
in darkness, your axis is correct.
 If patient response is not equal, ask patient which is clearer then rotate correcting cylinder
towards the red dot by 5/10/15degrees.
b. Bracketing Method
 Rotate correcting cylinder clockwise from original position until patient reports blur, take
note of displacement.
 If displacement is the same, your axis is correct.
 If not the same, add two displacement and then divide it by two, the answer is the final
cylinder axis.
 Check again.
CHECK AMOUNT:
Cross cylinder:
Position 1 – red dot parallel to the axis;
clearer – under correct – increase (-) cylinder lens
Position 2 – white dot parallel to the axis;
Clearer – over correct – decrease (-) cylinder lens
 If position 1 is clearer, increase (-) cylinder lens from correction because it signifies
under correction.
 If position 2 is clearer, decrease (-) cylinder lens because it signifies over correction.
 Rule still applies that for every -0.50 cylinder change, add or subtract +0.25D sphere.
8.Remove -0.50D sphere
9.Checking and finalizing the sphere (duochrome – bichrome test)
- Use Douchrome/Bichrome/red-green test
- Dim illumination
- Patient is directed to look at the Verhoeff’s ring which is placed in the 20/40 letters.
- Done monocularly and place +0.50D sphere.
- Ask patient if rings are equally clear, if equally clear, sphere correction is correct. If not equally
clear,
a. Red is clearer (RIM)- increase minus sphere or decrease plus sphere until equally clear.
b. Green is clearer (GRIM)- increase plus sphere or decrease minus sphere lens, until equally clear.
c. If there is no equally clear, leave green clearer.
10.Final prescription
 Simple Myopic Astigmatism: plano = (-) cylinder
 Compound Myopic Astigmatism: (-) sphere = (-) cylinder
 Simple Hyperopic Astigmatism: (+) sphere = (-) cylinder (same amount)
 Compound Hyperopic Astigmatism: (+) sphere = (-) cylinder (greater + sphere; low cylinder)
 Mixed Astigmatism: (+) sphere = (-) cylinder (low + sphere; low – cylinder

DYNAMIC SUBJECTIVE ROUTINE:

1. Before performing this test, ask the patient of essential things that would be useful for you to make
adjustment on giving your prescription for near such as age, occupation and visual requirement.
2. Place near target.
3. With subjective distance correction in place, let patient read the target until his best line.
 4. By adding sufficient plus lens on distance correction (start from +1.0), let the patient read the target until
patient can read J3, you can stop there or you may go further depending on the visual requirement of
patient.
5. In some cases, you may get the reading range,
a. From 16”, move target closer until first blur.
b. Again, from 16”, move target further until first blur.
c. Record both findings as your reading range.
6. Reading range is done after you’ve got the tentative add. With increase +0.25D sphere from tentative
add and get the reading range; decrease +0.25D sphere of tentative add and get the reading range.
7. You may choose from the 3 reading range with its corresponding amount, that will be your final
prescription (depending on the visual requirements of the patient.)

STEPS:
1. Fog – blur out
Rules in changing lenses:
(+) lens: place lens before removing previous lens
(-) lens: remove previous lens before placing new lens
2. Unfog – best line (strongest plus)
3. Proper fog/Sphere used to fog – (+0.50D)
4. Determination of astigmatism – place fan dial
- Determination of cylinder axis – axis opposite the darkest line.
- Determination of cylinder amount – place (-) cylinder lens (-0.25D cyl steps)
 every 0.50D cylinder change, add 0.25D in the spherical component.
 give the weakest (-) cylinder.
5. Remove proper fog.
6. Refining the Cylinder Axis- add (-0.50D)
 Jackson cross cylinder: handle parallel to the axis (if cylinder amount is less than 1.00D)
 Bracketing method: if cylinder is greater than 1.00D
7. Refining Cylinder amount- still with (-0.50D sph) in place.
 Target: one line above best line.
 Cross Cylinder: position 1: red dot parallel to the axis: clearer-under correct- increase (-) cylinder
lens.
 Cross Cylinder: position 2: white dot parallel to the axis: clearer-over correct- decrease (-)
cylinder lens.
8. Remove -0.50D sphere.
9. Finalizing the sphere (douchrome/bichrome test.
 Illumination: dim
 Monocularly and placing +0.50
 Target: Verhoeff’s Ring / 20/40letters
 Patient’s response: Red (RIM)- increase Minus
Green (GRIP)- increase plus

