- •Contents
- •General Introduction
- •Objectives
- •1 Geometric Optics
- •Rays, Refraction, and Reflection
- •Introduction
- •Point Sources, Pencils, and Beams of Light
- •Object Characteristics
- •Image Characteristics
- •Magnification
- •Image Location
- •Depth of Focus
- •Image Quality
- •Light Propagation
- •Optical Media and Refractive Index
- •Law of Rectilinear Propagation
- •Optical Interfaces
- •Law of Reflection (Specular Reflection)
- •Law of Refraction (Specular Transmission)
- •Normal Incidence
- •Total Internal Reflection
- •Dispersion
- •Reflection and Refraction at Curved Surfaces
- •The Fermat Principle
- •Pinhole Imaging
- •Locating the Image: The Lensmaker’s Equation
- •Ophthalmic Lenses
- •Vergence
- •Reduced Vergence
- •Thin-Lens Approximation
- •Lens Combinations
- •Virtual Images and Objects
- •Focal Points and Planes
- •Paraxial Ray Tracing Through Convex Spherical Lenses
- •Paraxial Ray Tracing Through Concave Spherical Lenses
- •Objects and Images at Infinity
- •Principal Planes and Points
- •Section Exercises
- •Focal Lengths
- •Gaussian Reduction
- •Knapp’s Law, the Badal Principle, and the Lensmeter
- •Afocal Systems
- •Section Exercises
- •Questions
- •Power of a Lens in a Medium
- •Spherical Interface and Thick Lenses
- •Thick Lens
- •Back Vertex Power Is Not True Power
- •Aberrations of Ophthalmic Lenses
- •Third-Order Seidel Aberrations
- •Chromatic Aberrations
- •Avoiding Aberrations
- •Mirrors
- •Reflection From a Plane Mirror
- •Spherically Curved Mirrors
- •Reversal of the Image Space
- •The Central Ray for Mirrors
- •Vergence Calculations for Mirrors
- •Spherocylindrical Lenses
- •Combination of Spherocylindrical Lenses
- •The Conoid of Sturm
- •The Jackson Cross Cylinder
- •Prisms
- •Prism Diopter
- •Prismatic Effect of Lenses and the Prentice Rule
- •Prism Aberrations
- •Fresnel Prisms
- •Chapter Exercises
- •Questions
- •Appendix 1.1
- •Quick Review of Angles, Trigonometry, and the Pythagorean Theorem
- •Appendix 1.2
- •Light Properties and First-Order Optics
- •2 Optics of the Human Eye
- •The Human Eye as an Optical System
- •Schematic Eyes
- •Important Axes of the Eye
- •Pupil Size and Its Effect on Visual Resolution
- •Visual Acuity
- •Contrast Sensitivity and the Contrast Sensitivity Function
- •Refractive States of the Eyes
- •Binocular States of the Eyes
- •Accommodation and Presbyopia
- •Epidemiology of Refractive Errors
- •Developmental Myopia
- •Developmental Hyperopia
- •Prevention of Refractive Errors
- •Chapter Exercises
- •Questions
- •3 Clinical Refraction
- •Objective Refraction Technique: Retinoscopy
- •Positioning and Alignment
- •Fixation and Fogging
- •The Retinal Reflex
- •The Correcting Lens
- •Finding Neutrality
- •Retinoscopy of Regular Astigmatism
- •Aberrations of the Retinoscopic Reflex
- •Subjective Refraction Techniques
- •Astigmatic Dial Technique
- •Stenopeic Slit Technique
- •Cross-Cylinder Technique
- •Refining the Sphere
- •Binocular Balance
- •Cycloplegic and Noncycloplegic Refraction
- •Overrefraction
- •Spectacle Correction of Ametropias
- •Spherical Correcting Lenses and the Far Point Concept
- •The Importance of Vertex Distance
- •Cylindrical Correcting Lenses and the Far Point Concept
- •Prescribing for Children
- •Myopia
- •Hyperopia
- •Anisometropia
- •Clinical Accommodative Problems
- •Presbyopia
- •Accommodative Insufficiency
- •Accommodative Excess
- •Accommodative Convergence/Accommodation Ratio
