Bino Laboratory Manual 3D

Centro Escolar University
Mendiola, Manila City

College of Optometry
Binocular Vision
Laboratory Exercises
Doctor of Optometry
Submitted to:
Dr. Maria Concepcion F. Anda
Submitted by:
Name: Date:
Year and Section:
Exercise #1
Parts and Function of Phoropter
I. OBJECTIVES
At the end of the exercise, the students should be able to:
1. Identify the different parts of the Phoropter and know its function
2. To manipulate the Phoropter head.
II. MATERIALS/INSTRUMENT
 Phoropter Head
III. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #2
Visual Test 3: HABITUAL PHORIA AT FAR
I. OBJECTIVES
1. Understand the significance of Visual Test #3

2. Realize the importance of VT #3 in Optometric Procedure
3. Perform VT # 3.
 Pencil, Clip Board, PD rule, Pointer, Phoropter, Snellen Chart
III. PROCEDURE
1. The patient is asked to sit on the refracting chair. Set the PD of the phoroptor
and align the phoroptor to the face of the Patient. Placed the lenses in place,
patients Habitual Correction at Far.
2. Then the patient is directed to observe the distant fixation target. The usual
target for this test is the 20/20 Snellen letters. If the patient cannot see these
letters, the size of the target should be increased until they can be identified
by the patient.
3. The patient is told to close his eyes and the dissociating device and
measuring prism are positioned. The patient is dissociated by 6 prism diopter
Base Up before the left eye. Then the measuring prism is placed before the
patient’s right eye and it is turned to 12 diopter Base- In.
4. The patient is now asked to open his eyes and will see 2 targets, a lower
image on the left side and an upper image on the right side.
5. Now begin the reduction of the amount of Base-In prism before the right eye.
Until they lined up one directly above the other or become vertically aligned.
6. As soon as the vertical alignment of the targets is obtained, either one eye of
the patients should be occluded or instructed to close his eyes.
7. If any Base-In prism remains in the measuring prism. It is recorded as Prism
diopter of Exophoria. If the measuring prism contains prism Base-out, it is
recorded as prism diopter of Esophoria.
IV. QUESTION
1. Why do we have to perform VT#3?
2. Which Eye sees the upper image and lower image? Explain the principle of
Prism.
3. Why do we have to occlude the eye as soon as the vertical alignment is
achieved?
4. Differentiate Exophoria from Esophoria.
V. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #3
Visual Test 13A: HABITUAL PHORIA AT NEAR
I. OBJECTIVES
1. Understand the significance of the Visual Test # 13a.

2. Realize the importance of VT #13a in the Optometric procedure.
3. Perform VT#13a.
 Pencil, Clip Board, PD rule, Pointer, Phoropter, Reduced Snellen Chart
III. PROCEDURE
1. The patient is asked to sit on the refracting chair. Set the PD of the phoroptor and
align the phoroptor to the face of the Patient. Place the lenses in place, patients
Habitual Correction at near.
2. Then the patient is directed to observe the near fixation target. The usual target
for this test is the 16/20 Reduced Snellen letters. If the patient cannot see these
letters, the size of the target should be increased until they can be identified by
the patient.
3. The patient is told to close his eyes and the dissociating device and measuring
prism are positioned. The patient is dissociated by 6 prism diopter Base Up
before the left eye. Then the measuring prism is placed before the patient’s right
eye and it is turned to 12 diopter Base-In.
4. The patient is now asked to open his eyes and will see 2 targets, a lower image
on the left side and an upper image on the right side.
Until they line up one directly above the other or become vertically aligned.
6. As soon as the vertical alignment of the targets is obtained, either one eye of the
patients should be occluded or instructed to close his eyes.
IV. QUESTION
1. Why do we have to perform VT#13a?
Prism.
achieved?
V. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #4
Visual Test 8: INDUCED PHORIA AT FAR
I. OBJECTIVES
4. Understand the significance of the Visual Test #8

5. Realize the importance of VT #8 in the Optometric procedure.
6. Perform VT#8
 Pencil, Clip Board, PD rule, Pointer, Phoropter, Snellen Chart
III. PROCEDURE
and align the phoroptor to the face of the Patient. Place the lenses in place,
patient’s subjective findings at far.
2. Then the patient is directed to observe the distance fixation target. The usual
target for this test is the 20/20 Snellen letters. If the patient cannot see these
letters, the size of the target should be increased until they can be identified by
the patient.
before the left eye. Then the measuring prism is placed before the patient’s
right eye and it is turned to 12 diopter Base-In.
7. If any Base-In prism remains in the measuring prism .It are recorded as Prism
IV. QUESTIONS
1. Why do we have to perform VT#8?
Prism.
achieved?
V. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #5
Visual Test 13B: INDUCED PHORIA AT NEAR
I. OBJECTIVES
1. Understand the significance of the Visual Test #13b.