ENDPOINT: Final Prescription

1. Simple Myopic Astigmatism: Plano = (-) cylinder
2. Compound Myopic Astigmatism: (-) Cyl (same amount)
3. Simple Hyperopic Astigmatism: (+) sph = (-) cyl (greater +sph, low -cyl), increase sphere, decrease
cylinder.
4. Mixed Astigmatism: (-) sph = (-) cylinder (low + sph, greater-cyl)
DYNAMIC SUBJECTIVE ROUTINE
LENSES IN PLACE: VT7 (distance)
TARGET: Jaeger’s Card (isolated)
TEST DISTANCE: 16”
ILLUMINATION: Bright
P.D ADJUSTMENT: at near
ENDPOINT: Total Near Correction

VT#8: INDUCED PHORIA AT FAR

PURPOSE
 Measure the magnitude of the deviation present with new correction in place.
 Measures the subjective angle and compared to the objective angle of deviation.
 Helps/directs in the optical management of patient.
 By suspending convergence, it allows the examiner to see the presence of muscular imbalance.
 Determine the status of accommodation and convergence (they should be equal.)
 To find out if the balance between accommodation and convergence has been restored.

TEST DISTANCE : 20ft or 6m

PRISM IN PLACE : 6 BU over OS (Dissociating prism/device)
12 BI over OD (Measuring prism/device)
TEST TARGET : 20/20 (one line above) best line Snellen Chart- Line 8
LENSES IN PLACE : VT#7 – Subjective findings
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Target should be illuminated, 20ft candle
ENDPOINT : Vertical alignment of targets
EXPECTED VALUE : Exophoria (1/2 exo – normal limit)
RECORDING : 0 - orthophoria
BI remaining - exophoria (compensation test VT#9&10)
BO remaining - esophoria (compensation test VT#11)
 BI prism in VT8: inhibition of convergence.

PROCEDURE:
1.Place VT#7 in place.
2.Instruct the patient to fixate at a target located at 20ft.
3.Place the prisms before the patient’s eye.
4.Reduce the amount of BI prism until the two targets become vertically aligned.

VT#9: TRUE ADDUCTION AT FAR

PURPOSE
 Compensating duction for exophoria at far.
 Determine the quality of patient’s binocular vision.
 Measures the amount of available convergence at far without the influence of accommodation.
 Blur determines the flexibility between accommodation and convergence.
 To determine the available convergence at far.

TEST DISTANCE : 20ft

TEST TARGET : 20/20 of Snellen / smallest readable
LENSES IN PLACE : VT#7 Subjective findings
PRISMS IN PLACE : Prisms ready to turn BO (should be both at zero)
AUXILLARY LENS : +0.25D sph to demonstrate blur (slight)
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Target should be well illuminated
ENDPOINT : Blurring (same to +0.25D blur)
EXPECTED VALUE : 7 – 9
 BO^ in VT(: Stimulation of convergence

PROCEDURE:
1.Place VT#7 as lenses in place.
2.Patient is instructed to look at far target.
3.Place first +0.25D sphere to demonstrate blur.
4.Remove auxillary lens and position the prisms ready to turn BO.
5.Prisms are then turned BO and ask the patient to indicated when the same blur already occurs.
6.The amount of prism, which has the same blurring effect, as the +0.25D above the subjective finding, is the
true adduction at far.

VT#10: CONVERGENCE AT FAR

PURPOSE
 It is the compensating duction for exophoria at far.
 Determines the quality of patient’s binocular vision.
 Measures the patient’s fusion amplitude/vergence amplitude.
 Measures the amount of available convergence at far with the influence of accommodation
 Measures the patient’s fusion amplitude/vergence amplitude.
 Break – determines the quality of binocular fusion function; measures vergence amplitude;
signifies that there is diplopia. (image are on non-corresponding retinal points)
 Recovery – determines any minimal or subtle change on binocular vision function; measures the
size of the Panum’s area

TEST DISTANCE : 20ft

TEST TARGET : 20/20 of Snellen / smallest readable
LENSES IN PLACE : VT#7 – Subjective findings
PRISMS IN PLACE : VT#9 findings or OU ready to turn BO simultaneously.
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Target should be well illuminated
ENDPOINT : Break
RECORDING : Break / Recovery (19/10 - recovery must be 1/2 of the break)
 BO6- stimulation of convergence- accommodation

PROCEDURE:
1.As soon as the target blurs and the amount of the prism have been recorded, continue turning the prism BO,
until the patient reports that the target is double, this is break test.
2.Decrease the amount of BO prism until the patient states that the target becomes single already. This is the
recovery test.
3.Add the 2 amounts of prism for both eyes (break and break, recovery and recovery) for recording.
4.Two answers will be recorded for this test, in the form of fraction (break/recovery). If the prism were able to
break the base in position, the recovery reading would be in negative form.

