BY: Dr.

Samarth mishra
 The refractometry( optometry) is an alternative method of finding
out the error of refraction by use of an optical equipment called
REFRACTOMETER/ OPTOMETER
 OPTICAL PRINCIPLES
 SCHEINER PRINCIPLE:

 scheiner{1619} observed that refractive error of eye can be

determined by using double pinhole apertures.

 Parallel rays of light entering the eye from a distant object,are

limited to two small bundles when double pinhole apertures are
placed in front of the pupil.

 Myopic bundles cross each other before reaching the retina

two small spots of lights are seen.

 Hypermetropic rays are intercepted by the retina before they

meet again two small spots are seen.
 These two points of light can be coalesced to a single point by
moving the double pinhole to the far point of eye.
 So from far point of eye,refractive error of eye can be found.

 Myopia

 Hyper-
metropia
 THE OPTOMETER PRINCIPLE:

 Porterfield{1759} coined term optometer.

 use a single converging lens placed at its focal length from the
eye instead of interchangeable trial lenses.

 Light from the target on far side of lens enters the eye with
vergence of zero/minus/plus, depending on the position of target.

 Vergence of light in the focal plane of optometer lens is linearly

related to the displacement of target.
 A scale with equal spacing can thus be made which would show the
no. of dioptres of correction.

( optometer principle)
 EARLY REFRACTOMETERS
 Early subjective optometers:

 During 1895-1920 were all subjective.

 Needed the pt. to adjust the instrument for best focus.
 Were unsuccessful because of instrument accomodation.
 E.g : badal optometer,
young optometer.

 Early objective optometers:

 Depends on examiner’s decision on when the image is clearest.

 Mainly based on optometer principle.
 LIMITATIONS OF THE EARLIER OPTOMETERS:

a) ALIGNMENT PROBLEM
b) IRREGULAR ASTIGMATISM
c) ACCOMODATION

 ALIGNMENT PROBLEM:

-As per scheiner principle both pinhole apertures must fit within
patient’s pupil.
-If the pt. fixation wanders or he/she move the head,the reading
is invalid.

-Thus,considerable cooperation is required!!

 IRREGULAR ASTIGMATISM:
-in irregular astigmatism, the best refraction over the
whole pupil maybe different in contrast to the two small
pinhole areas of the pupil.

 ACCOMODATION:
-on looking into the instrument,pt tends to
accommodate instrument myopia.
-alters the actual refractive status of the pt.
 GENERAL COMPARISON OF SUBJECTIVE &
OBJECTIVE INSTRUMENTS:

o Source of light:
objective refractometers use invisible infrared
light.
subjective refractometer  use visible light.

o Time required for refraction:

objective refractometer2-4 mins.

subjective refractometer4-8 mins.
o Information provided:
objective refractometer provide less info.
subjective refractometer supply more info.

o Pt cooperation factors:
objective refractometer req less pt cooperation.
subjective refractometer req more cooperation .

In general ,it has been observed that children >5yrs of

age can be refracted with objective refractometer,while
for subjective refractometer use the child should be
>8yrs of age.
o ocular factors:
-ocular diseases may limit the performance of
refractometers.
-in hazy media causing a drop in VA<6/18 ,the objective
refractometers donot function properly.
-in macular diseases objective better than subjective
refractometers.

o Over refraction capability:

- over-refraction in pts using spectacles,contact lenes,iol
is difficult with objective refractors d/t reflection.
 Some common charectristics of ARs:
 fixation target & control of accomodation:
-fixation target is provided to help control the patient’s
fixation & accommodation.
-mostly coloured photographs of outdoor scenes with
prominent central features in the distance are used.

-[accommodation is most relaxed when]:

a prominent feature is of low spatial frequency natural scenes
the visual scene has a wide band of spatial have
frequencies for observation. these
when the pt identifies the scene as one seen charecteristics.
at distance.
 Primary source of electromagnetic radiation in AR
-near infrared radiation (NIR)
- 780-950 nm.
-NIR is efficiently reflected back from fundus.
-is invisible to pt.

 Secondary source of electromagnetic radiationback

scatter from fundus.
 Nulling principle refractometers:
-change their optical system until the refractive error of
eye is neutralized. i.e until end point is reached.
-can function in higher signal/noise ratio.

• Open loop principle refractometers: (non-nulling)

-make measurements by analyzing the characteristics of
the radiation exiting the eye.
-more quick as they don’t require to change their optical
systems.
 objective refractometers are based on one or
more of following working principles:

 The scheiner principle

 The optometric principle
 The best focus principle
 The knife edge principle
 The ray-deflection principle
 The image size principle.
 ARs BASED ON SCHEINER PRINCIPLE:

-dates back to christopher scheiner,1619.

-light from a primary point source at near was collimated

through a condensing lens passed through the “scheiner’s
disc” directed to the eye.

