Optometer (ophthalmic instrument)

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The optometer was a device used for measuring the necessary spherical and/or cylindrical corrections to be prescribed for eyeglasses, from the middle of the 18th century until around 1922, when modern instruments were developed. [1] [2] [3] The term, coined in 1738 by W. Porterfield to describe his Scheiner slit optometer, [4] and used for 200 years to describe many different inventions to measure refractive error of the eye, has completely fallen out of usage today as the task of measuring eyes for spectacles is done with modern instruments, such as the phoropter.

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"Phoropter" is one of several generic names for modern instruments containing an optometer for each eye (battery of lenses for determination of optical error), combined with prisms and other attachments for measuring binocularity. The term refractor is another such term, and "vision tester" or other descriptive terms are used because "phoroptor", spelled with "-or", is a trademark of one company. [5]

Greens' Refractor, 1934 to 1978 Greens' refractor 001.jpg
Greens' Refractor, 1934 to 1978

Examples of optometers


The modern phoropter or refractor

In the middle of the 19th century, doctors tested for optical error using single hand-held lenses, held one at a time in front of the patient's eye, or in a trial frame. A wooden case with dozens or hundreds of lenses was held on the doctor's lap, or in a case near the patient's chair, as he or she examined the patient.

In the later part of the 19th century, the United States, Germany, France and the UK were actively inventing numerous mechanical optometers, to speed up the process of bringing lenses before the patients' eyes. Various patented or unpatented optometers were sold throughout the later 19th and the start of the 20th centuries, some containing rotating batteries of lenses in various arrangements, usually with the name of the inventor at the front.

Around 1910, binocularity was tested using trial frames which sat on the patient's face or on a support bar, with extra testing devices added to the front of the frames, such as Maddox rods, rotating prisms, and phorometers. The refraction part of the exam was done with trial lenses that fit into the back of the same trial frame. Optometer was the generic name for devices, crude and simple, with rotating batteries of sphere and cylinder lenses placed in front of each eye, one at a time; so there was no testing for binocularity. When the optometer and phorometer were combined into single instruments, the modern refractor/phoropter was born. This happened in the middle 1910s when two companies in the New York City area began to market competing versions. [12]

A third US company, Bausch & Lomb, joined the competition in 1934, while the other 2 made improvements. Around that time, many companies in Europe and Asia began making phoropters of their own design, as well as copying American models.

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Esotropia Form of strabismus

Esotropia is a form of strabismus in which one or both eyes turns inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. It is the opposite of exotropia and usually involves more severe axis deviation than esophoria. Esotropia is sometimes erroneously called "lazy eye", which describes the condition of amblyopia; a reduction in vision of one or both eyes that is not the result of any pathology of the eye and cannot be resolved by the use of corrective lenses. Amblyopia can, however, arise as a result of esotropia occurring in childhood: In order to relieve symptoms of diplopia or double vision, the child's brain will ignore or "suppress" the image from the esotropic eye, which when allowed to continue untreated will lead to the development of amblyopia. Treatment options for esotropia include glasses to correct refractive errors, the use of prisms and/or orthoptic exercises and/or eye muscle surgery. The term is from Greek eso meaning "inward" and trope meaning "a turning".

Far-sightedness Eye condition in which light is focused behind instead of on the retina

Far-sightedness, also known as long-sightedness, hypermetropia, or hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blurred effect is due to incoming light being focused behind, instead of on, the retina wall due to insufficient accommodation by the lens. Minor hypermetropia in young patients is usually corrected by their accommodation, without any defects in vision. But, due to this accommodative effort for distant vision, people may complain of asthenopic symptoms during prolonged reading. Some hypermetropes can see clear at distance, but near vision may be blurred due to insufficient accommodation. For this reason, this defect is referred as far-sightedness. If the hypermetropia is high, there will be defective vision for both distance and near. People may also experience accommodative dysfunction, binocular dysfunction, amblyopia, and strabismus. Newborns are almost invariably hypermetropic, but it gradually decreases as the newborn gets older.

LASIK Corrective ophthalmological surgery

LASIK or Lasik, commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and an actual cure for astigmatism, since it is in the cornea. LASIK surgery is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye's cornea in order to improve visual acuity. For most people, LASIK provides a long-lasting alternative to eyeglasses or contact lenses.

Orthoptics is a profession allied to the eye care profession. Orthoptists are the experts in diagnosing and treating defects in eye movements and problems with how the eyes work together, called binocular vision. These can be caused by issues with the muscles around the eyes or defects in the nerves enabling the brain to communicate with the eyes. Orthoptists are responsible for the diagnosis and non-surgical management of strabismus (squint), amblyopia and eye movement disorders. The word orthoptics comes from the Greek words ὀρθός orthos, "straight" and ὀπτικός optikοs, "relating to sight" and much of the practice of orthoptists concerns disorders of binocular vision and defects of eye movement. Orthoptists are trained professionals who specialize in orthoptic treatment, such as eye patches, eye exercises, prisms or glasses. They commonly work with paediatric patients and also adult patients with neurological conditions such as stroke, brain tumours or multiple sclerosis. With specific training, in some countries orthoptists may be involved in monitoring of some forms of eye disease, such as glaucoma, cataract screening and diabetic retinopathy

Eyeglass prescription Order written by an eyewear prescriber

An eyeglass prescription is an order written by an eyewear prescriber, such as an optometrist, that specifies the value of all parameters the prescriber has deemed necessary to construct and/or dispense corrective lenses appropriate for a patient. If an eye examination indicates that corrective lenses are appropriate, the prescriber generally provides the patient with an eyewear prescription at the conclusion of the exam.