- •Effect of Spectacle and Contact Lens Correction on Accommodation and Convergence
- •Prescribing Multifocal Lenses
- •Determining the Add Power of a Bifocal Lens
- •Types of Bifocal Lenses
- •Trifocal Lenses
- •Progressive Addition Lenses
- •The Prentice Rule and Bifocal Lens Design
- •Occupation and Bifocal Segment
- •Prescribing Special Lenses
- •Aphakic Lenses
- •Absorptive Lenses
- •Special Lens Materials
- •Therapeutic Use of Prisms
- •Chapter Exercises
- •Questions
- •Appendix 3.1
- •Common Guidelines for Prescribing Cylinders for Spectacle Correction
- •4 Contact Lenses
- •Introduction
- •Contact Lens Glossary
- •Clinically Important Features of Contact Lens Optics
- •Field of Vision
- •Image Size
- •Accommodation
- •Convergence Demands
- •Tear Lens
- •Correcting Astigmatism
- •Correcting Presbyopia
- •Contact Lens Materials and Manufacturing
- •Materials
- •Manufacturing
- •Patient Examination and Contact Lens Selection
- •Patient Examination
- •Contact Lens Selection
- •Contact Lens Fitting
- •Soft Contact Lenses
- •Rigid Gas-Permeable Contact Lenses
- •Toric Soft Contact Lenses
- •Contact Lenses for Presbyopia
- •Keratoconus and the Abnormal Cornea
- •Contact Lens Overrefraction
- •Gas-Permeable Scleral Contact Lenses
- •Therapeutic Lens Usage
- •Orthokeratology and Corneal Reshaping
- •Custom Contact Lenses and Wavefront Technology
- •Contact Lens Care and Solutions
- •Contact Lens–Related Problems and Complications
- •Infections
- •Hypoxic/Metabolic Problems
- •Toxicity
- •Mechanical Problems
- •Inflammation
- •Chapter Exercises
- •Questions
- •Appendix 4.1
- •Transmission of Human Immunodeficiency Virus in Contact Lens Care
- •Appendix 4.2
- •Federal Law and Contact Lenses
- •5 Intraocular Lenses
- •Intraocular Lens Designs
- •Classification
- •Background
- •Optical Considerations for Intraocular Lenses
- •Intraocular Lens Power Calculation
- •Piggyback and Supplemental Intraocular Lenses
- •Intraocular Lens Power Calculation After Corneal Refractive Surgery
- •Instrument Error
- •Index of Refraction Error
- •Formula Error
- •Power Calculation Methods for the Post–Keratorefractive Procedure Eye
- •Intraocular Lens Power in Corneal Transplant Eyes
- •Silicone Oil Eyes
- •Pediatric Eyes
- •Image Magnification
- •Lens-Related Vision Disturbances
- •Nonspherical Optics
- •Multifocal Intraocular Lenses
- •Types of Multifocal Intraocular Lenses
- •Clinical Results of Multifocal Intraocular Lenses
- •Accommodating Intraocular Lenses
- •Intraocular Lens Standards
- •Chapter Exercises
- •Questions
- •Appendix 5.1
- •History of Intraocular Lens Design
- •6 Optical Considerations in Keratorefractive Surgery
- •Corneal Shape
- •Angle Kappa
- •Pupil Size
- •Irregular Astigmatism
- •Application of Wavefront Analysis in Irregular Astigmatism
- •Causes of Irregular Astigmatism
- •Conclusion
- •Chapter Exercises
- •Questions
- •7 Optical Instruments and Low Vision Aids
- •Magnification
- •Telescopes
- •Galilean Telescope
- •Astronomical Telescope
- •Accommodation Through a Telescope
- •Surgical Loupe
- •General Principles of Optical Engineering
- •Terminology
- •Measurements of Performance of Optical Systems
- •Optical Instruments and Techniques Used in Ophthalmic Practice
- •Direct Ophthalmoscope
- •Indirect Ophthalmoscope
- •Fundus Camera
- •Slit-Lamp Biomicroscope
- •Gonioscopy
- •Surgical Microscope
- •Geneva Lens Clock
- •Lensmeter
- •Knapp’s Rule
- •Optical Pachymeter
- •Applanation Tonometry
