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Spectacle ! " #
prescription
Richa Naik

Aug. 27, 2016 • 52 likes • 9,805 views

$ % 23 of 43 & '

how to spectacle prescribe to myope and

hypermetrope..astgmatic person..di"
materials of specs
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! Spectacle prescription
1. Dr. Richa Naik
2. How to prescribe a spectacle to a person?? • Step 1: •
Objective refraction 1. Retinoscopy 2. Auto
refractometer 3. Photorefraction 4. Electrophysiological
method • Step 2 : • Subjective refraction.
3. Myope
4. Myopia upto 6D : in children <8 years of age…. 1.
full correction 2.Constantly wearing of glasses to avoid
developing squinting and to enhance developing
accommodation Always undercorrect myopes.
Always advise the patient to choose the lens that
makes the letter more clear and not the one which
makes the letter smaller and darker. in case of
exophoria minus correction can be given.
5. in adults <30 years…full correction in adults >30
years…not able to tolerate full correction over 3D
High myopia > 10D undercorrection is always better
to avoid problem of near vision and that of minification
of images.
6. Pseudomyopia
7. Cycloplegic refraction(atropine or HA) • If tendency
for accommodative spasm - Cycloplegic drops - Plus
over correction Increase accommodative facility by
exercise
8. Hypermetropia
9. Cycloplegic refraction is must. • If manifest error is
small..i.e. 1D or small, correction is given only if the
patient is symptomatic. • Children <4 years- accept full
cycloplegic correction once a child reaches school age,
reduce the plus lenses to 1/3 of refractive prescription(
but child is not allowed to accommodate more than
2.5D) Older children- may not accept full correction so
1st undercorrect and gradually increase the spherical
correction at 6 month interval till he accepts manifest
hypermetropia.
10. If there is associated exophoria undercorrection
for about 1-2 D In the presence of accommodative
convergent squint, full correction at 1st sitting
Remember_ hypermetropia may diminish with
growth of child..so refraction should be carried out
every 6 months. Try to give manifest correction for
adults.
11. Astigmatism
12. • Adult- 1st time diagnosed • Try optimal correction •
Undercorrection is acceptable with maintaining the
spherical equivalent • Rotate axis towards 90 & 180 •
Check binocular vision • Check one or both axis to be
parallel • adult- already astigmatic • It can be due to
change in power • - see pts comfort • -may require
undercorrection • Axis- try to maintain previous one • -
see binocular vision
13. Astigmatic dial technique Fog the eye( to relax
accommodation) with enough plus lenses by creating
compound myopic astigmatism. Patient is asked to
identify darkest and sharpest line.. Minus cylinder
added perpendicular to that axis Rule of 30 Switch
to distance vision chart and reduce plus lenses
14. Astigmatic fan test Add plus lens Refer the
patient to the fan chart and ask which line or group of
lines appear clearest & darkest Directing attention to
the maddox arrow Directing attention to the blocks
15. fogging Place enough PLUS lenses to FOG vision
to ~6/12 line Slowly reduce the plus power until best
VA is obtained Remember: “Maximum plus power for
best visual acuity”
16. Duochrome test Based on chromatic aberration
Green letters clearer = Add ‘+ 0.25DS’ Red letters
clearer = Add ‘- 0.25DS’ End-point is obtained when
the letters on the RedGreen chart appears equally dark
or when a reversal occurs.
17. Pin hole test Pin hole is put in front a!er
correction if patient is improving than our prescribed
lens is undercorrected.
18. JCC used to determine the cylindrical axis and the
cylindrical power for the patient.
19. Binocular Balancing The technique is also known
as "equalising". During the monocular refraction, a
di"erent state of relaxation of accommodation may
occur because one eye was under test while the other
was not. Thus, binocular balancing is performed to
balance between eyes. 1. Fogging and Alternate
occlusion method 2.Duochrome test with fogging 3.
Prism dissociation method
20. Presbyopia
21. The amount of presbyopic correction can be
calculated if the remaining amplitude of
accommodation(for his near point) is determined and
his working distance is specified. i.e. A emmetropic
patient has remaining amplitude of accommodation
3D(near point 33cm). In order to achieve comfortable
