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Textbook of Visual Science and Clinical Optometry_Bhattacharya_2009

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Acknowledgements

During my residency training and subsequent practising years, I felt the need of a comprehensive book covering all aspects of practical ophthalmic examinations and clinical optics.

I would like to thank M/s Appasamy Associates, Chennai, India for giving me the relevant photographs for publication.

I would also like to express my gratitude to Mr Sirajul Mullick, Department of Optometry Science (DOS) for the invaluable assistance he has extended to me during preparation of the chapters related to clinical optometry.

I would like to convey my gratitude to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi and all the technical staff.

I would also like to thank all my colleagues in different institutions for their continued encouragement.

Finally, I would like to thank my wife and children for their continued support and their patience for tolerating my preoccupation with the book.

Contents

	SECTION 1: ANATOMY
1. ANATOMY OF THE EYEBALL ...........................................		3
i. Cornea ............................................................................................		4
ii.	Sclera ...............................................................................................	8
iii.	Limbus ............................................................................................	9
iv.	Anterior Chamber ......................................................................	10
v.	Posterior Chamber .....................................................................	12
vi.	Uveal Tract ...................................................................................	12
vii.	Retina ............................................................................................	18
viii.	Optic Nerve .................................................................................	24
ix.	Lens ...............................................................................................	25
x. Vitreous Humour .......................................................................		27
xi. Blood Supply of Eyeball ...........................................................		28
2. ANATOMY OF APPENDAGES OF THE EYEBALL .....		31
i. Conjunctiva ..................................................................................		31
ii.	Eyelids ...........................................................................................	32
iii.	Lacrimal Apparatus ....................................................................	36
iv. Muscles of the Eye .....................................................................		38
v. Levator Palpebrae Superioris ...................................................		41
3. ANATOMY OF THE ORBIT...............................................		43
i.	Roof ...............................................................................................	43
ii.	Medial Wall ..................................................................................	44
iii.	Floor ..............................................................................................	45
iv. Lateral Wall ..................................................................................		45
v. Orbital Contents .........................................................................		45
vi. Superior Orbital Fissure (Sphenoidal) ....................................		45
vii. Interior Orbital Fissure (Sphenomaxillary) ...........................		46
viii. Optic Foramen (Optic Canal) ...................................................		46
ix. Surgical Anatomical Spaces within the Orbit .......................		47
	SECTION 2: PHYSIOLOGY AND
	NEUROLOGY OF VISION
4. PHYSIOLOGY OF THE OCULAR STRUCTURES .........		51

i.	Aqueous Humour ......................................................................	51
ii.	Vitreous Humour .......................................................................	54

xiv Textbook of Visual Science and Clinical Optometry

iii.	Cornea ..........................................................................................	55
iv. Lens ...............................................................................................		59
v. Tears ..............................................................................................		60
5. PHYSIOLOGY OF VISION .................................................		64
i. Photochemical Changes ............................................................		64
ii.	Electrical Changes .......................................................................	65
iii.	Visual Perceptions (or Sensations) ..........................................	69
iv. Colour Sense .....................................................................		76
6. THE NEUROLOGY OF VISION ........................................		84
i. Visual Pathway ...........................................................................		84
ii.	Pupillary Pathway ......................................................................	86
iii.	Pupillary Reflexes .......................................................................	88
iv.	Pupillary Reaction Disorders ....................................................	90

SECTION 3: LIGHT AND OPTICAL PRINCIPLES

7. LIGHT AND HUMAN EYE: BASIC OPTICAL
PRINCIPLES ............................................................................		95
i. Light and Electromagnetic Spectrum .....................................		95
ii. Basic Optical Principles of Human Eye .................................		97
iii. Axes and Angles of the Eye ..................................................		101
iv. Optical Aberrations of the Eye .............................................		102
v. Purkinje Images ........................................................................		108
vi. Retinal Image ............................................................................		109
8. ACCOMMODATION AND ITS ANOMALIES ............		110
i. Accommodation ........................................................................		110
ii. Insufficiency of Accommodation ...........................................		113
iii. Paralysis of Accommodation .................................................		113
iv. Spasm of Accommodation .....................................................		114
	SECTION 4: REFRACTIVE ERRORS
	AND CORRECTION
9. ERRORS OF REFRACTION ...............................................		119
i. Hypermetropia ..........................................................................		120
ii.	Myopia ........................................................................................	123
iii.	Astigmatism ...............................................................................	127
iv.	Anisometropia ...........................................................................	132
v.	Aphakia .......................................................................................	134
vi.	Pseudophakia .............................................................................	137
vii.	Presbyopia ..................................................................................	139