VT#11: ABDUCTION AT FAR

PURPOSE
 Compensating duction for esophoria at far.
 Measures the limit of negative vergence.
 To know if the visual pattern is organized to compensate phoria.
TEST DISTANCE : 20ft
TEST TARGET : 20/20 of Snellen / smallest readable
LENSES IN PLACE : VT#7 – Subjective findings
PRISMS IN PLACE : Ready to turn BI
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Target should be well illuminated
ENDPOINT : Recovery
EXPECTED VALUE : 9 / 5
RECORDING : Break / Recovery

PROCEDURE:
1.Place VT#7 as lenses in place.
2.Patient is instructed to look at a far target.
3.Place prisms ready to turn BI.
4.Ask the patient to report when the target becomes double (break).
5.Decrease the prism base in amount until the target becomes single (recovery).
6.Two answers will be recorded for this test, in the form of fraction (break/recovery). If the prism were able to
reach the BO position, the recovery would be in negative form.

VT#12: VERTICAL PHORIA & DUCTION AT FAR

PURPOSE
 To determine the muscular imbalance and binocular vision problem (present or absent).
 Determine the relative vertical position of the visual axis of the eye at distance when fusion has been
broken.
 To know the integration between accommodation and convergence pattern/status.
 To measure vertical phoria where convergence is suspended and no accommodation is present.
 Determine vertical alignment when fusion has broken.`

TEST DISTANCE : 20ft

TEST TARGET : 20/20 (one line above) best line of Snellen / smallest readable
LENSES IN PLACE : VT#7 – Subjective findings
PRISM IN PLACE : 12 prism BI over OD (Dissociating prism device)
6 prism BU over OS (Measuring device)
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Target should be well illuminated
ENDPOINT : Horizontal alignment of targets
EXPECTED VALUE : Orthophoria
RECORDING : BU remaining – right hyperphoria for OD; left hypophoria for OS
BD remaining – right hypophoria for OD; left hyperphoria for OS

PROCEDURE:
PHORIA PART: BINOCULARLY
1.Place VT#7 in place.
2.Patient fixates at a far target.
3.Adjust the phoropter at the patient’s eye.
4. Instruct the patient what he will see when the prisms are placed.
5. 12 prism BI over OD; 6 prism BU over OS; then slowly rotate 6 prism BU towards zero.

VT#12: VERTICAL PHORIA & DUCTION AT FAR

DUCTION
PURPOSE
  Measure the strength of SR and IR muscles. The strength of the muscle is greater than the
amount of prism reflected on the phoropter head. The strength of the muscle is not the break
value.

TEST DISTANCE : 20ft

TEST TARGET : 20/20 of Snellen / smallest readable
LENSES IN PLACE : VT#7 – Subjective findings
PRISMS IN PLACE : Ready to turn BU and BD (OU)
P.D. ADJUSTMENT : P.D. at far
ILLUMINATION : Target should be well illuminated
ENDPOINT : Break
EXPECTED VALUE : Orthophoria
RECORDING : OD: Right supra BD break/recovery
Right infra BU break/recovery
OS: Left supra BD break/recovery
Left infra BU break/recovery
Break – measures the limit of fusional movement and fusional vergence
Recovery – measures the height of panum’s area vertically - should be 0

PROCEDURE: DUCTION PART: MONOCULARLY

1. Position the prism to both eyes (at zero) ready to turn BU or BD.
2. Patient still fixates at far target.
3. The patient still fixating on the Snellen and BD prism is introduced before patient’s OD. Patient
should report as soon as the target is seen double. This is then recorded as break.
4. Reduce the amount of prism BD until patient reports single image, this is recovery value. And
recorded as break over recovery which is the right supraduction value.
5. Back to zero value, BU prism is introduced before OD. Ask the patient when the target becomes
double. This is then recorded as break.
6. Reduce the amount of BU prism until patient reports single image. This is the recovery value and
recorded as break over recovery, which is the right infraduction value.
7. Back to the zero value, do the same to the other eye.

VT#13a: HABITUAL PHORIA AT NEAR

PURPOSE
 Measures the magnitude of the deviation present with the correction or without any correction in
place (objective angle of deviation).
 Helps/directs in the optical management of patient.
 Determine the status of accommodation and convergence (as they should be equal).
 Difference between VT3 and 13a
a) Accommodation is stimulated in 13a, relax in VT3.
b) Discrepancy in amount of measuring prism is increased.
c) Convergence is stimulated.
d) Test target.
 Magnitude of phoria present (6 prism is normal)

TEST DISTANCE: 16" or 40cm.