2. Realize the importance of VT #13b in the Optometric procedure.
3. Perform VT#13b.
 Pencil, Clip Board, PD rule, Pointer, Phoropter, Reduced Snellen Chart
III. PROCEDURE
at near and align the phoroptor to the face of the Patient. Placed the lenses in
place, patient’s subjective findings at near.
2. 2 Then the patient is directed to observe the near fixation target. The usual
target for this test is the 16/20 Reduced Snellen letters. If the patient cannot
see these letters, the size of the target should be increased until they can be
identified by the patient.
before the left eye. Then the measuring prism is placed before the patient’s
right eye and it is turned to 12 diopter Base-In.
IV. QUESTIONS
1. Why do we have to perform VT#13b?

Prism.
achieved?
V. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #6
Visual Test 9: TRUE ADDUCTION AT FAR
I. OBJECTIVES
1. Understand the significance of the Visual Test #9.

3. Perform VT#9.
II. PROCEDURE
1. The patient is instructed to sit on the refracting chair, set the PD, placed the
phoroptor head on the patient. The test is performed through the patients
subjective Finding.
2. The patient is observing the distance snellen chart and the usual target is the
20/20 line or the smallest readable.
3. While the patient is viewing the smallest snellen letters visible through the
subjective finding, an additional Plus +0.25 Diopter Sphere is added to each
eye.
4. The patient is asked if he noticed the blur produced by this simultaneous
addition of plus sphere.
5. The plus +0.25 diopter spheres are removed and the risley Prism are positioned
so that they can be turned into a Base-Out direction.
6. The patient is instructed that this same blur will be produced again and as soon
as he notices this condition he is to report “Blur”.
7. Now, both rotary prisms should be turned in the Base-Out direction
simultaneously and slowly.
8. As soon as the patient reports “Blur” the total amount of Base-out prism in
both rotary prism is recorded.
9. The amount of Base-Out prism needed to cause a blur equivalent to a 0.25
diopter plus sphere above the subjective finding is recorded as the True
Adduction finding.
10. Record your finding by adding the amount of Prism base- out on both eyes.
III. QUESTIONS
1. What is the purpose of the +0.25 Dsph?
2. Why do we have to blur the target?
3. In what direction does the eye moves as you turn the rotary prism.
4. What is the significance of the test?
IV. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #7
Visual Test #10: CONVERGENCE AT FAR
I. OBJECTIVES

3. Perform VT#10.
II. PROCEDURE
1. This test is the continuation of VT# 9. When the patient has reported that the
target is blurred and the data for VT # 9 has been recorded, continue turning
more Base-Out prism binocularly and the patient is asked to report when the
target doubles.
2. When diplopia has been reported, the amount of Base-Out is recorded as the
Break Point for the test.
3. Then the patient is instructed to report when the target becomes one.
4. Now, the amount of Base-Out prism in the rotary prism is slowly decreased
binocularly and the amount of prism in place when the patient reports single
vision is recorded as the Recovery portion of the test.
5. Two results are recorded for the test and expressed as Fraction; Break/ Recovery.
The total amount of prism for both eyes is the one recorded.
6. Sometimes, the patient will not be able to regain fusion until a Base- In prism has
been introduced. In this case the Recovery is recorded in the minus value.
7. At times, the patient may report that the target is not doubling, but that it seems
to move to one side. The direction of movement detected by the patient should
be determined. He may report that the target moves toward his right or the target
moves towards his left.
III. QUESTIONS:
1. What is the effect of additional prism Base-Out to the eye?

