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Comprehensive
OPHTHALMOLOGY
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Comprehensive
A K Khurana
Professor,
Regional Institute of Ophthalmology,
Postgraduate Institute of Medical Sciences,
Rohtak- 124001, India
P R EPREFACE
FACE
Fourth edition of the book has been thoroughly revised, updated, and published in an attractive
colour format. This endeavour has enhanced the lucidity of the figures and overall aesthetics of the
book.
The fast-developing advances in the field of medical sciences and technology has beset the present-
day medical students with voluminous university curriculae. Keeping in view the need of the students
for a ready-made material for their practical examinations and various postgraduate entrance tests,
the book has been expanded into two sections and is accompanied with ‘Review of Ophthalmology’
as a pocket companion, and converted into a comprehensive book.
Section 1: Anatomy, Physiology and Diseases of the Eye. This part of the book includes 20
chapters, 1 each on Anatomy and Physiology of Eye and rest 18 on diseases of the different structures
of the eye.
Section II: Practical Ophthalmology. This section includes chapter on ‘Clinical Methods in
Ophthalmology’ and different other aspects essential to the practical examinations viz. Clinical
Ophthalmic Cases, Darkroom Procedures, and Ophthalmic Instruments.
Review of Ophthalmology: Quick Text Review and Multiple-Choice Questions. This pocket
companion provides an indepth revision of the subject at a glance and an opportunity of self-assessment,
and thus makes it the book of choice for preparing for the various postgraduate entrance examinations.
Salient Features of the Book
Each chapter begins with a brief overview highlighting the topics covered followed by relevant
applied anatomy and physiology. The text is then organized in such a way that the students
can easily understand, retain and reproduce it. Various levels of headings, subheadings, bold
face and italics given in the text will be helpful in a quick revision of the subject.
Text is complete and up-to-date with recent advances such as refractive surgery, manual small
incision cataract surgery (SICS), phacoemulsification, newer diagnostic techniques as well as
newer therapeutics.
To be true, some part of the text is in more detail than the requirement of undergraduate
students. But this very feature of the book makes it a useful handbook for the postgraduate
students.
The text is illustrated with plenty of diagrams. The illustrations mostly include clinical
photographs and clear-line diagrams providing vivid and lucid details.
Operative steps of the important surgical techniques have been given in the relevant chapters.
Wherever possible important information has been given in the form of tables and flowcharts.
An attraction of this edition of the book is a very useful addition of the ‘Practical
Ophthalmology’ section to help the students to prepare for the practical examinations.
(viii)
It would have not been possible for this book to be in its present form without the generous help
of many well wishers and stalwarts in their fields. Surely, I owe sincere thanks to them all. Those
who need special mention are Prof. Inderbir Singh, Ex-HOD, Anatomy, PGIMS, Rohtak, Prof.
R.C. Nagpal, HIMS, Dehradun, Prof. S. Soodan from Jammu, Prof. B. Ghosh, Chief GNEC, New
Delhi, Prof. P.S. Sandhu, GGS Medical College, Faridkot, Prof. S.S. Shergil, GMC, Amritsar, Prof.
R.K. Grewal and Prof. G.S. Bajwa, DMC Ludhiana, Prof. R.N. Bhatnagar, GMC, Patiala, Prof.
V.P. Gupta, UCMS, New Delhi, Prof. K.P. Chaudhary, GMC, Shimla, Prof. S. Sood, GMC,
Chandigarh, Prof. S. Ghosh, Prof. R.V. Azad and Prof. R.B. Vajpayee from Dr. R.P. Centre for
Opthalmic Sciences, New Delhi, and Prof. Anil Chauhan, GMC, Tanda.
I am deeply indebted to Prof. S.P. Garg. Prof. Atul Kumar, Prof. J.S. Tityal, Dr. Mahipal S.
Sachdev, Dr. Ashish Bansal, Dr. T.P. Dass, Dr. A.K. Mandal, Dr. B. Rajeev and Dr. Neeraj
Sanduja for providing the colour photographs.
I am grateful to Prof. C.S. Dhull, Chief and all other faculty members of Regional Institute of
Opthalmology (RIO), PGIMS, Rohtak namely Prof. S.V. Singh, Dr. J.P. Chugh, Dr. R.S. Chauhan,
Dr. Manisha Rathi, Dr. Neebha Anand, Dr. Manisha Nada, Dr. Ashok Rathi, Dr. Urmil Chawla
and Dr. Sumit Sachdeva for their kind co-operation and suggestions rendered by them from time
to time. The help received from all the resident doctors including Dr. Shikha, Dr. Vivek Sharma
and Dr. Nidhi Gupta is duly acknowledged. Dr. Saurabh and Dr. Ashima deserve special thanks
for their artistic touch which I feel has considerably enhanced the presentation of the book. My
sincere thanks are also due to Prof. S.S. Sangwan, Director, PGIMS, Rohtak for providing a working
atmosphere. Of incalculable assistance to me has been my wife Dr. Indu Khurana, Assoc. Prof.
in Physiology, PGIMS, Rohtak. The enthusiastic co-operation received from Mr. Saumya Gupta,
and Mr. R.K. Gupta, Managing Directors, New Age International Publishers (P) Ltd., New Delhi
needs special acknowledgement.
Sincere efforts have been made to verify the correctness of the text. However, in spite of best
efforts, ventures of this kind are not likely to be free from human errors, some inaccuracies,
ambiguities and typographic mistakes. Therefore, all the users are requested to send their feedback
and suggestions. The importance of such views in improving the future editions of the book cannot
be overemphasized. Feedbacks received shall be highly appreciated and duly acknowledged.
Rohtak A K Khurana
(ix)
CONTENTS
CONTENTS
Preface ............................................................................................................................................ vii
VISUAL PATHWAY
Each eyeball acts as a camera; it perceives the images
and relays the sensations to the brain (occipital
cortex) via visual pathway which comprises optic
nerves, optic chiasma, optic tracts, geniculate bodies
and optic radiations (Fig. 1.3).
bony cavity called orbit (Fig. 1.4). Each eyeball is z Visceral mesoderm of maxillary process.
located in the anterior orbit, nearer to the roof and Before going into the development of individual
lateral wall than to the floor and medial wall. Each eye structures, it will be helpful to understand the
is protected anteriorly by two shutters called the formation of optic vesicle, lens placode, optic cup
eyelids. The anterior part of the sclera and posterior and changes in the surrounding mesenchyme, which
surface of lids are lined by a thin membrane called play a major role in the development of the eye and
conjunctiva. For smooth functioning, the cornea and its related structures.
conjunctiva are to be kept moist by tears which are
produced by lacrimal gland and drained by the lacrimal
passages. These structures (eyelids, eyebrows,
conjunctiva and lacrimal apparatus) are collectively
called ‘the appendages of the eye’.