TEST TARGET: 16/20 or Reduced Snellen (isolated vertical targets)
LENSES IN PLACE: Habitual near correction
PRISM IN PLACE: 6 prism BU over OS (Dissociating device)
: 15 prism BI over OD (measuring device)
P.D. ADJUSTMENT: P.D. at near
ILLUMINATION: Target should be well illuminated/bright/20ft candle
ENDPOINT: Vertical alignment of targets
EXPECTED VALUE: Exophoria - 6 exo (normal limit)
RECORDING: 0 (zero) - orthophoria
BI remaining - exophoria
(compensation test VT# 16a and 16b)
BO remaining - esophoria
(compensation test VT# 17a and 17b
 BI prism in VT13a: inhibition of convergence

PROCEDURE: Get patient’s P.D first

(BINOCULARLY)
1. Place habitual near correction.
2. Patient fixating at near target
3. Place prisms before the patient’s eye.
4. You can occlude the eye when prisms are being positioned or you can position one prism first, normally
the dissociating prism (6^ BU) and place to the left eye. (non-dominant eye)
5. Instruct patient what he will see when prism is placed.
6. Place the 12prism BI to the right eye (dominant eye), then slowly adjusting the BI prism towards zero
until vertical alignment is obtained.

VT#13b: HABITUAL PHORIA AT NEAR

PURPOSE
 Measures the magnitude of the deviation present with the correction in place.
 Measures the subjective angle and compared to the objective angle of deviation.
 Helps/directs in the optical management of patient.
 By suspending convergence, it allows the examiner to see the presence of muscular imbalance.
 Determine the status of accommodation and convergence (they should be equal).
 To find out if the balance between accommodation and convergence has been restored at near.

TEST DISTANCE: 16" or arm length

TEST TARGET: 16/20 or Reduced Snellen (isolated vertical targets)
LENSES IN PLACE: Habitual near correction
15 prism BI over OD (Measuring device)
P.D. ADJUSTMENT: P.D. at near
ILLUMINATION: Target should be well illuminated/bright/20ft candle
ENDPOINT: Vertical alignment of targets
EXPECTED VALUE: Exophoria - 6 exo (normal limit)
RECORDING: 0 (zero) - orthophoria
BI remaining - exophoria
(compensation test VT# 16a and 16b)
BO remaining - esophoria
(compensation test VT# 17a and 17b
 BI prism in VT13b: inhibition of convergence

PROCEDURE:
1. Place VT7/ habitual near correction.
2. Patient fixating at near target.
3. Adjust the phoropter to the patient’s eye.
4. You can occlude the eye when prisms are being positioned or you can position one prism first, normally
the dissociating prism (6^ BU) and place to the left eye. (non-dominant eye)
5. Instruct patient what he will see when prism is placed.
 6. Place the 12prism BI to the right eye (dominant eye), then slowly adjusting the BI prism towards zero
until vertical alignment is obtained or until two targets become vertically aligned.

VT#14 A: DISSOCIATED CROSS CYLINDER/UNFUSED CROSS CYLINDER/MONOCULAR

CROSS CYLINDER
PURPOSE:
 To know if the patient is accommodating 2.50D and to know if there is lag of accommodation.
 To recheck the cylinder correction/accuracy of cylinder correction for near.
 To check whether binocular balance for distance correction is correct.
 To check binocular refraction.
 To check cylinder correction and determination of reading add.

TEST DISTANCE : 16 inches

TEST TARGET : cross grid
LENSES IN PLACE : VT 7-subjective findings
P.D. ADJUSTMENT : P.D. at near
PRISMS IN PLACE. : 3 prism BU OS
3 prism BD OD
AUXILLARY DEVICE: cross cylinders (0.50D) with red dot at 90 before each eye
ILLUMINATION: Part 1: bright/20 ft candle
Part 2: dim/ 2 ft candle
ENDPOINT: Equality of lines (monocularly)
Part 1: Equality or vertical lines darker.
Part 2: Equality (addition of +sph)
 If horizontal lines are darker, add plus lens.
 If vertical lines are darker, decrease plus lenses
 If equality can’t be achieved, leave vertical line darker.
RECORDING: Lenses in place upon equality in part 2.
AUXILLARY DEVICE: Cross cylinder (0.50D)-the red dot at 90degrees.
 +sphere inhibition of accommodation.