	Contents	xv
10. ESTIMATION AND CORRECTION OF
REFRACTIVE ERRORS .......................................................		142
i. Retinoscopy ................................................................................		142
ii. Autorefractometry ....................................................................		150
iii.	Photorefraction ..........................................................................	150
iv.	Subjective Refraction ................................................................	150
v.	Prescription for Spectacles ......................................................	152
SECTION 5: PRACTICAL OPHTHALMICS AND
	CLINICAL OPTOMETRY
11. MATERIALS—OPHTHALMIC LENS
AND SPECTACLE FRAME ................................................		159
i. Ophthalmic Lens Materials .....................................................		159
ii.	Spectacle Frame Materials ......................................................	163
12. OPHTHALMIC LENSES ....................................................		170
i. Spherical Lenses ........................................................................		170
ii.	Cylindrical Lenses .....................................................................	173
iii.	Unit of Lens Power .................................................................	174
iv.	Special Types of Lenses ..........................................................	175
v.	Transposition .............................................................................	178
vi. Neutralisation (Determination of Power of a Lens) ........		179
13. COATINGS AND TINTS OF LENSES...........................		183
i. Antireflection Coating (AR Coating) ...................................		183
ii.	Tints .............................................................................................	187
iii.	Photochromism .........................................................................	188
iv.	Hard Coating/Scratch Resistant Coating ............................	190
v.	Ultraviolet Inhibitors ................................................................	191
vi. Water Resistant/Hydrophobic Coating ...............................		191
vii. Polaroid Lenses .........................................................................		192
viii. Lens Care and Cleaning .........................................................		193
14. FRAMES AND LENSES: DIMENSIONS,
MEASUREMENTS AND STYLES....................................		194
i. Spectacle Frame Dimensions ..................................................		194
ii.	Parts of a Frame ......................................................................	195
iii.	Common Terminologies Associated with Frame .............	196
iv.	Shapes of Frames .....................................................................	196
v.	Common Types of Frames ....................................................	197
vi.	Special Types of Spectacle Frames .......................................	198
vii.	Informations Available from the Frame .............................	198
viii.	Lens Styles .................................................................................	200

xvi Textbook of Visual Science and Clinical Optometry

ix.	Optical Centre of Lens ............................................................	207
x.	Pupillary (or Interpupillary) Distance ..................................	207
xi.	Vertex Distance .........................................................................	210
15. CONTACT LENS .................................................................		211
i.	Indications ..................................................................................	211
ii.	Advantages Over Spectacles ..................................................	212
iii.	Optics of Contact Lenses ........................................................	213
iv.	Scleral Contact Lens .................................................................	214
v.	Semiscleral (or Soft or Hydrogel) Contact Lens ...............	215
vi.	Corneal (or Rigid) Contact Lens ..........................................	216
vii.	Fitting Procedures ....................................................................	217
viii. Contact Lens Related Informations and Terminologies ..		220
ix. Assessment of Soft Contact Lens Fitting ............................		222
x. Assessment of Rigid Contact Lens Fitting .........................		223
xi. Determination of Contact Lens Power ...............................		225
xii. Complications of Contact Lens Wear ..................................		226
	SECTION 6: SPECIAL CHAPTERS
16. OPHTHALMIC INSTRUMENTATION ..........................		231
i. Slit-lamp Biomicroscope ..........................................................		231
ii. Tonometry .................................................................................		244
iii.	Gonioscopy ................................................................................	250
iv. Indirect Biomicroscopy ............................................................		258
v. Lens Measure (or Geneva Lens Measure) ..........................		263
vi. Keratometer (or Ophthalmometer) ......................................		264
vii. Lensometer (or Focimeter) ....................................................		266
viii. Direct Ophthalmoscope ...........................................................		269
17. LOW VISION AND LOW VISUAL AID .......................		273
i. Clinical Assessment of a Patient with Low Vision ...........		273
ii. Management of Patients with Low Vision .........................		276
iii. Working Principle of Low Visual Aids ...............................		277
iv. Low Visual Devices ..................................................................		278
18. PAEDIATRIC EYE EXAMINATION ...............................		281
i. History Taking ..........................................................................		281
ii. Ophthalmic Examination Proper ...........................................		281
iii.	Clinical Examination of the Eye Proper ..............................	287
iv.	Milestones—Normal Visual Maturation and Reflexes ......	288
v.	Normal Visual Acuity Maturation (Age-related) ...............	289