(a neuroectodermal structure),
z Lens placode, a specialised area of surface
Fig. 1.4. Section of the orbital cavity to demonstrate eyeball and its accessory structures.
6 Comprehensive OPHTHALMOLOGY
some distance along the inferior surface of the optic In the posterior part of optic cup the surrounding
stalk and is called the choroidal or fetal fissure fibrous mesenchyme forms sclera and extraocular
(Fig. 1.7). muscles, while the vascular layer forms the choroid
and ciliary body.
DEVELOPMENT OF VARIOUS
OCULAR STRUCTURES
Retina
Retina is developed from the two walls of the optic
cup, namely: (a) nervous retina from the inner wall,
and (b) pigment epithelium from the outer wall
(Fig. 1.10).
(a) Nervous retina. The inner wall of the optic cup is
a single-layered epithelium. It divides into several
layers of cells which differentiate into the following
three layers (as also occurs in neural tube):
Fig. 1.7. Optic cup and stalk seen from below to show
Crystalline lens
The crystalline lens is developed from the surface
ectoderm as below :
Lens placode and lens vesicle formation (see page
5, 6 and Fig. 1.6 .
Primary lens fibres. The cells of posterior wall of
lens vesicle elongate rapidly to form the primary lens
fibres which obliterate the cavity of lens vesicle. The
primary lens fibres are formed upto 3rd month of
gestation and are preserved as the compact core of
lens, known as embryonic nucleus (Fig. 1.11).
Fig. 1.10. Development of the retina. Secondary lens fibres are formed from equatorial cells
of anterior epithelium which remain active through
z Matrix cell layer. Cells of this layer form the rods
out life. Since the secondary lens fibres are laid down
and cones.
concentrically, the lens on section has a laminated
z Mantle layer. Cells of this layer form the
appearance. Depending upon the period of
bipolar cells, ganglion cells, other neurons of
development, the secondary lens fibres are named as
retina and the supporting tissue.
below :
z Marginal layer. This layer forms the ganglion
z Fetal nucleus (3rd to 8th month),
cells, axons of which form the nerve fibre
z Infantile nucleus (last weeks of fetal life to
layer. puberty),
(b) Outer pigment epithelial layer. Cells of the outer z Adult nucleus (after puberty), and
wall of the optic cup become pigmented. Its posterior z Cortex (superficial lens fibres of adult lens)
part forms the pigmented epithelium of retina and the Lens capsule is a true basement membrane produced
anterior part continues forward in ciliary body and by the lens epithelium on its external aspect.
iris as their anterior pigmented epithelium.
Cornea (Fig. 1.9)
Optic nerve 1. Epithelium is formed from the surface ectoderm.
It develops in the framework of optic stalk as 2. Other layers viz. endothelium, Descemet's
below: membrane, stroma and Bowman's layer are derived
from the fibrous layer of mesenchyme lying anterior
z Fibres from the nerve fibre layer of retina grow
to the optic cup (Fig. 1.9).
into optic stalk by passing through the choroidal
fissure and form the optic nerve fibres. Sclera
z The neuroectodermal cells forming the walls of Sclera is developed from the fibrous layer of
optic stalk develop into glial system of the nerve. mesenchyme surrounding the optic cup (corres-
z The fibrous septa of the optic nerve are ponding to dura of CNS) (Fig. 1.9).
developed from the vascular layer of mesenchyme
Choroid
which invades the nerve at 3rd fetal month.
It is derived from the inner vascular layer of
z Sheaths of optic nerve are formed from the layers
mesenchyme that surrounds the optic cup (Fig. 1.9).
of mesenchyme like meninges of other parts of
central nervous system. Ciliary body
z Myelination of nerve fibres takes place from z The two layers of epithelium of ciliary body
brain distally and reaches the lamina cribrosa just develop from the anterior part of the two layers
before birth and stops there. In some cases, this of optic cup (neuroectodermal).
extends up to around the optic disc and presents z Stroma of ciliary body, ciliary muscle and blood
as congenital opaque nerve fibres. These develop vessels are developed from the vascular layer of
after birth. mesenchyme surrounding the optic cup (Fig. 1.9).
ANATOMY AND DEVELOPMENT OF THE EYE 9
Vitreous
1. Primary or primitive vitreous is mesenchymal in
origin and is a vascular structure having the
hyaloid system of vessels.
2. Secondary or definitive or vitreous proper is
secreted by neuroectoderm of optic cup. This is
an avascular structure. When this vitreous fills
the cavity, primitive vitreous with hyaloid vessels
is pushed anteriorly and ultimately disappears.
3. Tertiary vitreous is developed from neuro-
ectoderm in the ciliary region and is represented
by the ciliary zonules.
Eyelids
Eyelids are formed by reduplication of surface
ectoderm above and below the cornea (Fig. 1.12). The
folds enlarge and their margins meet and fuse with
each other. The lids cut off a space called the
conjunctival sac. The folds thus formed contain some
mesoderm which would form the muscles of the lid
and the tarsal plate. The lids separate after the seventh
month of intra-uterine life.
Iris
z Both layers of epithelium are derived from
the marginal region of optic cup (neuro-
ectodermal) (Fig. 1.9).
z Sphincter and dilator pupillae muscles are
derived from the anterior epithelium (neuro-
ectodermal).
z Stroma and blood vessels of the iris develop
from the vascular mesenchyme present anterior Fig. 1.12. Development of the eyelids, conjunctiva and
to the optic cup. lacrimal gland.
10 Comprehensive OPHTHALMOLOGY
25 mm (10 weeks) Lumen of optic nerve obliter- z Corneal diameter is about 10 mm. Adult size
ated. (11.7 mm) is attained by 2 years of age.
z Anterior chamber is shallow and angle is narrow.
50 mm (3 months) Optic tracts completed, pars
z Lens is spherical at birth. Infantile nucleus is
ciliaris retina grows
present.
forwards, pars iridica retina
z Retina. Apart from macular area the retina is fully
grows forward. differentiated. Macula differentiates 4-6 months
60 mm (4 months) Hyaloid vessels atrophy, iris after birth.
sphincter is formed. z Myelination of optic nerve fibres has reached
230-265 mm Fetal nucleus of lens is the lamina cribrosa.
complete, z Newborn is usually hypermetropic by +2 to +3 D.
(8th month) all layers of retina nearly z Orbit is more divergent (50°) as compared to
developed, macula starts adult (45°).
differentiation. z Lacrimal gland is still underdeveloped and tears
265-300mm Except macula, retina is fully are not secreted.