PROCEDURE:
(MONOCULARLY)
 If you use prism, do part 1 for each eye, before doing part2 for each eye.
 If you use an occluder, do part 1 and 2 for one eye before you proceed to the other eye.
PART 1: Bright Illumination/20ft candle
1. Patient is to fixated at the near target.
2. Place 3^ BU over OS and 3^BD over OD/you may occlude on eye, the patient will report the presence
of 2 grid targets, one higher than the other. The higher image is for OD, the lower image is for OS.
3. Prism in place, instruct patient to fixate at upper image-cross grid.
4. Patient is asked if lines are equally clear and black in the upper target and in the lower target
a. If the astigmatic correction is correct, the patient should report that vertical and horizontal lines
are EQUALLY clear and black, now proceed to part 2.
b. If patient reports UNEQUALITY, ask patient which is darker:
b.1. VERTICAL LINES DARKER
For axis 180o- increase (-) cylinder until equal, and then proceed to part 2.
For axis 90o- decrease (-) cylinder until equal, and then proceed to part 2.
b.2. HORIZONTAL LINES DARKER:
For axis 180o- decrease (-) cylinder until equal, and then proceed to part 2.
For axis 90o- increase (-) cylinder until equal, and then proceed to part 2.
  Stop when equality is obtained. If equality is not obtained, record the lenses, which leaves the
vertical lines darker.
5. Be sure that the lines are equally dark before proceeding to part 2.

PART 2: Dim Illumination: 20ft candle

1. Patient still fixating at near target.
2. Place Jackson’s Cross Cylinder, red dot at 90degrees then ask patient if the lines are equally clear.
3. Whatever the response (equally clear, vertically clear or horizontally clear), increase (+) lens sphere
until equality, then further increase (+) until vertical lines are clear, then reduce (+) lens until equality
(always get the highest plus.
 Plus sphere (0.25) is now added before each eye until the patient reports the vertical lines darker
and blacker in both the upper and lower target
 Plus sphere is now slowly reduced in 0.25D steps until equality of the lines is obtained for each
target.
4. If equality of lines is impossible, record the total lenses in place that leave the vertical lines darker

VT#14 B: Fused Cross Cylinder

PURPOSE:
 To find the tentative add for presbyope.
 Use to evaluate the accommodative posture of patient by viewing a near target under binocular
condition.
 Contribute to functional analysis when over or under accommodation is suspected.

TEST DISTANCE : 16 inches

TEST TARGET : cross grid
LENSES IN PLACE : 14a (dissociated cross cyl) findings
P.D. ADJUSTMENT : P.D. at near
AUXILLARY DEVICE : cross cylinders (0.50D) with red dot at 90 before each eye
ILLUMINATION : dim
ENDPOINT : Horizontal alignment of targets
Equality (Binocularly)- Reduce (+) Sphere
No equality – Leave Horizontal line Darker.
 If horizontal lines are darker- add plus (+) lens.
 If vertical lines are darker- decrease plus (+) lens.
 If equality is impossible- leave the horizontal lines darker.
RECORDING : Lenses in place upon equality.
 No prism in 14B because it is fused.

 (+) Sphere inhibition of accommodation.

PROCEDURE:
1. Remove prism/occluder or any dissociating device. 2 ft candles illumination, cylinder still in place.
2. Jackson’s cross cylinder in place binocularly, red dot at 90degrees; with same near target.
3. We ask the patient if equally clear to compare the horizontal and vertical lines and to report which lines
are the darkest.
4. Reduce plus lens until equality. Sufficient plus spheres should be added for the patient to report vertical
lines darker. Gradually decrease plus until the patient reports horizontal line darker
5. If no equality, leave horizontal lines darker.
6. If equally clear, that means that 14a is your 14b. To confirm, reduce plus lens.
7. Total lens in place are recorded as fused cross cyl test.

SIGNIFICANCE:
 1. To determine the amount of accommodation free of convergence at near under fused condition
binocularly.
2. Measure the degree embedding of visual problem.
3. Control lens for near point testing in the presence of low amplitude.

VT#15a: INDUCED PHORIA THROUGH UNFUSED CROSSED CYLINDER

 Determine the effect of phoria upon the dissociated cross cylinder findings.

TEST DISTANCE : 16 inches or arms length

TEST TARGET : cross grid
LENSES IN PLACE : VT#14a- dissociated cross cyl findings
PRISM IN PLACE: 6^ BU-OS (Dissociating prism)
15^ BI-OD (Measuring Prism)
P.D. ADJUSTMENT : P.D. at near
ILLUMINATION : normal
ENDPOINT : Vertical alignment of targets
RECORDING : 0 (zero) - orthophoria
BI remaining - exophoria
BO remaining - esophoria

 BI prism in VT15A: inhibition of convergence.

PROCEDURES: (BINOCULARLY)
1. Place VT#14A finding as your lens in place.
2. Patient is instructed to fixate at the near target.
3. You can occlude the eye when prisms are being positioned or you can position one prism first, normally
the dissociating prism (6^ BU) and place to the left eye. (non-dominant eye).
4. Instruct patient what he will see when prism is placed. Patient reports presence of two targets, one
higher than the other.
5. Place the 15^ BI to the right eye (dominant eye), then by slowly adjusting the BI^ towards zero until
vertical alignment is obtained.

