Ophthalmic Dispensing II
Credit hour : 2
Course code : 431
For 2nd year optometry students
Alemayehu D.
(BSc, MSc in clinical optometry)
09/23/20 1
Anisometropia and aniseikonia
High Myopia
High Hyperopia
Paediatric dispensing
Progressive lens fitting
Occupational lenses
Safety eye wear
Glazing
Clinical Dispensing and fitting of spectacles in
general clinic
Demonstration
09/23/20 2
At the end of this session you be able to:
◦ Define anisometropia and aniseikonia
◦ List cause of anisometropia and aniseikonia
◦ List types of aniseikonia
◦ Differentiate clinical significance od anisometropia
◦ Analysis challenges of dispensing anisometropia
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Definition
Cause
Types
Challenges
Case analysis
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What is anisometropia?
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Anisometropia:
◦ Unequal power of two eyes
◦ Cause unequal retinal image size and shape
◦ 0.25 difference is anisometropia
◦ Affects all age group regardless sex, ethnicity
◦ Can be spherical or meridional anisometropia
◦ But need sooner correction for young children. Why?
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No need for correction
◦ Anti-metropia
◦ If one eye is dominant and no longer binocular with sensible
anisometropic lenses
Spectacles
◦ Mainly our focus
Contact lenses
◦ For aniseikonic correction
◦ To maintain binocularity
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Refractive Surgery
◦Changing corneal shape
Intraocular surgery
◦High refractive error e.g. myope remove lens
◦ Implant IOL
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Walking on the grass will cure poor eyesight
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Spectacle does not eliminate problems from anisometropia.
Why?
◦ Characteristics of lenses
Magnification/minification
Prismatic effect
Spectacle magnification:
◦ Is magnification of image in single eye with and with out correcting
lenses
◦ Is not the magnification b/n two eyes 09/23/20 1
Spectacle magnification (SM): is ratio of
Retinal image size in corrected eye
Retinal image size in same uncorrected eye
There are two factors that contributing to SM:
◦ Shape factor (t, n &F1) like telescope
Has no net power on it but can cause change in magnification
◦ Power factor (d & F’v)
They contribute independently
There contribution is expressed as:
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SM= (shape factor) * (power factor)
◦ (1/1-t/nF1) (1/1-hF’v)
Where
t- thickness of the lens in meter
n-refractive index
F1- front surface power
F’v- back surface power
h- distance from back vertex of lens to entrance pupil
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SM= 1
1 - dF
Where
d -is distance from back vertex of lens to eye’s
entrance pupil (approximately 3mm behind cornea)
and
F -is the power of the thin compensating lens.
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RE: -8.00Ds and LE: -5.00Ds
For the above prescription if spectacles are to be prescribed with a
vertex distance is 0.013 m and the entrance pupil is 0.003m
behind the vertex of the cornea,
d = 0.013 + 0.003 = 0.016 m.
Using the above formula
for the right eye (─ 8.00Ds) SM = 0.886 = 0.886 – 1 = ─ 0.114 =
─ 11.4% (loss).
For the left eye (─ 5.00Ds) SM = 0.926 = 0.926 – 1 = ─ 0.074 =
─7.4% (loss)
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The right eye suffers a ─11.4% magnification (11.4% minification)
while
The left eye suffers a ─7.4% magnification (7.4% minification)
relative to the eyes uncompensated retinal image size.
This shows a 4% difference in retinal image sizes.
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What is the Contact lens magnification for the
above Rx?
OD: -8.00Ds
OS: -5.00Ds
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This can be calculated by using Prentice’s Equation for thin
lenses;
P = cF
where
P is the prismatic effect, c is the distance in centimeter from
the optical centre of the lens and F is the power of the lens.
The patient may complain about double vision or
uncomfortable upon vertical directions of gaze. Why mostly in
vertical gaze?
What normally happens is that the patient will tell you that if
he holds reading material at eye level while looking straight
ahead, the vision is more comfortable. 09/23/20 1
If for example the patient drop there position of gaze to 10 mm below
the optical center:
◦ OD: -8.00Ds
◦ OS: -5:00Ds, what is the prismatic effect
09/23/20 1
This is also a common complaint with astigmatic
anisometropic patients where the powers differ along
the vertical meridians.
More head movement would have to be encountered.
The obvious choice would be to select small and
narrow frames.
However, this is not always possible because some
patients have large faces.
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Be in group and discuss on:
What lens materials you need to
consider?
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Magnification caused by the anisometropia. (different
refracting states of the eyes).
Aniseikonia (different retinal image sizes) due to the two
different magnifications produced by the lenses.
Possible diplopia (double vision) on vertical positions of
gaze (if spectacles are to be prescribed) due to the
prismatic effect caused by the two different
compensating lenses.
Lens materials.
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What do you want to know before prescribing
anisometropic?
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Recognition of anisometropia
◦ Type of prescription
Spherical
Astigmatism
Age of the patient
◦ Amblyopic treatment
Past visual history
◦ Hx of past glasses - Binocularity
◦ Alternatively - Dominance eye
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Visual demand of the patient
◦ Binocularity ( stereopsis)
Working environment
Ocular status
◦ Any medial opacity
◦ Active disease that reduce vision
Systemic condition
◦ Diabetic mellitus
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Tolerance
◦ require a compensating prism at the off-centre visual point of their
lenses
◦ Why some subjects doesn't complain for significant anisometropic
eye glasses?
Some anisometropic subjects, however, are able to adapt to the differential
prism and exhibit no symptoms.
Some will just suppress, especially at higher levels.
Others, at lower levels, may have good fusional reserves and tolerate the
differential prism.
◦ Subjects with marked anisometropic amblyopia benefit from prism
compensation even though vision is monocular.
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Choice of lens
Eliminating or reducing the differential prism responsible for
the diplopia when viewing through the NVP of the lenses can
be done through the following methods:
◦ Slab-off
◦ Different round bifocal segment sizes
◦ Franklin split
◦ Prism controlled bifocals
◦ Cemented or bonded bifocal segments.
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E.g. Meridional anisometropia
Rx before cataract removal from the left eye:
R +3.00/-1.00x10 VA 6/6-1 add +2.50.
L +2.75/-1.00x45 VA 6/36 add +2.50
◦ Rx following left lens implant:
R +3.25/-1.00x10 VA 6/6-1 add +2.75
L +2.25/-2.25x175 VA 6/6-1 add +2.75
Assuming a near visual point (NVP) of 10mm below the optical centre
◦ Think of vertical imbalance
◦ So compare before and after?
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Any questions?
Thank you for your
attention!
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