(9th month) developed, infantile nucleus Postnatal period
of lens begins to appear,
z Fixation starts developing in first month and is
pupillary membr-ane and completed in 6 months.
hyaloid vessels disappear. z Macula is fully developed by 4-6 months.
z Fusional reflexes, stereopsis and accommodation
Eye at birth is well developed by 4-6 months.
z Anteroposterior diameter of the eyeball is about z Cornea attains normal adult diameter by 2 years
16.5 mm (70% of adult size which is attained by of age.
7-8 years). z Lens grows throughout life.
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CHAPTER
2 2
MAINTENANCE OF CLEAR
INTRODUCTION OCULAR MEDIA
Physiology of tears
Physiology of cornea
Physiology of Eye
and Vision
Physiology of vision, The cornea forms the main refractive medium of the
Physiology of binocular vision, eye. Physiological aspects in relation to cornea
Physiology of pupil, and include:
Physiology of ocular motility. Transparency of cornea,
Cornea, Accommodation.
PHYSIOLOGY OF AQUEOUS HUMOUR AND stages (Fig. 2.1). The all trans-retinal so formed is
MAINTENANCE OF INTRAOCULAR PRESSURE soon separated from the opsin. This process of
The aqueous humour is a clear watery fluid filling the separation is called photodecomposition and the
anterior chamber (0.25ml) and the posterior chamber rhodopsin is said to be bleached by the action of
(0.06ml) of the eyeball. In addition to its role in light.
maintaining a proper intraocular pressure it also plays Rhodopsin regeneration. The 11-cis-retinal is
an important metabolic role by providing substrates regenerated from the all-trans-retinal separated from
and removing metabolities from the avascular cornea the opsin (as described above) and vitamin-A (retinal)
and the crystalline lens. For details see page 207.
supplied from the blood. The 11-cis-retinal then
reunits with opsin in the rod outer segment to form
the rhodopsin. This whole process is called
PHYSIOLOGY OF VISION
rhodopsin regeneration (Fig. 2.1). Thus, the bleaching
Physiology of vision is a complex phenomenon which of the rhodopsin occurs under the influence of light,
is still poorly understood. The main mechanisms whereas the regeneration process is independent of
involved in physiology of vision are : light, proceeding equally well in light and darkness.
Initiation of vision (Phototransduction), a
PHOTOTRANSDUCTION
The rods and cones serve as sensory nerve endings
for visual sensation. Light falling upon the retina
causes photochemical changes which in turn trigger
a cascade of biochemical reactions that result in
generation of electrical changes. Photochemical
changes occuring in the rods and cones are
essentially similar but the changes in rod pigment
(rhodopsin or visual purple) have been studied in
more detail. This whole phenomenon of conversion
of light energy into nerve impulse is known as
phototransduction.
Photochemical changes
The photochemical changes include :
Fig. 2.1. Light induced changes in rhodopsin.
Rhodopsin bleaching. Rhodopsin refers to the visual
pigment present in the rods – the receptors for night Visual cycle. In the retina of living animals, under
(scotopic) vision. Its maximum absorption spectrum constant light stimulation, a steady state must exist
is around 500 nm. Rhodopsin consists of a colourless under which the rate at which the photochemicals are
protein called opsin coupled with a carotenoid called bleached is equal to the rate at which they are
retinine (Vitamin A aldehyde or II-cis-retinal). Light regenerated. This equilibrium between the photo-
falling on the rods converts 11-cis-retinal component decomposition and regeneration of visual pigments
of rhodopsin into all-trans-retinal through various is referred to as visual cycle (Fig. 2.2).
PHYSIOLOGY OF EYE AND VISION 15
more in dim light (scotopic vision) and cones in bright where there are maximum number of cones and
light (photopic vision). decreases very rapidly towards the periphery (Fig.
Dark adaptation curve (Fig. 2.3) plotted with 2.4). Visual acuity recorded by Snellen's test chart is
illumination of test object in vertical axis and duration a measure of the form sense.
of dark adaptation along the horizontal axis shows
that visual threshold falls progressively in the
darkened room for about half an hour until a relative
constant value is reached. Further, the dark adaptation
curve consists of two parts: the initial small curve
represents the adaptation of cones and the remainder
of the curve represents the adaptation of rods.
in these tests may either consist of letters (Snellen’s 1. Trichromatic theory. The trichromacy of colour
chart) or broken circle (Landolt’s ring). More complex vision was originally suggested by Young and
targets include gratings and checker board patterns. subsequently modified by Helmholtz. Hence it is called
Recognition. It is that faculty by virtue of which an Young-Helmholtz theory. It postulates the existence
individual not only discriminates the spatial of three kinds of cones, each containing a different
characteristics of the test pattern but also identifies photopigment which is maximally sensitive to one of
the patterns with which he has had some experience. the three primary colours viz. red, green and blue.
Recognition is thus a task involving cognitive The sensation of any given colour is determined by
components in addition to spatial resolution. For the relative frequency of the impulse from each of the
recognition, the individual should be familiar with the three cone systems. In other words, a given colour
set of test figures employed in addition to being able consists of admixture of the three primary colours in
to resolve them. The most common example of different proportion. The correctness of the Young-
recognition phenomenon is identification of faces. Helmholtz’s trichromacy theory of colour vision has
The average adult can recognize thousands of faces. now been demonstrated by the identification and
Thus, the form sense is not purely a retinal chemical characterization of each of the three
pigments by recombinant DNA technique, each
function, as, the perception of its composite form (e.g.,
having different absorption spectrum as below (Fig.
letters) is largely psychological.
2.5):
Minimum discriminable refers to spatial distinction
Red sensitive cone pigment, also known as
by an observer when the threshold is much lower
erythrolabe or long wave length sensitive (LWS)
than the ordinary acuity. The best example of minimum
cone pigment, absorbs maximally in a yellow
discriminable is vernier acuity, which refers to the
portion with a peak at 565 mm. But its spectrum
ability to determine whether or not two parallel and extends far enough into the long wavelength to
straight lines are aligned in the frontal plane. sense red.
Green sensitive cone pigment, also known as
3. Sense of contrast
chlorolabe or medium wavelength sensitive
It is the ability of the eye to perceive slight changes
(MWS) cone pigment, absorbs maximally in the
in the luminance between regions which are not
green portion with a peak at 535 nm.
separated by definite borders. Loss of contrast
Blue sensitive cone pigment, also known as
sensitivity results in mild fogginess of the vision.
cyanolabe or short wavelength sensitive (SWS)
Contrast sensitivity is affected by various factors
cone pigment, absorbs maximally in the blue-violet
like age, refractive errors, glaucoma, amblyopia, portion of the spectrum with a peak at 440 nm.
diabetes, optic nerve diseases and lenticular changes.