VT#15b: INDUCED PHORIA THROUGH FUSED CROSSED CYLINDER

PUROSE:
 Determine the type of phoria at near after the associated cross cylinder test.

TEST DISTANCE : 16 inches or arms length

TEST TARGET : 16/20 of Reduced Snellen (isolated vertical terget)
LENSES IN PLACE : VT#14- associated cross cyl findings
PRISM IN PLACE : 6 prism BU over OS (dissociating prism)
15 prism BI over OS (measuring prism)
P.D. ADJUSTMENT : P.D. at near
ILLUMINATION : normal
ENDPOINT : Vertical alignment of targets
RECORDING : 0 (zero) - orthophoria
BI remaining - exophoria
BO remaining – esophoria
 BI^ in VT#15a: inhibition of convergence.

PROCEDURES: (BINOCULARLY)
1. Place 14b findings as your lens in place. Cross cylinder remains.
2. Patient is to fixate at near target.
 3. You can occlude the eye when prisms are being positioned or you can position one prism first, normally
the dissociating prism (6^ BU) and place to the left eye. (non-dominant eye)
4. Instruct patient what he will see when prism is in placed. Patient reports presence of two targets, one
higher than the other.
5. Place the 15^ BI to the right eye (Dominant eye), then by slowly adjusting the BI^ towards zero until
vertical alignment is obtained.

VT#16a: POSITIVE RELATIVE CONVERGENCE

PURPOSE:
 To determine the effect of positive relative convergence upon refractive condition of the patient.
 Compensating duction at near in case VT#13b is exophoric higher than 6 exophoria.
 Probe convergence with accommodation fix.
 Measures the ability of MR (medial rectus) contraction (amount of prism than the actual amount of
contraction of the MR.

TEST DISTANCE : 16” or Arms length

TEST TARGET : 16/20 of Reduced Snellen (Isolated Vertical Test Target)
LENSES IN PLACE: Myope-habitual correction
Hyperope/ Emmetrope – VT7
Presbyope- Net of VT#14b/TNC
PRISMS IN PLACE: Ready to turn BO.
P.D ADJUSTMENT: P.D. at near
ILLUMINATION : Normal
EXPECTED VALUE: 15
ENDPOINT : Blurring/Blur-out
RECORDING : Prism in place when blur-out
 BO^ in VT16a: convergence is stimulated.

PROCEDURE: (BINOCULARLY)
1. With selected lens in place, patient is instructed to look near the target.
2. Place prisms ready to turn BO.
3. Increase gradually the amount of BO (binocularly with the same speed) until the blur out point is
reached.
4. The total amount of BO positioned before both eyes is recorded as the positive relative convergence.

SIGNIFICANCE:
1. To measure the ability of the patient to tolerate the movement of convergence towards the plane of
regards.
2. Determine the total amount of convergence.

VT#16b: POSITIVE FUSIONAL RESERVE

PURPOSE:
 Additional fusional movement to maintain SBV, to keep image on corresponding retinal points.
 Break- to place on non-corresponding retinal points, diplopia exists.
Recovery- fusional movement is initiated to place image again on corresponding retinal points.

TEST DISTANCE : 16” or Arms length

TEST TARGET : 16/20 of Reduced Snellen (Isolated Vertical Test Target)
LENSES IN PLACE : Myope- habitual correction
Hyperope/Emmetrope- VT#7
Presbyope- net of VT#14B
PRISMS IN PLACE : VT#16a Findings
P.D ADJUSTMENT : P.D. at near
ILLUMINATION : Normal
ENDPOINT : Break
RECORDING : Break/ Recovery
Break- to place the image on non-corresponding points; diplopia to exist.
Recovery- initial movement initiated to place image again on corresponding retinal points
EXPECTED VALUE: 21/15

PROCEDURE:
1. VT#16a findings in place.
2. Continue turning BO prisms binocularly until image becomes double.
3. Total amount of prisms is recorded as break.
4. Reduced amount of prism
5. Ask the patient to indicate if a single image is obtained. The total amount of prism in place is recorded
as recovery.
6. Two answers will be recorded for this test, in the form of fraction (break/recovery). If the prism were
able to reach the BI position, the reading would be in negative form.

VT#17a: NEGATIVE RELATIVE CONVERGENCE

PURPOSE:
 To determine the limit of fusional convergence at near.
 To measure the ability of patient to tolerate the movement of convergence away from the patient while
accommodation is at the plane of regard.
 Blurring is seen because image is outside the fovea but still on corresponding retinal points.