- •Specular Microscopy
- •Keratometer
- •Topography
- •Ultrasonography of the Eye and Orbit
- •Macular Function Tests
- •Scanning Laser Ophthalmoscopes
- •Scheimpflug Camera
- •Autorefractors
- •Optical Coherence Tomography
- •Optical Aids
- •Magnifiers
- •Telescopes
- •Prisms
- •High-Add Spectacles
- •Nonoptical Aids
- •Electronic Devices
- •Lighting, Glare Control, and Contrast Enhancement
- •Nonvisual Assistance
- •Eccentric Viewing or Fixation Training
- •Instruction and Training
- •Chapter Exercises
- •Questions
- •Appendix 7.1
- •Approach to the Patient With Low Vision
- •8 Physical Optics
- •The Corpuscular Theory of Light
- •Diffraction
- •The Speed of Light
- •The Superposition of Waves
- •Coherence
- •Electromagnetic Waves
- •Polarization
- •Refractive Index and Dispersion
- •Reflection, Transmission, and Absorption
- •The Electromagnetic Spectrum
- •Frequency and Color
- •Energy in an Electromagnetic Wave
- •Quantum Theory
- •Light Sources
- •Thermal Sources
- •Luminescent Sources
- •Fluorescence
- •Phosphorescence
- •Lasers
- •Light–Tissue Interactions
- •Photocoagulation
- •Photoablation
- •Photodisruption
- •Photoactivation
- •Light Scattering
- •Rayleigh Scattering
- •Mie Scattering
- •The Tyndall Effect
- •Radiometry and Photometry
- •Light Hazards
- •Clinical Applications
- •Polarization
- •Interference
- •Diffraction
- •Imaging and the Point Spread Function
- •Image Quality—Modulation Transfer Function
- •Chapter Exercises
- •Questions
- •Appendix 8.1
- •Radiometric and Photometric Units
- •Basic Texts
- •Related Academy Materials
- •Requesting Continuing Medical Education Credit
Figure 1-41 Illustration of Knapp’s law. If the refractive power of eyes is the same but the axial length varies (a, b, c), a correcting lens placed at the anterior focal point of each eye (Feye) will produce an identical retinal image size regardless
of the axial length. In this example, the power of the correcting lens will change depending on the axial length of the eye. However, the retinal image size will remain constant. (Illustration b y C. H. Wooley.)
For example, if eyes have identical refractive power and differ only in axial length, then placing a lens at the anterior focal point of each eye will produce retinal images identical in size. However, it is rare that the difference between eyes is purely axial. In addition, the anterior focal point of the eye is approximately 17 mm in front of the cornea (see Chapter 2). Although it is possible to wear glasses so the spectacle lens is 17 mm in front of the eye, most people prefer to wear them at a corneal vertex distance of 10–15 mm. Because the clinician is rarely certain that any ametropia is purely axial, Knapp’s law has limited clinical application.
Manual lensmeters make use of the same principle, although for an entirely different reason. When applied to lensmeters, Knapp’s law is called the Badal principle. One type of optometer used for performing objective refraction is based on a variation of Knapp’s law wherein the posterior focal plane of the correcting lens coincides with the anterior nodal point of the eye. The effect is the same. Retinal image size remains constant. In this application, the law is called the optometer principle. Optical engineers use a variation of Knapp’s law called telecentricity to improve the performance of telescopes and microscopes. Regardless of the name, the principle remains the same.