Further, contrast sensitivity may be impaired even in
the presence of normal visual acuity.
4. Colour sense
It is the ability of the eye to discriminate between
different colours excited by light of different
wavelengths. Colour vision is a function of the cones
and thus better appreciated in photopic vision. In
dim light (scotopic vision), all colours are seen grey
and this phenomenon is called Purkinje shift.
Theories of colour vision
The process of colour analysis begins in the retina
and is not entirely a function of brain. Many theories
have been put forward to explain the colour
perception, but two have been particularly influential: Fig. 2.5. Absorption spectrum of three cone pigments.
18
18 Comprehensive OPHTHALMOLOGY
COMPREHENSIVE OPHTHALMOLOGY
Thus, the Young-Helmholtz theory concludes that Colour apponency occurs at ganglion cell onward.
blue, green and red are primary colours, but the cones According to apponent colour theory, there are
with their maximal sensitivity in the yellow portion of two main types of colour opponent ganglion cells:
the spectrum are light at a lower threshold than green. Red-green opponent colour cells use signals
It has been studied that the gene for human from red and green cones to detect red/green
rhodopsin is located on chromosome 3, and the gene contrast within their receptive field.
for the blue-sensitive cone is located on chromosome Blue-yellow opponent colour cells obtain a
7. The genes for the red and green sensitive cones yellow signal from the summed output of red and
are arranged in tandem array on the q arm of the X green cones, which is contrasted with the output
chromosomes. from blue cones within the receptive field.
2. Opponent colour theory of Hering. The opponent
colour theory of Hering points out that some colours
PHYSIOLOGY OF OCULAR
appear to be ‘mutually exclusive’. There is no such
colour as ‘reddish-green’, and such phenomenon can MOTILITY AND BINOCULAR VISION
be difficult to explain on the basis of trichromatic
PHYSIOLOGY OF OCULAL MOTILITY
theory alone. In fact, it seems that both theories are
See page 313.
useful in that:
The colour vision is trichromatic at the level of PHYSIOLOGY OF BINOCULAR SINGLE VISION
photoreceptors, and See page 318.
CHAPTER
OPTICS
Light
3 3
Geometrical optics
Optics and
Refraction
ERRORS OF REFRACTION
Anomalies of accommodation
Presbyopia
Insufficiency of accommodation
Paralysis of accommodation
Spasm of accommodation
Hypermetropia
Myopia DETERMINATION OF ERRORS OF
Astigmatism REFRACTION
Anisometropia
Objective refraction
Aniseikonia
Subjective refraction
ACCOMMODATION AND ITS
ANOMALIES SPECTACLES AND CONTACT LENSES
Accommodation Spectacles
Mechanism Contact lenses
Far point and near point
Range and amplitude REFRACTIVE SURGERY
reflected rays. A line drawn at right angle to the 2. Spherical mirror. A spherical mirror (Fig. 3.3) is a
surface is called the normal. part of a hollow sphere whose one side is silvered
Laws of reflection are (Fig. 3.1): and the other side is polished. The two types of
1. The incident ray, the reflected ray and the normal spherical mirrors are : concave mirror (whose
at the point of incident, all lie in the same plane. reflecting surface is towards the centre of the sphere)
2. The angle of incidence is equal to the angle of and convex mirror (whose reflecting surface is away
reflection. from the centre of the sphere.
Cardinal data of a mirror (Fig. 3.3)
The centre of curvature (C) and radius of
surface.
Principal axis of the mirror is the straight line
Mirrors
A smooth and well-polished surface which reflects
regularly most of the light falling on it is called a mirror.
Types of mirrors
Mirrors can be plane or spherical.
1. Plane mirror. The features of an image formed by
a plane mirror (Fig. 3.2) are: (i) it is of the same size as
the object; (ii) it lies at the same distance behind the Fig. 3.3. Cardinal points of a concave mirror.
mirror as the object is in front; (iii) it is laterally
inverted; and (iv) virtual in nature. Principal focus (F) of a spherical mirror is a point
on the principal axis of the mirror at which, ray
incident on the mirror in a direction parallel to the
principal axis actually meet (in concave mirror) or
appear to diverge (as in convex mirror) after
reflection from the mirror.
Focal length (f) of the mirror is the distance of
Table 3.1. Images formed by a concave mirror for different positions of object
Fig. 3.4. Images formed by a concave mirror for different positions of the object : (a) at infinity; (b) between infinity and
C; (c) at C; (d) between C and F; (e) at F; (f) between F and P.
22 Comprehensive OPHTHALMOLOGY
Prism
A prism is a refracting medium, having two plane
surfaces, inclined at an angle. The greater the angle
formed by two surfaces at the apex, the stronger the
prismatic effect. The prism produces displacement of
the objects seen through it towards apex (away from
the base) (Fig. 3.7). The power of a prism is measured
in prism dioptres. One prism dioptre (∆) produces
displacement of an object by one cm when kept at a
distance of one metre. Two prism dioptres of
displacement is approximately equal to one degree of
arc.
Uses. In ophthalmology, prisms are used for : lens power is taken as negative. It is measured
1. Objective measurement of angle of deviation as reciprocal of the focal length in metres i.e. P
(Prism bar cover test, Krimsky test). = 1/f. The unit of power is dioptre (D). One
2. Measurement of fusional reserve and diagnosis dioptre is the power of a lens of focal length one
of microtropia. metre.
3. Prisms are also used in many ophthalmic
Types of lenses
equipments such as gonioscope, keratometer,
Lenses are of two types: the spherical and cylindrical
applanation tonometer.
(toric or astigmatic).
4. Therapeutically, prisms are prescribed in patients
with phorias and diplopia. 1. Spherical lenses. Spherical lenses are bounded by
two spherical surfaces and are mainly of two types :
Lenses
convex and concave.
A lens is a transparent refracting medium, bounded
(i) Convex lens or plus lens is a converging lens. It
by two surfaces which form a part of a sphere
may be of biconvex, plano-convex or concavo-convex
(spherical lens) or a cylinder (cylindrical or toric lens).
(meniscus) type (Fig. 3.9).
Cardinal data of a lens (Fig. 3.8)
1. Centre of curvature (C) of the spherical lens is
the centre of the sphere of which the refracting
lens surface is a part.
2. Radius of curvature of the spherical lens is the
radius of the sphere of which the refracting
surface is a part.