Index .........................................................................................

291

Abbreviations

AC	Anterior chamber
AC/A	Accommodative convergence / Accommodation ratio
add	Addition for near vision
ARC	Abnormal retinal correspondence
ARMD	Age-related macular degeneration
BE	Both eyes
BIO	Binocular indirect ophthalmoscopy
BOZD	Back optic zone diameter
BOZR	Back optic zone radius
BRAO	Branch retinal artery occlusion
BRVO	Branch retinal vein occlusion
BVP	Back vertex power
CB	Ciliary body
cd	Candela
C/D	Cup disc ratio
CF	Counting fingers
CL	Contact lens
CLARE	Contact lens acute red eye
CME	Cystoid macular oedema
CNV	Choroidal neovascularisation
cpd	Cycle per degree
CRAO	Central retinal arterial occlusion
CRVO	Central retinal vein occlusion
CR-39	Columbia Resin 39
Ct	Carat
CVS	Computer vision syndrome
D	Diopter
DBL	Distance between lenses
DBR	Distance between rims
Dk	Oxygen permeability

xviii Textbook of Visual Science and Clinical Optometry

Dk/t	Oxygen transmissibility
ECCE	Extracapsular cataract extraction
EOG	Electrooculogram
ERG	Electroretinogram
ERP	Early receptor potential
EUA	Examination under anaesthesia
EW	Extended wear contact lens
FAZ	Foveolar avascular zone
FM100	Farnsworth-Munsell 100 Hue test
ftcs	Footcandles
FVP	Front vertex power
GAG	Glycosaminoglycans
GPC	Giant papillary conjunctivitis
HEMA	Hydroxyethyl methacrylate
HM	Hand movements
ICCE	Intracapsular cataract extraction
IO	Inferior oblique
IOL	Intraocular lens
IOP	Intraocular pressure
IPD	Interpupillary distance
IR	Infrared, inferior rectus
J	Jaeger type notation
KCS	Keratoconjunctivitis sicca
KP	Keratic precipitates
LE	Left eye
LPS	Levator palpebrae superioris
LR	Lateral rectus
LVA	Low vision aid
M	Magnification
MAR	Minimum angle of resolution
MR	Medial rectus
N	N system of notation
n	Index of refraction
nm	Nanometer
OD	Oculus dexter, i.e. right eye
OKN	Optokinetic nystagmus
OS	Oculus sinister, i.e. left eye

	Abbreviations xix
OU	Oculus uterque, i.e., both eyes
PAL	Progressive addition lens
PAM	Potential acuity meter
PAS	Peripheral anterior synechiae
PD	Pupillary distance
PL	Perception of light
PMMA	Polymethyl methacrylate
POAG	Primary open-angle glaucoma
PVD	Posterior vitreous detachment
PXF	Pseudoexfoliation
RAPD	Relative afferent pupillary defect
RE	Right eye
RGP	Rigid gas permeable contact lens
RPE	Retinal pigment epithelium
SO	Superior oblique
SR	Superior rectus
TD	Total diameter
TM	Trabecular meshwork
UV	Ultraviolet
V	Abbé’s number/constringence/V-value, vision
VA	Visual acuity
VEP	Visual evoked potential
VER	Visual evoked response
VKC	Vernal keratoconjunctivitis

αAngle alpha Prism diopter

κAngle kappa

λAngle lambda; wavelength ∞ Infinity

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