Afocal Systems
Consider an optical system consisting of 2 thin lenses in air (Fig 1-42). The lens powers are +2 D and –5 D, respectively. Where is Fp for this system? The posterior focal point is where incoming parallel rays focus. However, as ray tracing demonstrates, rays entering the system parallel to the optical axis emerge parallel to the axis. This system has no focal points; in other words, it is an afocal system.
Figure 1-42 The Galilean telescope, an afocal system. The lenses are separated by the difference in focal lengths. F is simultaneously the posterior focal point of the plus lens and the anterior focal point of the minus lens. (Illustration developed
b y Kevin M. Miller, MD, and rendered b y C. H. Wooley.)
If an object is 2 m in front of the first lens, where is the image and what is the transverse magnification? Vergence calculations show that the image is virtual, that it is 44 cm to the left of the second lens (14 cm to the left of the first lens), and that the transverse magnification is 0.4×. If an object is 4 m in front of the first lens, vergence calculations show that the image is virtual, that it is 76 cm to the left of the second lens, and that the transverse magnification is exactly 0.4. In afocal systems, the transverse magnification is the same for every object regardless of location.
Where are the principal planes for this system? Actually, it has no principal planes. Remember, the principal planes are the unique conjugates with a transverse magnification of 1. In this system, the transverse magnification is always 0.4 and never 1. If the transverse magnification were equal to 1, it would be 1 for every pair of conjugates. Consequently, there would be no unique set of planes that could be designated principal planes. In general, afocal systems do not have cardinal points.
Afocal systems are used clinically as telescopes or low vision aids. The 2 basic types of refracting telescopes are the Galilean telescope (named for, but not invented by, Galileo) and the Keplerian, or astronomical telescope (invented by Johannes Kepler). The Galilean telescope consists of 2 lenses. The first lens, the objective lens, is always positive and usually has a low power, whereas the second lens, the eyepiece, or ocular, is always negative and usually has a high power. The lenses are separated by the difference in their focal lengths. The afocal system depicted in Figure 1-42 is a Galilean telescope. The Galilean telescope is also used in some slit-lamp biomicroscopes.
The Keplerian telescope also consists of 2 lenses, a low-power objective and a high-power ocular, but both are positive and separated by the sum of their focal lengths. The image is inverted. For comparison, construct a Keplerian telescope using +2 D and +5 D trial lenses.
For each telescope,
where
Peye = power of the eyepiece or ocular Pobj = power of the objective lens
fobj = focal length of the objective lens
feye = focal length of the eyepiece (negative for concave lenses)
For afocal telescopes like the Galilean and the Keplerian telescopes, the focal point of the objective lens and the focal point of the ocular lens are in the same position.
Each form of telescope has advantages and disadvantages. The advantage of a Galilean telescope is that it produces an upright image and is shorter than a Keplerian telescope. These features make the Galilean telescope popular as a spectacle-mounted visual aid or in surgical loupes.
Conversely, the Keplerian telescope uses light more efficiently, making faint objects easier to see (Fig 1-43). In the Keplerian design, all the light from an object point collected by the objective lens ultimately enters the eye. In the Galilean design, some of the light collected by the objective is lost. Because astronomical observation is largely a matter of making faint stars visible, all astronomical telescopes are of the Keplerian design. The inverted image is not a problem for astronomers, but inverting prisms are placed inside the telescope. Common binoculars and handheld visual aids are usually of the Keplerian design.
Figure 1-43 Comparison of Galilean and Keplerian telescopes. In the Galilean telescope (A), some of the light collected by the objective is lost. In the Keplerian telescope (B), all the light collected enters the eye. (Illustration developed b y Kevin M. Miller,
MD, and rendered b y C. H. Wooley.)