Fig. 3.10. Images formed by a convex lens for different positions of the object, (a) at infinity ; (b) beyond 2F1 ; (c) at 2F1;
(d) between F1 and 2F1; (e) at F1; (f) between F1 and optical centre of lens
Table 3.2. Images formed by a convex lens for various positions of object
1. At infinity At focus (F2) Real, very small and inverted Fig. 3.10 (a)
2. Beyond 2F1 Between F2 and 2F 2 Real, diminished and inverted Fig. 3.10 (b)
3. At 2F1 At 2F2 Real, same size and inverted Fig. 3.10 (c)
4. Between F 1 and 2F1 Beyond 2F2 Real, enlarged and inverted Fig. 3.10 (d)
5. At focus F1 At infinity Real, very large and inverted Fig. 3.10 (e)
6. Between F1 and On the same side of Virtual, enlarged and erect Fig. 3.10 (f)
the optical centre lens
of the lens
Fig. 3.14. Refraction through a convex cylindrical lens. Fig. 3.15. Sturm's conoid.
26 Comprehensive OPHTHALMOLOGY
Total dioptric power is +58 D, of which cornea The principal point (P) lies 1.5 mm behind the
The anterior focal point is 15.7 mm in front of the Optical aberrations of the normal eye
anterior surface of cornea. The eye, in common with many optical systems in
The posterior focal point (on the retina) is 24.4 practical use, is by no means optically perfect; the
mm behind the anterior surface of cornea. lapses from perfection are called aberrations.
The anterior focal length is 17.2 mm (15.7 + 1.5) Fortunately, the eyes possess those defects to so
and the posterior focal length is 22.9 mm (24.4 – small a degree that, for functional purposes, their
1.5). presence is immaterial. It has been said that despite
Axes and visual angles of the eye imperfections the overall performance of the eye is
The eye has three principal axes and three visual little short of astonishing. Physiological optical
angles (Fig. 3.17). defects in a normal eye include the following :
1. Diffraction of light. Diffraction is a bending of
Axes of the eye light caused by the edge of an aperture or the rim of a
1. Optical axis is the line passing through the lens. The actual pattern of a diffracted image point
centre of the cornea (P), centre of the lens (N) produced by a lens with a circular aperture or pupil is
and meets the retina (R) on the nasal side of the a series of concentric bright and dark rings (Fig. 3.18).
fovea. At the centre of the pattern is a bright spot known as
2. Visual axis is the line joining the fixation point the Airy disc.
(O), nodal point (N), and the fovea (F).
3. Fixation axis is the line joining the fixation point
(O) and the centre of rotation (C).
Fig. 3.17. Axis of the eye: optical axis (AR); visual axis
(OF); fixation axis (OC) and visual angles : angle alpha Fig. 3.18. The diffraction of light. Light brought to a focus
(ONA, between optical axis and visual axis at nodal point does not come to a point,but gives rise to a blurred disc
N); angle kappa (OPA, between optical axis and pupillary of light surrounded by several dark and light bands (the
line – OP); angle gamma (OCA, between optical axis and 'Airy disc').
fixation axis).
2. Spherical aberrations. Spherical aberrations occur
Visual angles (Fig. 3.17) owing to the fact that spherical lens refracts peripheral
1. Angle alpha. It is the angle (ONA) formed rays more strongly than paraxial rays which in the
between the optical axis (AR) and visual axis case of a convex lens brings the more peripheral rays
(OF) at the nodal point (N). to focus closer to the lens (Fig. 3.19).
2. Angle gamma. It is the angle (OCA) between the The human eye, having a power of about
optical axis (AR) and fixation axis (OC) at the +60 D, was long thought to suffer from various
centre of rotation of the eyeball (C).
amounts of spherical aberrations. However, results
3. Angle kappa. It is the angle (OPA) formed
from aberroscopy have revealed the fact that the
between the visual axis (OF) and pupillary line
dominant aberration of human eye is not spherical
(AP). The point P on the centre of cornea is
considered equivalent to the centre of pupil. aberration but rather a coma-like aberration.
Practically only the angle kappa can be measured 3. Chromatic aberrations. Chromatic aberrations
and is of clinical significance. A positive angle kappa result owing to the fact that the index of refraction of
results in pseudo-exotropia and a negative angle any transparent medium varies with the wavelength
kappa in pseudo-esotropia. of incident light. In human eye, which optically acts
28 Comprehensive OPHTHALMOLOGY
ERRORS OF REFRACTION
Emmetropia (optically normal eye) can be defined as
a state of refraction, where in the parallel rays of light
coming from infinity are focused at the sensitive layer
Fig. 3.19. Spherical aberration. Because there is greater of retina with the accommodation being at rest
refraction at periphery of spherical lens than near centre, (Fig. 3.21).
incoming rays of light do not truly come to a point focus.
Etiology
Nomenclature for various components of the
hypermetropia is as follows:
Hypermetropia may be axial, curvatural, index,
Total hypermetropia is the total amount of refractive
positional and due to absence of lens.
error, which is estimated after complete cycloplegia
1. Axial hypermetropia is by far the commonest
with atropine. It consists of latent and manifest
form. In this condition the total refractive power
hypermetropia.
of eye is normal but there is an axial shortening
of eyeball. About 1–mm shortening of the antero- 1. Latent hypermetropia implies the amount of
posterior diameter of the eye results in 3 dioptres hypermetropia (about 1D) which is normally
of hypermetropia. corrected by the inherent tone of ciliary muscle.
2. Curvatural hypermetropia is the condition in The degree of latent hypermetropia is high in
which the curvature of cornea, lens or both is children and gradually decreases with age. The
flatter than the normal resulting in a decrease in latent hypermetropia is disclosed when refraction
the refractive power of eye. About 1 mm increase is carried after abolishing the tone with atropine.
in radius of curvature results in 6 dioptres of 2. Manifest hypermetropia is the remaining portion
hypermetropia. of total hypermetropia, which is not corrected by
3. Index hypermetropia occurs due to decrease in the ciliary tone. It consists of two components,
refractive index of the lens in old age. It may also the facultative and the absolute hypermetropia.
occur in diabetics under treatment. i. Facultative hypermetropia constitutes that
4. Positional hypermetropia results from posteriorly part which can be corrected by the patient's
placed crystalline lens. accommodative effort.
5. Absence of crystalline lens either congenitally or ii. Absolute hypermetropia is the residual part
acquired (following surgical removal or posterior of manifest hypermetropia which cannot be
dislocation) leads to aphakia — a condition of corrected by the patient's accommodative
high hypermetropia. efforts.
Thus, briefly:
Clinical types Total hypermetropia = latent + manifest (facultative +
There are three clinical types of hypermetropia: absolute).
