Autorefractors & Phoropters

Question 1

What is the definition of an autorefractor?

Answer 1

An instrument designed to automatically measure refractive error

Question 2

What is an autorefractor also known as?

Answer 2

An automated refractor or an objective optometer.

Question 3

What is an optometer?

Answer 3

A device to measure refractive error that obviates or restricts the use of trial lenses

Question 4

What are the uses of an autorefractor and why?

Answer 4

 Screening - Especially pre-screening in optometric practice  Where speed and ease of use are required

 Widely used in the developing world - Vision Aid Overseas

Measuring accommodation in research studies

Does the job of a retinoscope

Question 5

Why does a px look at a distant target in an autorefractor?

Answer 5

To relax their accommodation as much as possible.

Question 6

What is a simple optometer?

Answer 6

Question 7

What are the disadvantages of a simple optometer?

Answer 7

• Large depth of focus
• The target can stimulate accommodation ( making the Rx wrong)
• Scale is non-linear ( in terms of progression)
• The apparent size of the target varies ( as you bring it closer)
• Proximal accommodation
• Astigmatism ( Simple optometers cannot measure astigmatism)
• Relies on subjective response

[All of these problems apart from Proximal accommodation, are largely solved in modern objective instruments]

Question 8

What is proximal accommodation?

Answer 8

The awareness that a object is close to us thus we accommodate

Question 9

What is the Scheiner principle and how is it used to measure vision?

Answer 9

It involves placing a Scheiner disk in front of the eye.

For an emmetrope when an object is placed at the far point, they will only see one line. A coincident image is placed on the retina.

For a myope they will see 2 crossed lines as image forms in front of the retina.

For a hypermetrope, they will see 2 uncrossed lines as the image forms behind the retina.

Question 10

What is the advantage of the Scheiner disk over the simple optometer?

Answer 10

It allows for a better assessment of focus.

Question 11

What are the disadvantages of the Scheiner principle?

Answer 11

• Target can stimulate accommodation
• Scale is non-linear
• When are images coincident- i.e. the images touching doesn’t necessarily indicate the end point
• Proximal accommodation

Question 12

True or false - Modern autorefractors still use the Scheiner principle.

Answer 12

True

Question 13

True or False - Both the simple optometer and modern autorefractors use visible light to measure refraction.

Answer 13

False - Modern autorefractors use infrared radiation

Question 14

Why do modern autorefractors use Infrared radiation?

Answer 14

The retina reflects infrared radiation better than visible light.

Infrared light is invisible to the human eye - so no effect on px comfort or pupil diameter.

Question 15

True or false - light of different wavelengths will focus at different lengths in the eye

Answer 15

True - some colours such as blue focus in front of the retina whereas other colours such as green focus behind the retina.

Question 16

True or false - green light wavelength focuses on the retina.

Answer 16

True - that’s why we ask our px to look at the green of the duochrome when we refract them.

(It relaxes accommodation).

Question 17

What is transverse chromatic aberration and what does it cause?

Answer 17

Transverse chromatic aberration is an aberration caused by different wavelengths focusing at different lengths in the eye. As a result colour fringes may be seen.

Question 18

What calibration is needed in a modern Autorefractor as a result of using Infrared light as a pose to visible light?

Answer 18

An adjustment of around -0.50D to -1.00 D needs to be made to the ocular refraction due to using a different wavelength.

Question 19

True or false - IR light is reflected from deeper in the fundus than visible light.

Answer 19

True - Visible light is reflected fro the ILM whereas IR is reflected from the sclera.

This requires a correction of around -0.50D. ( The machine applies this correction factor).

Question 20

True or false- Autorefractors measure astigmatism

Answer 20

True

It measures power in six different positions ( whereas realistically it would only need to measure in three) in order to increase accuracy.

The modern autorefractor provides us with the sph/cyl and axis

Question 21

What are typical specifications of autorefractors?

Answer 21

• Can measure Up to ± 25D of sphere
• Can measure Up to ± 10D of cyl
• Minimal Pupil Diameter needed is at least 2.0mm
• They use an Autofogging technique to relax accommodation
• Some have subjective refraction facility –Internal targets for duochrome, x cyl, fan and block, subjective refraction 
• Some may also carry out keratometry

Question 22

How can we attempt to control proximal accommodation?

Answer 22

By giving them a target that appears in the distance ( e.g. a hot air balloon in the distance of a picture).

Modern autorefractors use automatic progressive fogging in order to try to control this.

Question 23

What is the benefit of the handheld autorefractor?

Answer 23

Can be used for Pxs who are disabled and cannot move to the machine.

Question 24

What are the drawbacks of IR autorefractors/optometers?

Answer 24

▪ Pupil diameters of 3mm or less produce may not give a reading ▪ Cost - they are expensive

▪ Requires good fixation - children may get bored

▪ Retinoscopy provides information on cataract assessment – retro-illumination - this is not provided by autorefractors

▪ Proximal accommodation remains an issue

▪ Tends to overminus - particularly with children

Question 25

What wavelength do modern autorefractors operate at?

Answer 25

850nm

Question 26

Which of the following is an advantage of retinoscopy over an autorefractor?

A. Proximal Accommodation

B. Image quality information

C. Controlling fixation

D. Cost

E. Portability

Answer 26

All of them

Question 27

What is a Refractor Head/Phoropter?

Answer 27

A contained unit allowing rapid lens presentation before each and both eyes by mechanical or electronic means

Question 28

What are all the different features included in a phoropter?

Answer 28

• Sphere/cyl lens tracks
• Cross cyl twirl
• Occluder
• Pinhole
• Polaroid filters
• Maddox rod
• Rotary prisms
• Vertex distance gauge
• Near target - To measure Convergence for near

Question 29

What are the advantages of refractor heads/Phoropters?

Answer 29

• Speed: which helps stabilise accommodation and keep attention
• Quick and easy to compare VA with two different lens powers
• Accuracy of cyl axis – automatical alignment of JCC
• Risley-rotary prism for fusional reserves
• Patient comfort (nose, ears)
• Lens cleanliness - don’t have to clean a trial frame - easy to wipe down phoropter

Advantages of the electronic phoropters are (also):

• Comparison check: Show old rx for each eye separately - with change in cyl
• Data transfer and storage - Automatically
• Practitioner comfort (remote and less physically demanding)
• Looks high tech - wow factor for the patient!

Question 30

What are some disadvantages of Phoropters?

Answer 30

• The glass protecting the lenses can steam up - especially with masks
• Proximal accommodation- still a problem
• Variable vertex distance - if px keeps moving around
• Not always ideal for:

 Very young

 Presbyopic contact lenses (performance is pupil dependent)

 Patients with visual impairment

 Barrier to communication

 Particularly with anxious patients

• Can create an artificial visual environment for near vision testing