TEST DISTANCE : 16” or Arms length

TEST TARGET : 16/20 of Reduced Snellen (Isolated Vertical Test Target)
LENSES IN PLACE : Myope- habitual correction
Hyperope/Emmetrope- VT#7
Presbyope- net of VT#14B
PRISMS IN PLACE : Ready to turn BI
P.D ADJUSTMENT : P.D. at near
ILLUMINATION : Normal
ENDPOINT : Blurring
EXPECTED VALUE: 14
RECORDING : Prism in place when blur-out.
 BI^ in VT#17a: Convergence is inhibited.

PROCEDURE: (BINOCULARLY)
1. With selected lens in place, patient is instructed to look near the target.
2. Place prism ready to turn BO.
3. Increase gradually the amount of BO (binocularly with the same speed) until the blur out point is reached.
4. The total amount of BO positioned before both eyes is recorded as the positive relative convergence.

VT#17b: NEGATIVE FUSIONAL RESERVE

PURPOSE:
 To determine the amount of tolerance, where the eyes can still maintain single binocular vision (SBV)
 Break- image of non-dominant eye is on non-corresponding retinal points.
-no fusional movement when diplopia is experienced by the patient
Recovery- fusional movement is initiated to recover single binocular vision (SBV).
TEST DISTANCE : 16” or arms length
TEST TARGET : 16/20 of reduced Snellen (isolated vertical test target)
LENSES IN PLACE : Myope- habitual correction
Hyperope/Emmetrope- VT#7
Presbyope- net of VT#14B

P.D ADJUSTMENT : PD at near

ILLUMINATION : Normal
EXPECTED VALUE: 22/18
ENDPOINT : Break
RECORDING : Break/ Recovery
 BI^ in VT#17B: convergence is inhibited
 Whatever is the prism findings, divide it into 2 for the 2 eyes in the prescription.

PROCEDURES: (BINOCULARLY)
1. With VT#17a findings in place, further increase BI until target is seen double.
2. Reduce the amount of BI slowly and equally before each eye.
3. Two answers will be recorded for this test, break and recovery. If prisms were able to reach the BO position,
the readings will be in negative form.

VT18: VERTICAL PHORIA & DUCTION AT NEAR

PURPOSE:
PHORIA PART:
 Determine the muscular imbalance and binocular vision problem (present or absent).
 Determine the relative vertical position of the visual axis of the eye at near when fusion has been
broken.
 To know the integration between accommodation and convergence pattern/status.
 To measure vertical phoria where convergence is suspended and no accommodation is present.
 Determine vertical alignment when fusion has broken.

TEST DISTANCE : 16” or arm length

TEST TARGET : 16/20, (one line above) best line reduced Snellen (horizontal isolated target)
LENSES IN PLACE : VT#7- Subjective findings / TNC
PRISM IN PLACE :15prism BI over OD (dissociating device/prism)
:16prism BU over OS (measuring device/prism)
P.D ADJUSTMENT : P.D at near
ILLUMINATION : Target should be well illuminated.
EXPECTED VALUE : Orthophoria
ENDPOINT : Horizontal alignment of target.
RECORDING : BU remaining- right hyperphoria for OD
Left hyperphoria for OS
BD remaining- right hypophoria for OD
Left hypophoria for OS

PHORIA PART: BINOCULARLY

PROCEDURE:
1. Place VT#7/TNC as lens in place.
2. Patient fixates at near target.
3. Adjust the phoropter at the patient’s eye. Instruct the patient what he will see when the prisms are placed.
4. 15 prism BI over OD; 6prism BU over OS; then slowly rotate 6 prism BU towards zero.

DUCTION PART: MONOCULARLY

PURPOSE:
 Measure the strength of SE and IR muscle ( the strength of the muscle is greater than the amount of
prism reflected on the phoropter head). The strength of the muscle is not the break value.

PRISMS IN PLACE : Ready to turn BU and BD (OU)

TEST TARGET :16/20, (one line above) best line reduced Snellen (horizontal isolated target)
EXPECTED VALUE : Orthoprhoria
ENDPOINT : BD Break
RECORDING : OD: right supra BD break/recovery
Right infra BU break/recovery

OS: Left supra BU break/recovery

Left infra BU break/recovery

PROCEDURE:
1. Position the prism to both eyes (a zero) ready to turn BU and BD.
2. Patient is still fixated at near target on the reduced Snellen and BD prism is introduced before patient’s OD.
Patient should report as soon as the target is seen as double. This then is recorded as break.
3. Reduce the amount of prism BD until patient reports the single image, this is recovery value, and recorded as
break over recovery which is the right supraduction value.
4. Back to zero value. BU prism is produced before OD. Ask the patient when target becomes double. This is
then recorded as break.
5. Reduce the amount of BU prism until patient reports single image. This is the recovery value and recorded as
break over recovery, which is the right infraduction value.
6. Back to zero value, do the same to the other eye.