1. Simple or developmental hypermetropia is the
Clinical picture
commonest form. It results from normal biological
variations in the development of eyeball. It includes Symptoms
axial and curvatural hypermetropia. In patients with hypermetropia the symptoms vary
2. Pathological hypermetropia results due to either depending upon the age of patient and the degree of
congenital or acquired conditions of the eyeball which refractive error. These can be grouped as under:
are outside the normal biological variations of the 1. Asymptomatic. A small amount of refractive error
development. It includes : in young patients is usually corrected by mild
Index hypermetropia (due to acquired cortical accommodative effort without producing any
sclerosis), symptom.
Positional hypermetropia (due to posterior 2. Asthenopic symptoms. At times the hypermetropia
subluxation of lens), is fully corrected (thus vision is normal) but due
30 Comprehensive OPHTHALMOLOGY
3. Intraocular lens implantation is the best available 6. Visual status and refraction will vary depending
method of correcting aphakia. Therefore, it is the upon the power of IOL implanted as described
commonest modality being employed now a days. above.
For details see page 195.
MYOPIA
4. Refractive corneal surgery is under trial for
Myopia or short-sightedness is a type of refractive
correction of aphakia. It includes:
error in which parallel rays of light coming from infinity
i. Keratophakia. In this procedure a lenticule
are focused in front of the retina when
prepared from the donor cornea is placed between
accommodation is at rest (Fig. 3.24).
the lamellae of patient's cornea.
ii. Epikeratophakia. In this procedure, the lenticule
prepared from the donor cornea is stitched over
the surface of cornea after removing the
epithelium.
iii. Hyperopic Lasik (see page 48)
PSEUDOPHAKIA
The condition of aphakia when corrected with an Fig. 3.24. Refraction in a myopic eye.
intraocular lens implant (IOL) is referred to as
pseudophakia or artephakia. For types of IOLs and Etiological classification
details of implantation techniques and complications 1. Axial myopia results from increase in antero-
see page 195. posterior length of the eyeball. It is the
Refractive status of a pseudophakic eye depends commonest form.
upon the power of the IOL implanted as follows : 2. Curvatural myopia occurs due to increased
1. Emmetropia is produced when the power of the curvature of the cornea, lens or both.
IOL implanted is exact. It is the most ideal situation. 3. Positional myopia is produced by anterior
Such patients need plus glasses for near vision only. placement of crystalline lens in the eye.
2. Consecutive myopia occurs when the IOL 4. Index myopia results from increase in the refractive
implanted overcorrects the refraction of eye. Such index of crystalline lens associated with nuclear
patients require glasses to correct the myopia for sclerosis.
distance vision and may or may not need glasses for 5. Myopia due to excessive accommodation occurs
near vision depending upon the degree of myopia. in patients with spasm of accommodation.
3. Consecutive hypermetropia develops when the
under-power IOL is implanted. Such patients require Clinical varieties of myopia
plus glasses for distance vision and additional +2 to 1. Congenital myopia
+3 D for near vision. 2. Simple or developmental myopia
Note: Varying degree of surgically-induced 3. Pathological or degenerative myopia
astigmatism is also present in pseudophakia 4. Acquired myopia which may be: (i) post-traumatic;
(ii) post-keratitic; (iii) drug-induced, (iv)
Signs of pseudophakia (with posterior chamber IOL).
pseudomyopia; (v) space myopia; (vii) night
1. Surgical scar may be seen near the limbus.
myopia; and (viii) consecutive myopia.
2. Anterior chamber is slightly deeper than normal.
3. Mild iridodonesis (tremulousness) of iris may be 1. Congenital myopia
demonstrated. Congenital myopia is present since birth, however, it
4. Purkinje image test shows four images. is usually diagnosed by the age of 2-3 years. Most of
5. Pupil is blackish in colour but when light is the time the error is unilateral and manifests as
thrown in pupillary area shining reflexes are anisometropia. Rarely, it may be bilateral. Usually
observed. When examined under magnification the error is of about 8 to 10 which mostly remains
after dilating the pupil, the presence of IOL is constant. The child may develop convergent squint
confirmed (see Fig. 8.26). in order to preferentially see clear at its far point
OPTICS AND REFRACTION 33
6. Visual fields show contraction and in some cases that clear image is formed on the retina (Fig. 3.29).
ring scotoma may be seen. The basic rule of correcting myopia is converse
7. ERG reveals subnormal electroretinogram due to of that in hypermetropia, i.e., the minimum
chorioretinal atrophy. acceptance providing maximum vision should be
Complications prescribed. In very high myopia undercorrection
(i) Retinal detachment; (ii) complicated cataract; (iii) is always better to avoid the problem of near
vitreous haemorrhage; (iv) choroidal haemorrhage (v) vision and that of minification of images.
Strabismus fixus convergence.
Treatment of myopia
1. Optical treatment of myopia constitutes
prescription of appropriate concave lenses, so
include balanced diet rich in vitamins and proteins another but the vertical meridian is more curved than
and early management of associated debilitating the horizontal. Thus, correction of this astigmatism
disease. will require the concave cylinders at 180° ± 20° or
4. Low vision aids (LVA) are indicated in patients convex cylindrical lens at 90° ± 20°. This is called
of progressive myopia with advanced 'with-the-rule' astigmatism, because similar astigmatic
degenerative changes, where useful vision cannot condition exists normally (the vertical meridian is
be obtained with spectacles and contact lenses. normally rendered 0.25 D more convex than the
5. Prophylaxis (genetic counselling). As the horizontal meridian by the pressure of eyelids).
pathological myopia has a strong genetic basis,
2. Against-the-rule astigmatism refers to an
the hereditary transfer of disease may be
astigmatic condition in which the horizontal meridian
decreased by advising against marriage between
is more curved than the vertical meridian. Therefore,
two individuals with progressive myopia.
correction of this astigmatism will require the
However, if they do marry, they should not
presciption of convex cylindrical lens at 180° ± 20° or
produce children.
concave cylindrical lens at 90° ± 20° axis.
ASTIGMATISM 3. Oblique astigmatism is a type of regular
Astigmatism is a type of refractive error wherein the astigmatism where the two principal meridia are not
the horizontal and vertical though these are at right
refraction varies in the different meridia. Consequently,
angles to one another (e.g., 45° and 135°). Oblique
the rays of light entering in the eye cannot converge
astigmatism is often found to be symmetrical (e.g.,
to a point focus but form focal lines. Broadly, there
cylindrical lens required at 30° in both eyes) or
are two types of astigmatism: regular and irregular.
complementary (e.g., cylindrical lens required at 30°
REGULAR ASTIGMATISM
in one eye and at 150° in the other eye).