2. What type of diplopia is seen?
3. What eye is suppressing if the target moves toward the right?
4. What eye is suppressing if the target moves toward the left?
5. What is the significance of VT# 10
IV. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #8
Visual Test 11: ABDUCTION AT FAR
I. OBJECTIVES

3. Perform VT#11.
II. PROCEDURE
1. When the patient has reported that the targets is blurred, continue turning Base-in
prism binocularly then, asked the patient to report when the target doubles.
2. As the patient sees 2 images or diplopia, the amount of Base-in prism is recorded as
the break point for the test.
3. Then, instruct the patient to report when the target becomes one.
4. Record the amount of Base-in prism when the patient already reports that he sees one
image. It is expected to have a decreased amount binocularly and that recording
would be for the recovery.
5. Two results are recorded for the test and expressed in this equation:
BREAK/RECOVERY.
6. There are cases that the patient will not be able to regain fusion until Base-out prism
has been introduced. This will be recorded with the amount of Base-out prim in
minus sign.
7. At times, the patient may report that the target is not doubling, but only moves on one
side. The direction of the movement detected by the patient should be determined.
The patient may report that the target moves toward his right or left.
III. QUESTIONS
1. What is the effect of additional prism Base-in to the eye?
2. What type of diplopia is seen?
3. What eye is suppressing if the target moves towards the right?
4. What eye is suppressing if the target moves towards the left?
5. What is the significance of VT #11?
IV. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #9
Visual Test 12: VERTICAL PHORIA AND DUCTION AT FAR
I. OBJECTIVES

3. Perform VT#12.
II. PROCEDURE
1. This test is consists of two parts, first the vertical phoria test and secondly the
vertical duction test.
2. Part 1 is the Phoria test, this test is taken through the subjective finding with
the patient observing the Snellen target.
3. The patient is dissociated with 10 to 15 prism base-in before the right eye.
And 6-8 prism base-up before the left eye.
4. The patient will see two targets one is on the lower left side of the field.
5. The patient is asked to report when the targets are aligned horizontally(
directly across from each other)
6. Now, the amount of base-up is slowly reduced before the left eye. Any base-
up remaining in the prism before the left eye when the patient has reported
horizontal alignment would be recorded as diopters of right hyperphoria, and
any prism base-down remaining in the prism before the left eye would be
recorded as diopters of left hyperphoria.
7. Part 2 of the test, upon completion of the vertical phoria portion of the test,
both Risley prisms are turned so that they can operate in a base-up or base-
down direction.
8. Both rotaries should now read zero. the patient is again observing the Snellen
target through the subjective finding and prism base-down is introduced
before the right eye. The patient is cautioned to report as soon as the target
doubles.
9. The amount of prism base-down is noted as soon as the patients reports
diplopia. Now, the amount of prism base-down is slowly reduced until the
patient’s reports single vision. This would be recorded as right supraduction
10. Then prism base-up is turned in before the right eye and the patient again
asked to report when the target doubles. This is recorded as the break finding.
11. The amount of base-up before the right eye is gradually reduced and the
patient is asked to report when he regains single vision. This is recorded as
the recovery value. This duction is known as the right infraduction.
12. If is necessary to reduce the amount of prism before the right eye to such a
degree that the opposite prism direction is entered, the recovery value is
recorded as minus value
III. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #10
Visual Test 16A: POSITIVE RELATIVE CONVERGENCE
I. OBJECTIVES
1. Understand the significance of the Visual Test #16A.

2. Realize the importance of VT #16A in the Optometric procedure.
3. Perform VT#16A.
II. PROCEDURE
1. This is a near point base-out to blur-out prism test.
2. The lenses through which the test will be taken depend upon the refractive condition
of the patient.
3. If the patient is non-presbyope, hyperope or emmetrope, the test is taken through the
subjective findings.
4. If the patient is a presbyope, the test is taken through the net fused cross-cylinder test.
5. If the patient is a myope, the test is taken through the habitual near point lenses.
6. With the correct lenses in place, the patient’s attention is fixed upon the target and he
is told o report when he is no longer able to read a single letter of the 20/20 lines.
7. Both Risley prism are positioned before the patient so that they can be turned in the
Base-out direction. Normal illumination is used in this test.
8. As the patient continues to observe the target, the amount of base-out is gradually
increased (binocularly at the same rate of speed) until the blur-out point is reached.
9. The total amount of base-out before both eyes is recorded as the positive relative
convergence test.
III. ILLUSTRATION & RECORDING
Name: Date:
Year and Section:
Exercise #11
Visual Test 16B: POSITIVE RELATIVE CONVERGENCE
I. OBJECTIVES
1. Understand the significance of the Visual Test #16B.