VT#19: AMPLITUDE OF ACCOMMODATION

PURPOSE:
 Measures the protection of accommodation pattern brought about by senility or advancing age.
 Determination of ADD or near correction.

TEST DISTANCE : 13 inches

TEST TARGET : J3 or 62 of Jaeger’s Card
LENSES IN PLACE : NON-PRESBYOPE -VT#7 (subjective finding)- minus sphere added until print
is difficult to read.
PRESBYOPE- NET OF VT#14B/TNC- plus sphere added until clear
P.D ADJUSTMENT : P.D at near
ILLUMINATION : Normal/bright
ENDPOINT : Total blur (unable to recognize any letter)
NON-PRESBYOPE: increase (-) lens until total blur
PRESBYOPE: increase (+) lens until total blur.

COMPUTATION:
Total Blur (VT#19) minus Lens in Place=_______minus working distance=_______no sign for final answer
but Diopter.

 (-) Sph: accommodation is stimulated.

PROCEDURE: (BINOCULARLY)
1. Instruct patient to read near target.
2. If patient is non-presbyope, increase minus (-) sphere until total bur/difficult to read.
3. If patient is presbyope, increase plus (+) sphere until total blur/difficult to read.
4. Record it by subtracting gross of VT#19 from VT#7 and dioptric working distance (2.50).

 Remove prisms or both eyes. VT#7 remains.

 .62M in in the Jeager’s Chart (read) – 16” away.

VT#20: POSITIVE RELATIVE ACCOMMODATION

PURPOSE:
 Determine the amount of accommodation that can be stimulated without the change in convergence at
16”.
 Increase of accommodation in excess of that can normally demanded for a given binocular fixation
distance with convergence constant.
 Changes in accommodation that can be elicited when convergence is held constant.
 Probe accommodation with convergence fix.
 Interaction between accommodation and convergence. (Negative Relative Convergence)
 Finding the reserve or range of accommodation.

LENSES IN PLACE : Myope- habitual minus correction (habitual minus at near)

Non-presbyope/ Hyperope/ Emmetrope – VT#7
Presbyope- net of 14B
TARGET :20/20 of Reduced Snellen (Isolated horizontal target)
TEST DISTANCE : 16” or 40cm or arm length
ILLUMINATION : bright/normal
P.D ADJUSTMENT : P.D at near
ENDPOINT : First sustained blur (by increasing minus lens)
EXPECTED VALUE : -2.25 to -2.50
RECORDING : First Blur (total blur) of best VA or RSTC in 20/20, it must be blurred.
 (-) Sphere accommodation is stimulated.

PROCEDURES: (BINOCULARLY)
1. Instruct patient to fixate at near target. (done binocularly)
2. Increase minus (-0.25D steps) lens until first sustained blur is achieved by patient.
3. Record finding as your positive relative accommodation.
 For emmetrope: put minus sphere until reduced Snellen blurs. Record amount of minus about the control
lenses in place.

Total Lens in Place

-
Subjective findings
PRA

Ex: -2.00D
-
+1.00D__
+3.00D

VT#21: NEGATIVE RELATIVE ACCOMMODATION

PURPOSE:
 Relaxation and reduction of accommodation below the normally demanded for a given binocular
fixation distance.
 Determine the amount of accommodation that can be relax without change in accommodation.
 Changes in accommodation that can be elicited when convergence is held constant.
 Probe accommodation with convergence fix.
  Interaction between accommodation and convergence. (Positive Relative Convergence)
 Finding the reserve or range of accommodation.

LENSES IN PLACE : Myope- habitual correction

Non-presbyope/hyperope/Emmetrope- VT#7-Subjective Finding/TNC
Presbyope- Net of 14B
TEST TARGET : 20/20 Reduced Snellen (isolated horizontal target)
TEST DISTANCE : 16” or arm length
ILLUMINATION : Normal/Bright
P.D ADJUSTMENT : P.D at near
ENDPOINT : First sustained blur (by increasing plus (+) lens)
EXPECTED VALUE : +1.75 to +2.00 or higher
RECORDING : First blur
 (+) sphere accommodation is inhibited.

PROCEDURES:
1. Instruct patient to fixate at near object.
2. Increase plus (+0.25D steps) lens until first sustained blur is achieved by patient. - Use plus lens.
3. Record findings as your negative relative accommodation.
Ex: #7- +0.50, #21-+4.00

NRA= +4.00 – (+0.50)

= +3.50- total reading add