near vision he must keep one third of this in
reserve….so he must use only 2D. If he wishes to see 25
cm clearly he needs 4D of accommodation n so
requires 2D of presbyopic correction.
22. Spectacle for presbyopics Bifocals 1. Franklin split
bifocals 2.Franklin cemented bifocals 3. Fused 4.Double
segment 5.Solid Trifocals Progressive
23. Franklin split bifocal lens Earliest design A
distance lens whose flat bottom abuts the flat top of a
separate near lens.
24. Franklin cemented bifocals Near portion is
constructed by attaching supplementary lens to the
surface of a distance lens of same RI. Ulraviolet cured
epoxy resin used as adhesive. Almost obsolete.
25. Fused bifocals 2 di"erent material is used…button
is of flint glass and main lens is of crown glass.
Advantage- inconspicuous dividing line, mechanical
stability and low cost Disadvantage- chromatic
aberrations
26. Solid(executive) bifocal Single piece construction
Near addition is produced by a di"erent curvature of
either- back or front surface Full width horizontal
junction i.e.Plastic bifocals
27. Double segment(trifocal) Close work above eye
level i.e. librarian, electrician and painter Fused as
well as 1 piece
28. Progressive lens Power of lenses change gradually
between the distance and near zones. No visible
interface between zones. 2 types 1. Hard 2.So!
(newer)
29. Types of lenses Flat lenses 1. Biconcave or
biconvex 2.Plano-concave or plano- convex Curved
lenses 1. Meniscus lens 2.Toric lens 3. Lenticular lens
4.Apheric lens
30. Meniscus lens Base curve -semifinished lens Base
curve is added to anterior surface and optician grinds
its other surface to get required power deep meniscus
lens Periscopic lens
31. Lenticular lenses Used for high power Central
portion – power – aperture – 30mm Peripheral
portion – carrier – 1.2-2 mm thinner than central part
Reduce the weight of spectacle and aberrations
32. Toric lens Where one surface is spherical and other
surface is toroidal. What is toroidal surface? if we
visualise a cylinder its one axis is curved while other is
straight which is the axis of cylinder…now straight axis
is also curved then surface will become toroidal.
Spherical lens is ground on anterior surface and
posterior surface is made toroidal Base curve used 6D
Di"erence between base curve and curvature of toric
surface equals the cylindrical power
33. Aspheric lenses used to make high plus aphakic
lenses by modifying the lens curvature peripherally to
reduce aberration and provide better peripheral vision
Base curve for aphakic lens is relatively flat.
34. Lens material Polycarbonate lens
Photochromatic lens High index lens Polarised
lens Tinted lens Trivex lens Anti reflective coating
lens Yellow filter
35. Polycarbonate lenses These lenses are impact-
resistant and are a good choice for people who
regularly participate in sporting activities, work in a job
environment in which their glasses may be easily
scratched or broken for children who may easily drop
and scratch their glasses. Polycarbonate lenses
provide ultraviolet protection.
36. High index lenses Designed for people who
require high power prescriptions, these lenses are
lighter and thinner than the standard thick lenses that
may otherwise be needed.
37. Polarised lenses Light reflected from water or a
flat surface can cause unwanted glare. Polarised lenses
reduce glare and are useful for sport and driving.
38. Photochromatic lenses Made from either glass or
plastic, these glasses change from clear to tinted when
exposed to sunlight. This eliminates the need for
prescription sunglasses. These lenses may not darken
in a car because the windscreen could block the
ultraviolet rays from the sun.
39. Tinted lens Decreases transmittance Done when
patient is uncomfortable in bright lights or exposed to
UV radiation Transmittance level Uses 75-80% Indoor
uses 20-25% Mountain climbing , flying 20% sunglasses
40. Trivex lenses Made from a newer plastic with
similar characteristics of polycarbonate lenses. It is
light weight, thin and impact-resistant and may result
in better vision correction in some people than
polycarbonate lenses. Anti reflective coating glasses for
IR copper and gold coating reflect approximately 98%
of IR above 750 nm Yellow filters Shooter’s glasses It
increases contrast for longer wavelength objects
viewed against shorter wavelength background
41. THANK YOU

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