CLINICAL REFRACTION & INSTRUMENTATION

Assignment:

Submitted to Mam Mamoona

Submitted by Ammara Anwar
70091519
DOVS 7th (B)

 On which principle Ketatometer is

based on , Discuss Javal Schiotz
Keratometer!

Keratometer:
A keratometer, also known as an ophthalmometer, is a diagnostic instrument for
measuring the curvature of the anterior surface of the cornea, particularly for
assessing the extent and axis of astigmatism & the procedure is known as
keratometery.
It was invented by the German physiologist Hermann von Helmholtz in 1851, although an earlier
model was developed in 1796 by Jesse Ramsden and Everard Home.

Kerato =Cornea , Metery= Measurement of

Uses:
 Evaluating degree of astigmatism for diagnosis.
 Fitting of eyeglasses and contact lenses.
 Analyzing and diagnosing patients having keratoconus.
 Determining intraocular lens power for patients suffering from cataracts.
 Assess refractive error in case with hazy media
  Assess integrity of cornea & tearfilm
 Establish baseline data , should be done in all patient.

Keratometer uses the relationship between object size (O), image size (I),
the distance between the reflective surface and the object (d), and the
radius of the reflective surface (R). If three of these variables are known (or
fixed), the fourth can be calculated using the formula

R= 2d x I/O
R: Radius of curvature of the cornea in meters.
d: Distance of the object from the cornea.
I: Size of the image.
O: Size of the object

Now, the refractive power of the cornea can be given by the formula

D = (n-1)/R

D: Dioptric refracting power of the corneal surface.

n: refractive index of the instrument (n= 1.3375 generally)

Principle:
 Keratometer utilizes reflactive properties of cornea in order to measure its
radius of curvature
 By measuring the size of an image, formed by reflection from cornea, of an
object of known size & position a measurement of radius can be calculated
 Anterior surface of the cornea acts as a concave mirror. The keratometer
uses a target, also known as mires; of a known size at a known distance
from the cornea.
One & two position Keratometer:
 Keratometers that require rotation through 90° in order to measure second
principle meridians are known as two position keratometers
  Keratometers that do not require rotation in order to measure second
principle meridians are known as one position keratometers
 The Javal-Schiotz keratometer is a two position instrument
which uses a fixed image and doubling size and adjustable
object size to determine the radius of curvature of the reflective
surface.

Javal-Shiotz Keratometer:

The Javal-Schiotz keratometer is a two position instrument which uses a

fixed image and doubling size and adjustable object size to determine
the radius of curvature of the reflective surface.

It uses two self illuminated mires (the object), one a red square, the
other a green staircase design, which are held on a circumferential track
in order to maintain a fixed distance from the eye. In order to get
repeatable, accurate measurements, it is important that the instrument
stays focused.

It uses the Scheiner principle, common in autofocus devices, in which the

converging reflected rays coming towards the eyepiece are viewed through
(at least) two separate symmetrical apertures.

Principle : Variable object size & constant image size

Mechanical adjustment & parts:

 Focusing knob
  Rotating grip for locating the axis
 Chin rest
 Locking knob
 Elevating knob
 Eye piece
 Head rest adjusting knob
 Occluding shield
 Head rest
 Chin rest adjusting knob
 Leveling sight
 Horizontal measuring drum
 Vertical measuring drum
 Axis scale

Steps to use Javal Shiotz Keratometer:

 Eyepiece Adjustment: First, the eyepiece needs to be turned
counterclockwise entirely. A white sheet of paper can be placed in front
of the telescope part. The eyepiece should be turned clockwise until the
instrument reaches a sharp focus for a given target object.

 The height of the device should be aligned with the level of the patient’s
sight sign.

 The non-testing eye of the patient should be blocked.

 The patient should then be asked to look directly at the center of the
device. The patient should be able to see the picture of the circles in
their eyes.
 The instrument should be adjusted in order to see a sharp image of the
staircase and rectangle targets.
 The instrument can be rotated for aligning the line in the staircase target
with the line in the rectangle target.
 The measuring knob can be turned until both the staircase and
rectangle targets overlap.
 The values will now be displayed on the keratometer scale.
 Only central pair of images are used when measurements are made
 When two control images just meet, the scales associated with mires
sepration indicate the corect corneal radius & diaoptric power of cornea .