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Subjective Refraction is a technique to determine the combination of lenses that will provide the best corrected visual acuity (BCVA). [1] It is a clinical examination used by orthoptists , optometrists and ophthalmologists to determine a patient's need for refractive correction, in the form of glasses or contact lenses.
Cross cylinder, which is a combination of two cylindrical lenses with equal strength and opposite power, is used in subjective refraction to diagnose astigmatism, and assess the strength and axis of the astigmatic power etc. [3] Maddox rods, made up of cylindrical lenses arranged in parallel, are used to detect strabismus and diplopia. [4]
Following that "objective refraction" the clinician typically shows the person lenses of progressively higher or weaker powers in a process known as subjective refraction. Cycloplegic agents are frequently used to more accurately determine the amount of refractive error, particularly in children [23]
Jackson cross cylinder of +/- 0.25 diopter. Jackson cross cylinder is a single low power lens, which is a combination of a plus cylinder and a minus cylinder of equal power with axis perpendicular to each other, with a handle placed between the two axes at 45 degrees.
By measuring this zone, the autorefractor can determine when a patient's eye properly focuses an image. The instrument changes its magnification until the image comes into focus. The process is repeated in at least three meridians of the eye and the autorefractor calculates the refraction of the eye, sphere, cylinder and axis.
The Maddox rod is a handheld instrument composed of red parallel plano convex cylinder lens, which refracts light rays so that a point source of light is seen as a line or streak of light. [2] Due to the optical properties, the streak of light is seen perpendicular to the axis of the cylinder. [3] Maddox rod and pen torch used in Maddox rod testing
Another rarely used refraction technique involves the use of a stenopaeic slit (a thin slit aperture) where the refraction is determined in specific meridians – this technique is particularly useful in cases where the patient has a high degree of astigmatism or in refracting patients with irregular astigmatism.
Retinoscopy is particularly useful in prescribing corrective lenses for patients who are unable to undergo a subjective refraction that requires a judgement and response from the patient (such as children or those with severe intellectual disabilities or communication problems).