The astigmatism is regular when the refractive power 4. Bioblique astigmatism. In this type of regular
changes uniformly from one meridian to another (i.e., astigmatism the two principal meridia are not at right
there are two principal meridia). angle to each other e.g., one may be at 30o and other
at 100°.
Etiology
Optics of regular astigmatism
1. Corneal astigmatism is the result of abnormalities
of curvature of cornea. It constitutes the most As already mentioned, in regular astigmatism the
common cause of astigmatism. parallel rays of light are not focused on a point but
form two focal lines. The configuration of rays
2. Lenticular astigmatism is rare. It may be:
refracted through the astigmatic surface (toric
i. Curvatural due to abnormalities of curvature of
surface) is called Sturm’s conoid and the distance
lens as seen in lenticonus.
between the two focal lines is known as focal interval
ii. Positional due to tilting or oblique placement of
of Sturm. The shape of bundle of rays at different
lens as seen in subluxation.
levels (after refraction through astigmatic surface) is
iii. Index astigmatism may occur rarely due to
described on page 25.
variable refractve index of lens in different meridia.
3. Retinal astigmatism due to oblique placement Refractive types of regular astigmatism
of macula may also be seen occasionally. Depending upon the position of the two focal lines in
relation to retina, the regular astigmatism is further
Types of regular astigmatism
classified into three types:
Depending upon the axis and the angle between the
1. Simple astigmatism, wherein the rays are focused
two principal meridia, regular astigmatism can be
on the retina in one meridian and either in front
classified into the following types :
(simple myopic astigmatism – Fig. 3.30a) or behind
1. With-the-rule astigmatism. In this type the two (simple hypermetropic astigmatism – Fig. 3.30b) the
principal meridia are placed at right angles to one retina in the other meridian.
OPTICS AND REFRACTION 37
Symptoms
Symptoms of regular astigmatism include: (i) defective
vision; (ii) blurring of objects; (iii) depending upon
the type and degree of astigmatism, objects may
appear proportionately elongated; and (iv) asthenopic
symptoms, which are marked especially in small
amount of astigmatism, consist of a dull ache in the
eyes, headache, early tiredness of eyes and
sometimes nausea and even drowsiness.
Signs
1. Different power in two meridia is revealed on
retinoscopy or autorefractometry.
2. Oval or tilted optic disc may be seen on
ophthalmoscopy in patients with high degree of
astigmatism.
3. Head tilt. The astigmatic patients may (very
exceptionally) develop a torticollis in an attempt
to bring their axes nearer to the horizontal or
vertical meridians.
4. Half closure of the lid. Like myopes, the astigmatic
patients may half shut the eyes to achieve the
greater clarity of stenopaeic vision.
Investigations
1. Retinoscopy reveals different power in two
different axis (see page 548)
2. Keratometry. Keratometry and computerized
corneal topotograpy reveal different corneal
curvature in two different meridia in corneal
astigmatism (see page 554)
3. Astigmatic fan test and (4) Jackson's cross cylinder Fig. 3.30. Types of astigmatism : simple myopic (A); simple
test. These tests are useful in confirming the power hypermetropic (B); compound myopic (C); compound
and axis of cylindrical lenses (see pages 555, 556). hypermetropic (D); and mixed (E).
38 Comprehensive OPHTHALMOLOGY
Hij trad kort daarna, namelijk den 26sten Juli 1654, in het huwelijk
met mejufvrouw Barbara de Mey dochter van Elias de Mey en Maria
Viruly. Zij was geboren den 13den December 1629 en was alzoo 25
jaren oud toen zij met Leeuwenhoek huwde. Uit dit huwelijk werden
hem vijf kinderen geboren, en wel drie zonen en twee dochters,
waarvan hij er slechts één over hield, daar de overige hem door den
dood ontnomen werden. Deze overgeblevene was zijne dochter
Maria, die ongehuwd bleef en haar vader tot in zijn hoogen
ouderdom en op zijn sterfbed verzorgde.
Intusschen werd hij door het Bestuur van Delft met eene betrekking
begiftigd, die hem een voor dien tijd niet onaanzienlijk inkomen
verschafte, terwijl de diensten, daaraan verbonden, gering waren,
zoodat hij genoegzamen vrijen tijd overhield om zich aan zijn
geliefkoosde studiën en onderzoekingen te kunnen wijden. Deze
post bestond in de betrekking van „Kamerbewaarder der Kamer van
Heeren Schepenen van Delft”, eene bediening, volgens van Haastert,
in vroegere dagen waardig genoeg aan den deftigen burgerstand.
Deze betrekking werd hem den 26sten Maart 1660, dus toen hij 28
jaren oud was, gegeven. Hij vervulde deze betrekking gedurende 39
jaren, namelijk tot aan het jaar [20]1699, doch behield het salaris
daaraan verbonden tot aan zijn dood.
Van het jaar 1654 af, vermoedelijk het jaar dat hij zich voor goed in
Delft met der woon vestigde, tot het jaar 1673 toe, het jaar waarin
het eerst microscopische waarnemingen van Leeuwenhoek door
bemiddeling van Dr. Reinier de Graaf, aan de „Royal Society” te
Londen werden medegedeeld, en zijn naam alzoo in het buitenland
en spoedig daarna overal algemeen bekend is geworden, vinden wij
niets omtrent hem aangeteekend. Er was dus een tijdvak van 19
jaren, dat men een tijdvak van voorbereiding kan noemen, waarin hij
zich voldoende kon oefenen, zoowel in het aanleeren als verder
volmaken van de kunst om de lenzen, die hij voor zijne microscopen
gebruikte en die wij zullen zien dat hij zelf vervaardigde, zoodanig te
slijpen en te polijsten, dat zij de bewondering van kenners en
geleerden, opwekten. Men trachtte op allerlei wijzen achter zijn
geheim te komen, hetgeen hij echter zorgvuldig voor zich zelven
hield. Hij zal zich overigens gedurende dien tijd vlijtig hebben
geoefend in het beschouwen van de voorwerpen, die zijne aandacht
wekten.
Leeuwenhoek zal ook wel een geruimen tijd noodig gehad hebben
eer hij in de bewerking zijner instrumenten, waartoe hij al de
benoodigdheden zelf maakte, die vaardigheid verkregen had, dat zij
ten gebruike geschikt waren. Hij getuigt zelf daarvan, in een brief
aan de „Royal Society” van 12 Januari 1689 28. „Ick hebbe hier
vooren geseit, hoe ik myn Instrumenten hebbe toegestelt, die
eenige veel netter en bequamer souden maken. Dog men moet
weten, dat ik in geen konsten ben onderwesen, daartoe men hamer
of vijl gebruikt, als alleen, dat ik heb gesien, hoe men het staal hard,
en tempert, en een dril maakt, waarmede men een gat in yser,
koper, of silver drilt. Hoe en waarmede een silver-smit syn silver
aaneen soldeert.
