OPT 2083

CLINICAL STUDIES I
L11 ASTIGMATISM CORRECTION: FAN & BLOCK

Wong Bing Seng, MHSc.(Optom)

CYLINDER DETERMINATION
• Jackson Cross cylinder (JCC)
• Fan & Block
• Stenopaic Slit
• Axis rotation
• Etc…
Fan & Block
• It is an alternative procedure for the assessment of astigmatism.
• Not all patient able to respond accurately to the demands of JCC →
so, fan & block or other techniques should be used in these cases.
• Advantages : accommodation is well controlled as the patient is
fogged prior to the procedure →ensure COLC and both focal lines are
in front of retina.
• Disadvantages : less accurate at determining small cylinders than JCC.
RESIDUAL ASTIGMATISM
• VA at initial MPMVA/BVS shows the residual cylinder power.

• Use the VA to estimate for the residual astigmatism/cyl.

• The residual tell you the fogging lens needed for the next procedure
(optional):
1
• Fogging lens needed, F = 𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑐𝑦𝑙 + 0.50DS
2
RESIDUAL ASTIGMATISM
• ESTIMATION OF RESIDUAL ASTIGMATISM
• Cylindrical error:
• Use factor 9, eg: VA Estimated
cyl
6/9 ± 1.00DC
6/18 ± 2.00DC
6/27 ± 3.00DC

• NOTE: only applicable for VA tested at 6m

FAN & BLOCK
Fan & Block: Axis Quadrant Determination
VA unaided → retinoscopy (spherocyl.) →VA
1. Initial MPMVA/BVS

2. Don’t forget to occlude non-tested eye.

3. Remove cyl determined from retinoscopy ->add +0.50DS to the

sphere. (the COLC is now in front of the retina).
Fan & Block: Axis Quadrant Determination
4. Draw an analogy between the lines on the fan and the hours of
a clock → Ask the patient if any of the lines on the fan appear
clearer & darker than other lines.
Fan & Block: Axis Quadrant Determination
5. If the patient reports that all the lines are equally clear (or blur)
→fog further by +0.50DS → Ask the patient again if any lines are
clearer & darker.
• If the lines remain equally clear or blur → No astigmatism present.
Fan & Block: Axis Refinement
6. If some lines are reported as clearer, point the arrow that joins the
blocks towards the clearest line → Adjust the arrow until its 2 barbs
appear equally clear → one block should be clearer than the other
(block with the lines running parallel with the clearest fan).

Fan

Arrowhead Block
Fan & Block: Axis Refinement
7. Ask the patient to look at the clearer block → Add +0.50DS → Ask if
the block blurs.
• If it does blur → continue Step 8
• If the block does not blur – it is possible that the retinoscopy result provided
a significantly under-corrected cylinder, leaving the back focal line behind the
retina after Step 3. → Additional +0.50DS lenses should be added until the
clearer block just blur.
Fan & Block: Cylinder Power
8. Set the cylinder axis in the trial frame/phoropter at the axis
indicated by the arrow → Add minus cylinder at this axis until the
blurred block just becomes as clear as the other.
• If there is a reversal, in that the more blurred block becomes clearer, take the
lower cylinder power.

9. Reduce the plus fogging sphere to determine the second

MPMVA/BVS : Fog/
10. Unfog technique

11. Repeat the Fan & Block technique for the LE →Binocular Balancing.
Next…. Binocular Balancing
Technique