-modern version of scheiner principle is accomplished with

infrared light emitting diodes(IR-LEDs) that are optically
presented in substitution for the apertures in a scheiner disc.
 AR based on scheiner principle:

acuity systems 6600

grand seiko(RH burton’s BAR 7 in the USA;BAR 8 with

autok)

nidek (marco’ s AR-800 & 820 in the USA;ARK 900 with

autoK)

takagi

topcon
 Basic working features of scheiner’s principle
autorefractors:

nulling refractors: these are nulling refractors that

optically substitute IR-LEOs for the apertures of a
traditional scheiner’s disc.

concept of badal optometer: is used to accomplish

projection of NIR into the eye,collection of fundal reflex
& determination of refractive status.
corneal reflex: is removed & the vitreoretinal reflex is
attenuated by a corneal reflex block introduced into the
path of radiation returning from the fundus.

specialized photodetection device: to analyse the

position of fundus images created by the optical train.

meridional refractive errors: are neutralized & the two

primary meridia of the eye are found by a second nulling
process.

refractive power endpoints: these ARs can reach

refractive power endpoints at speeds of 100 D/SEC.
 ARs BASED ON RETINOSCOPIC PRINCIPLE:

 Called autoretinoscopes. Based on following two chr.

 Direction of motion of the observed fundus reflex: with the

direction of motion of incident radiation.
 E.g bausch & lomb ophthalmetron.( no longer available in
market)

 Speed of motion of observed fundus reflex: with respect to the

motion of incident radiation.
E.g nikon NR-5500
nikon retinomax
tomey TR-1000
carl zeiss meditec “acuitus”
nidek OPD-scan
 Basic working features of retinoscopic principle ARs:

source optical train of an autoretinoscope imitates the

function of a streak retinoscope.

motion of incident rectangular beams is usually created

by a slotted drum rotating about a source of NIR.

refractors based on the analysis of the direction of

motion of the retinoscopic fundus reflex are nulling
refractors.
- neutralization by use of badal optometer.

autoretinoscopes based on the analysis of the speed of

motion of fundus reflex are open loop(non-nulling)
corneal reflex: is masked from photodetection as it falls
on the spaces between photocells.

vitreoretinal & corneal reflexes can be filtered by the

polarization of incoming NIR to the eye & the removal of
polarized NIR returning from the eye in the fundus
image.

autoretinoscopes are meridional refractors.

photodetection devices are usually composed of 2-4

photocells.
 ARs BASED ON BEST FOCUS PRINCIPLE:

Utilizes the automatic detection of a change of image

contrast at the fundus.
i.e by capturing the vergence of incident radiation
necessary to bring about max contrast.

dioptron

canon autorefractor ( based on best focus

principle)
hoya autorefractor
 Basic working feature of dioptron:
( rest no longer available)
are both nulling & meridional refractors.

neutralization is achieved with the use of badal optometer.

refractive endpoint is obtained when the referred image of a

secondary fundus source attains highest contrast at the plane
of a photo detection device.

vitreoretinal reflex

corneal reflex, can be filtered by the polarization

& removal of polarized NIR
returning from the eye
coaxial reflex
 ARs BASED ON KNIFE-EDGE PRINCIPLE:

knife edge principle is related to retinoscopy,& it is the basis

of photorefraction.

it is a retroreflective method using the same entrance & exit

pupil of the device under test.

Basic working principle:

use the concept of reciprocity such that radiation from the

fundus reflex is returned to the primary source.
are nulling refractometers.
Cylinder power & axis are neutralized with the use of two
stokes lenses.
coaxial reflexes from the extensive common optical path can
be reduced by tipping of common-path elements.
 ARs BASED ON RAY-DEFLECTION PRINCIPLE:

E.g : canon R 30
hoya
welch-allyn sure-sight(hartmann -shack
handheld)
VISX waveScan(hartmann -shack wavefront
refractor)
bausch & lomb zywave (hartmann-shack wavefront
refractor)
alcon ladarwave(hartmann-shack wavefront
refractor)
topcon KR-9000PW
 BASIC WORKING PRINCIPLE:

 Are open loop (non-nulling) meridional refractors.

 Design is similar to that of autoretinoscope & to a

scheiner principle refractor in that discrete,fixed
pupillary areas are used.

 Measures the linear deflection of fundus image.

 Primary source & photodetectors are fixed.

 Corneal reflex removed by placing a central aperture in

a plane conjugate to the pupil in the detection path.
 Coaxial reflexes from the few common path elements
can be filtered by the polarization & removal of
polarized NIR returning from the eye.
 ARs BASED ON IMAGE-SIZE PRINCIPLE:

E.g: grand seiko( RH burton’s handheld BAR 600 in USA)

grand seiko WR 1500K( a “see-through” instrument)
topcon RM-A7000

basic working principle:

 Size of optical image on the retina is a function of the
refractive error.

 The refractive status therefore be determined by

measuring the size of an annular secondary fundus
source.
 Detection system consists a fundus camera: a
CCD(charge coupled device) camera is used as detector.

 Design is same as scheiner principle refractors.

 Instrument measures the size of fundus image in three

or more different meridia.

 Video imaging of fundus reflex accomplished by fundus

camera.

 Image analysis of video image performed by computer

programme.

 Refractive power found by open-loop(non-nulling)

process.
 SUBJECTIVE AUTOREFRACTORS:

 VISION ANALYSER:
introduced by humphrey in 1975.
was combined with humphrey lens analyser to form
over-refraction system.

 SR-IV PROGRAMMED SUBJECTIVE REFRACTOR:

uses optometer principle.

an axially moving cylindrical lens to achieve smoothly
variable spherocylindrical powerover a wide range.
 SUBJECTIVE AUTOREFRACTOR-7:

instrument has spherical optics only.

since no astigmatic correction is possible, and VA
cannot be measured with spheres, this is only a
screening instrument.
THANK
YOU