„Dit gesien hebbende, heb ik myn selven soo verre geoefent, dat ik
sedert veel jaren myn gereetschap hebbe gemaakt, hetwelke ik in
verscheide saken hebbe van node gehad. En dus is het, dat
hetgeene dat ik tot myn gebruik van node hebbe, alleen maar uyt
den rouwe by my gemaakt werd.”
Behalve het slijpen van glas had hij zich ook zelf geoefend in het
glasblazen, en het bewerken van metalen; zoo beschrijft hij, in een
brief aan Mr. Antonius Heinsius van 18 Aug. 1695 30 hoe hij een
glazen bol geblazen heeft om voor zekere proef tot het onderzoek
van buskruit te dienen, „UEd. Gestr. Heere zoude wel meenen dat ik
in de kunst van glasblasen, bij de kaars of lamp geoefend was. Ik
hebbe geen andere kennisse van glasblasen gehad, als dat, wanneer
op onse jaarmart een glasblaser in de stad was gekomen, die sijn
glas-blazen bij de lamp, om gelt liet zien, en als doen op desselfs
handeling agting nemende, heb ik het bij de hand gevat, en dus kan
ik alleen [25]maar blasen, hetgeene ick tot mijne verrigtinge van
noode hebbe.” Ook blijkt uit het gesprek met Uffenbach dat hij in het
glasblazen groote ervaring gekregen had. Uffenbach zegt daarvan in
zijn verhaal van zijn bezoek bij Leeuwenhoek 31.
Het blijkt echter, dat reeds in zeer oude tijden het vergrootend
vermogen van bolle, doorschijnende lichamen, alsmede de kunst om
glas en berg-kristal te slijpen, bekend is geweest en men met het
einde der XVde eeuw reeds daarin eenige vordering had gemaakt,
doch er verliepen meer dan twee eeuwen eer het eenvoudig
microscoop uitgevonden werd, welke uitvinding ten onrechte aan
Drebbel in het jaar 1621 wordt toegeschreven. Het waarschijnlijkst,
volgens Harting, is, dat de uitvinding der brillen, die alleen daarin
bestond, dat men begonnen was de lenzen te [29]slijpen met een
verderen brandpunts-afstand dan vroeger, tusschen 1285 en 1290
geschied is. Verder zegt Harting 35, dat het brillenslijpen, na 1363,
allengs tot een handwerk was geworden, dat men op het laatst der
XVIde eeuw twee brillenslijpers te Middelburg (de genoemde
Janssens) vond, en ten tijde van Leeuwenhoek drie te Leiden, zooals
hij zelf in een brief aan G. C. Leibnitz, d.d. 28 September 1715 36
zegt: „daar sijn drie Glaseslijpers geweest te Leyden, bij dewelke de
studenten het glaseslijpen gingen leeren” enz. Uit een en ander
blijkt, dat het zeker is, dat het samengesteld microscoop te
Middelburg reeds eenige jaren vóór 1610 is uitgevonden.
Wij zagen boven, dat Dr. Reinier de Graaf in den brief, [30]dien hij bij
de toezending der eerste waarnemingen van Leeuwenhoek aan de
„Royal Society” te Londen schreef, als eene bijzonderheid
mededeelde „dat deze Leeuwenhoek onlangs microscopen gemaakt
had, uitmuntende boven die tot hiertoe vervaardigd worden door
Eustachio Divini.” Deze microscopen van Eustachio de Divinis nu
waren in dien tijd zeer beroemd en worden beschreven in de
„Philosophical Transactions” no. 42, pag. 842. Divini had, behalve de
objectieflens, twee plano-convexe oogglazen zoodanig geplaatst, dat
zij elkander in het midden hunner bolle oppervlakte raakten. Deze
oogglazen waren ongeveer zoo breed als de handpalm eens mans,
en de buis, waarin zij besloten waren, was zoo dik als een mans dij.
Een vrij onhandig instrument alzoo, dat niet gemakkelijk in het
gebruik moet zijn geweest en veel overeenkomst met een kleine
mortier moet hebben gehad. Het was omstreeks 16½ duim lang; de
verschillende vergrootingen werden verkregen door uittrekking tot
verschillende lengte. De geringste vergrooting was van 41, de
sterkste van 143maal in middellijn.
Hij besteedde veel zorg aan het kiezen van het geschiktste soort van
glas, en gebruikte ook gerold bergkristal. De zuiverheid en
helderheid er van moet buitengemeen groot geweest zijn, hetgeen
blijkt, zoowel uit de getuigenis zijner tijdgenooten, als uit vele der
daarmede gedane waarnemingen van hemzelven.
Fig. 1.
Fig. 2 A.
4o. Een rood marokijn lederen étui met vijf in koper gevatte lenzen
en eene lens nog niet in koper gevat, dus in het geheel zes.
Een en ander was uit Rusland weder naar Nederland terug gebracht
door den Hoogleeraar de Gorter, door wiens betrekkingen het aan
den vader van den briefschrijver en later aan hem was present
gedaan. Als eene bijzonderheid meldde hij mij nog dat op het étui
met eigenaardige krulletters geschreven staat „Anth. van
Leeuwenhoek”. Tevens berichtte mij ZEd., dat hij van plan was een
en ander aan de Leidsche Hoogeschool ten [36]geschenke aan te
bieden; derhalve zijn de op de Academie berustende voorwerpen
kennelijk de bovenbeschrevene.
Fig. 3.
Deze Catalogus, in het bezit van Prof. Harting, voert den volgenden
titel:
Als eene bijzonderheid staat bij no. 126 een koperen stel vermeld,
dat „het vergrootglas geslepen is van een sandje en het object is
een sandje.” Bij drie der microscopen staat opzettelijk dat het
vergrootglas is geslepen van Amersfoortsche diamant. Van de
gouden wogen er twee 10 Engels 17 azen, de derde 10 Engels 14
azen. Een der eerste van deze gouden werd verkocht voor 23 gulden
15 stuivers, terwijl de beide anderen opgehouden werden. De
overige microscopen golden: de koperen van 15 stuivers tot 3
gulden het paar; de zilveren 2 tot 7 gulden, 1 koperen stel, waarvan
het object was „ongeboren oesters” (!) in een glazen buisje 8
gulden. Een enkel der zilveren gold 10 gulden.