2. Realize the importance of VT #16B in the Optometric procedure.
3. Perform VT#16B.
II. PROCEDURE
1. This is a continuation of VT 16A, as soon as the total amount of prism base-out
necessary to blur-out the 20/20 reduced Snellen target has been recorded, we
continue turning more base-out prism binocularly until the patients reports that
the target doubled, is starting to move to one side, or that the target becomes
clear. As soon as one of these responses is obtained, the total amount of base-out
prism in both risley prism is recorded as the Break.
2. Now reduction is started of the amount of base-out and the patient is instructed to
report as soon as the targets go together and become one. As soon as binocular
singe vision has been regained, the total amount of Base-out in both prism is
recoded as the Recovery
3. These two results are recorded as Break/ Recovery. In some cases the patient
may not regain single vision until base-in prism has been introduced. In this
instance the amount of base-in would be recorded as the recovery. But must have
a minus sign.
4. The normal response under increasing amounts of base-out is for the patient to
report diplopia, in some cases the patient will report that the target moving to one
side, This indicate that the patient is suppressing.
5. The direction in which the target moves should be recorded and the eye that is
suppressing.
Name: Date:
Year and Section:
Exercise #12
Visual Test 17A: NEGATIVE RELATIVE CONVERGENCE
I. OBJECTIVES
4. Understand the significance of the Visual Test #17A.

5. Realize the importance of VT #17A in the Optometric procedure.
6. Perform VT#17A.
II. MATERIALS
 Reading rod, clip, Reduced Snellen chart
III. PROCEDURE
1. This is a near point base - in to blur - in prism test.
2. The lenses through which the test will be taken depend upon the refractive
condition of the patient.
3. If the patient is non-presbyope, hyperope or emmetrope, the test is taken
through the subjective findings.
4. If the patient is presbyope, the test is taken through the net fused cross-cylinder
test.
5. If the patient is a myope, the test is taken through the habitual near point lenses.
6. With the correct lenses in place. the patients attention is fixed upon the target
and he is told to report when he is no longer able to read a single letter of the
20/20 lines
7. Both Risley prisms are positioned before the patient so that they can be turned
in the Base-in direction. Normal illumination is used in this test.
8. As the patient continues to observe the target, the amount of base-in is gradually
increased (binocularly at the same rate of speed) until the blur-in point is
reached.
9. The total amounts of base-in before both eyes are recorded as the negative
divergence test.
IV. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #13
Visual Test 17B: NEGATIVE FUSIONAL RESERVE
I. OBJECTIVES
1. Understand the significance of the Visual Test #17B.

2. Realize the importance of VT #17B in the Optometric procedure.
3. Perform VT#17B.
II. PROCEDURE
1. This is a continuation of VT17a,as soon as the total amount of prism base-
in necessary to blur-out the 20/20 reduced Snellen target has been recorded,
we continue turning more base-in-prism binocularly until the patient
reports that the target doubled, is starting to move to one side, or that the
target becomes clear. As soon as one of these responses is obtained, the
total amount of base - in prism in both Risley prism is recorded as the
Break.
2. Now reduction is started of the amount of base - in and the patient is
instructed to report as soon as the targets go together and become one. As
soon as binocular single vision has been regained, the total amount of Base
- in in both prism is recorded as the Recovery.
3. These two results are recorded as Break/Recovery. In some cases the
patient may not regain single vision until base - out prism has been
introduced.In this instance the amount of base-out would be recorded as the
recovery, but must has a minus sign.
4. The normal response under increasing amounts of base-in is for the patient
to report diplopia, in some cases the patient will report that the target
moving to one side. These indicate that the patient is suppressing.
5. The direction in which the target moves should be recorded and the eye that
is suppressing.
III. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #14
Visual Test 18: VERTICAL PHORIA AND DUCTION AT FAR
I. OBJECTIVES