Refractive surgery Medical specialty

Refractive eye surgery is optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Refractive eye surgeries are used to treat common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

Intraocular lens Lens implanted in the eye to treat cataracts or myopia

Intraocular lens (IOL) is a lens implanted in the eye as part of a treatment for cataracts or myopia. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic, or false lens. Such a lens is typically implanted during cataract surgery, after the eye's cloudy natural lens (cataract) has been removed. The pseudophakic IOL provides the same light-focusing function as the natural crystalline lens. The phakic type of IOL is placed over the existing natural lens and is used in refractive surgery to change the eye's optical power as a treatment for myopia (nearsightedness). This is an alternative to LASIK.

Anisometropia is when two eyes have unequal refractive power. Generally, a difference in power of two diopters or more is the accepted threshold to label the condition anisometropia.

Eye examination A series of tests assessing vision and pertaining to the eyes

An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.

Autorefractor

An autorefractor or automated refractor is a computer-controlled machine used during an eye examination to provide an objective measurement of a person's refractive error and prescription for glasses or contact lenses. This is achieved by measuring how light is changed as it enters a person's eye.

Phoropter Ophthalmic testing device

A phoropter or refractor is an ophthalmic testing device. It is commonly used by eye care professionals during an eye examination, and contains different lenses used for refraction of the eye during sight testing, to measure an individual's refractive error and determine their eyeglass prescription. It also is used to measure the patients' phorias and ductions, which are characteristics of binocularity.

Otoscope

An otoscope or auriscope is a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum. Because the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of earwax (cerumen), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope, but confirm the presence of obstructing symptoms.

Worth 4 dot test

The Worth Four Light Test, also known as the Worth's Four Dot test or W4LT, is a clinical test mainly used for assessing a patient's degree of binocular vision and binocular single vision. Binocular vision involves an image being projected by each eye simultaneously into an area in space and being fused into a single image. The Worth Four Light Test is also used in detection of suppression of either the right or left eye. Suppression occurs during binocular vision when the brain does not process the information received from either of the eyes. This is a common adaptation to strabismus, amblyopia and aniseikonia.

Astigmatism Type of eye defect

Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. This results in distorted or blurred vision at any distance. Other symptoms can include eyestrain, headaches, and trouble driving at night. Astigmatism often occurs at birth and can change or develop later in life. If it occurs in early life and is left untreated, it can result in amblyopia.

Aniseikonia is an ocular condition where there is a significant difference in the perceived size of images. It can occur as an overall difference between the two eyes, or as a difference in a particular meridian. If the ocular image size in both eyes are equal, the condition is known as iseikonia.

The design of photographic lenses for use in still or cine cameras is intended to produce a lens that yields the most acceptable rendition of the subject being photographed within a range of constraints that include cost, weight and materials. For many other optical devices such as telescopes, microscopes and theodolites where the visual image is observed but often not recorded the design can often be significantly simpler than is the case in a camera where every image is captured on film or image sensor and can be subject to detailed scrutiny at a later stage. Photographic lenses also include those used in enlargers and projectors.

The aim of an accurate intraocular lens power calculation is to provide an intraocular lens (IOL) that fits the specific needs and desires of the individual patient. The development of better instrumentation for measuring the eye's axial length (AL) and the use of more precise mathematical formulas to perform the appropriate calculations have significantly improved the accuracy with which the surgeon determines the IOL power.

Subjective refraction Technique to determine the combination of lenses that will provide the best corrected visual acuity

Subjective Refraction is a technique to determine the combination of lenses that will provide the best corrected visual acuity (BCVA). 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. The aim is to improve current unaided vision or vision with current glasses. Glasses must also be comfortable visually. The sharpest final refraction is not always the final script the patient wears comfortably.

Bagolini striated glasses test, or BSGT, is a subjective clinical test to detect the presence or extent of binocular functions and is generally performed by an optometrist or orthoptist or ophthalmologist. It is mainly used in strabismus clinics. Through this test, suppression, microtropia, diplopia and manifest deviations can be noted. However this test should always be used in conjunction with other clinical tests, such as Worth 4 dot test, Cover test, Prism cover test and Maddox rod to come to a diagnosis.

Ophthalmic trial frame Tool used in eye examination

A trial frame is a tool used by ophthalmic professionals like ophthalmologists and optometrists. It is basically an adjustable spectacle frame with multiple cells, used to hold corrective lenses, and other accessories in subjective refraction and retinoscopy.

References

  1. "The Modern Phorometer," 1917, Henry DeZeng, self-published, Camden New Jersey
  2. "Instructions for L. A. Berteling's Compound Optometer," 1885, L. A. Berteling, George Spaulding & Co. San Francisco
  3. "Ein Neues Optometer," 1863, Karl Burow, Berlin
  4. "Thomas Young's Contribution to Visual Optics", Journal of Vision, Oct 14, 2010, David A. Atchison and W. Neil Charman.
  5. "Visual Optics and Refraction" by David D. Michaels, Mosby 1980, p. 232
  6. U.S. Patent Office
  7. "Instructions for L. A. Berteling's Compound Optometer," 1885, L. A. Berteling, George Spaulding & Co. San Francisco, p. 17
  8. "Instructions for L. A. Berteling's Compound Optometer," 1885, L. A. Berteling, George Spaulding & Co. San Francisco, p. 16
  9. "The Modern Phorometer," 1917, Henry DeZeng, self-published, Camden New Jersey, p.26
  10. "The Modern Phorometer," 1917, Henry DeZeng, self-published, Camden New Jersey, p 46
  11. "The Modern Phorometer," 1917, Henry DeZeng, self-published, Camden New Jersey, frontispiece
  12. phoropter