3. Perform VT #18.
II. PROCEDURE
1. This test is consists of two parts, first the vertical phoria test and secondly
the vertical duction test.
2. Part 1 is the Phoria test, this test is taken through the subjective finding
with the patient observing the Reduced Snellen.
3. The patient is dissociated with 15 prism base-in before the right eye. And
6-8 prism base-up before the left eye.
4. The patient will see two targets one is on the lower left side of the field.
5. The patient is asked to report when the targets are aligned horizontally
(directly across from each other)
6. Now, the amount of base-up is slowly reduced before the left eye. Any
base-up remaining in the prism before the left eye when the patient has
reported horizontal alignment would be recorded as diopters of right
hyperphoria, and any prism base-down remaining in the prism before the
left eye would be recorded as diopters of left hyperphoria.
7. Part 2 of the test, upon completion of the vertical phoria portion of the test,
both Risley prism are turned so that they can operate in a base-up or base-
down direction.
8. Both rotaries should now read zero, the patient is again observing the
Reduced Snellen target through the subjective finding and prism base-down
is introduced before the right eye. The patient is cautioned to report as soon
as the target doubles.
9. The amount of prism base-down is noted as soon as the patient reports
diplopia. Now, the amount of prism base- down is slowly reduced until the
patient’s reports single vision. This would be recorded as right
supraduction.
10. Then prism base-up is turned in before the right eye and the patient again
asked to report when the target doubles. This is recorded as the break
finding.
11. The amount of base-up before the right eye is gradually reduced and the
patient is asked to report when he regains single vision. This is recorded as
the recovery value. This duction is known as the right infraduction.
12. If is necessary to reduce the amount of prism before the right eye to such a
degree that the opposite prism direction is entered, the recovery value is
recorded as minus value.

Name: Date:
Year and Section:
Exercise #15
Visual Test 19: AMPLITUDE OF ACCOMMODATION
I. OBJECTIVES
At the end of the exercise, the students should be able to measure the protection
of accommodation pattern brought about by senility or advancing age.
II. PROCEDURE
1. Instruct the patient to read near target.
2. If the patient is non-presbyope, increase minus (-) sphere until total blur.
3. If the patient is presbyope, increase plus (+) sphere until total blur.
4. Record this by subtracting gross of VT 19 from VT 7 and dioptric working
distance of 2.5.
III. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #16
Visual Test 20: POSITIVE RELATIVE ACCOMMODATION
I. OBJECTIVES
1. Determine the amount of accommodation that can be stimulated without

change in convergence
2. Interaction between accommodation and convergence
3. Changes in accommodation that can be elicited when convergence is held
constant
4. Finding the reserve or range of accommodation
II. PROCEDURE
1. Instruct the patient to look at near target
2. Increase minus (-0.25 D steps) lens until patient achieves first sustained blur.
3. Record findings as your positive relative accommodation.
III. ILLUSTRATION
Name: Date:
Year and Section:
Exercise #17
Visual Test 21: NEGATIVE RELATIVE ACCOMMODATION
I. OBJECTIVES
1. Relaxation and reduction of accommodation below the normal demand for given
binocular fixation distance
2. To determine the amount of accommodation that can be relaxed without change in
convergence
3. Changes in accommodation that can be elicited when convergence is held
constant.
4. Finding the reserve or range of accommodation.
II. PROCEDURES
1. Instruct the patient to look at near target
2. Increase minus (-0.25 D steps) lens until patient achieves first sustained blur.
3. Record findings as your negative relative accommodation.
III. ILLUSTRATION
Binocular Vision
Laboratory Exercises
Phoria, Tropia and Visual Alignment Tests
Maddox Rod Test Howell Card

Worth-Four Dot Test Maddox Wing
Hirschberg Test RAF rule
Krimsky Test Prism Bar
Brock String Apperture Rule
Bagolini Test Bruckner Test
Tranaglyph/Vectogram
Submitted by:

Bino Laboratory Manual 3D

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bino Laboratory Manual 3D

Uploaded by

Copyright:

Available Formats

Centro Escolar University

Mendiola, Manila City

1. Understand the significance of Visual Test #3

1. Understand the significance of the Visual Test # 13a.

4. Understand the significance of the Visual Test #8

1. Understand the significance of the Visual Test #13b.

1. Why do we have to perform VT#13b?

1. Understand the significance of the Visual Test #9.

1. Understand the significance of the Visual Test #10.

Break Point for the test.

vision is recorded as the Recovery portion of the test.

1. What is the effect of additional prism Base-Out to the eye?

1. Understand the significance of the Visual Test #11.

1. Understand the significance of the Visual Test #12.

1. Understand the significance of the Visual Test #16A.

1. Understand the significance of the Visual Test #16B.

4. Understand the significance of the Visual Test #17A.

1. This is a near point base - in to blur - in prism test.

condition of the patient.

3. If the patient is non-presbyope, hyperope or emmetrope, the test is taken

through the subjective findings.

in the Base-in direction. Normal illumination is used in this test.

1. Understand the significance of the Visual Test #17B.

1. Understand the significance of the Visual Test #18.

III. ILLUSTRATION & RECORDING

1. Determine the amount of accommodation that can be stimulated without

Maddox Rod Test Howell Card

You might also like