the eye but no information about

Keratometry spherical ametropia

Keratometry (K) is the measurement of the
corneal curvature; corneal curvature
determines the power of the cornea.
Differences in power across the cornea
(opposite meridians) results in astigmatism

1619, Scheiner used a set of glass spheres

of known radii to determine corneal
curvature

1796, Ramsden, the inventor of the

keratometer, developed an instrument that
used an object of known size, a doubling
device, a magnifying device –the three
essential elements of a keratometer- to
measure the corneal curvature

1854, Helmholtz improved Ramsden’s

design and developed an instrument for
laboratory used

1881, Javal and Schiotz modified

Helmholtz’s instrument for clinical use by
developing dials that would allow the
immediate measurement of the corneal
curvature

The Keratometer
● Is the clinical technique used to
measure the curvature of the anterior
surface of the cornea (2-4mm radius)
● The refracting power of the cornea is
determined in each of the two
principal corneal meridians
● Provides the practitioner with
information about the astigmatism of
Optical and Doubling
Principle of the
Keratometer
Optical Principle
● Reflect an object of known size at a
known distance off the corneal
surface, determine the size of the
reflected image with a measuring
telescope, and calculate the power on
the basis of an assumed index of Mires in focus
refraction (1.3375)
Doubling Principle
● An illuminated circle with a small
cross on either side is to be reflected
from the cornea. It is then doubled
by a prism to which the examiner
will superimpose the right-hand
cross belonging to one image with
the left-hand cross belonging to the
other to obtain an accurate
measurement of the image size
Mires out of focus

Clinical Uses of
Keratometry
Informations provided by the Keratometer:
● Objective method for determining
curvature of the cornea
● Objective method for determining
the amount and direction of corneal
astigmatism
● Objective method for determining
the quality of the corneal refracting
surface
● Objective method for determining
the stability of the corneal refracting
surface
NOTE: Any time a clinician has difficulty
generating a measurement aside from the
previously mentioned, immediately try to
identify why. It could be dry eye, a
compromised cornea, meibomian gland
dysfunction, corneal disease, or even poor
patient positioning or fixation during
examination.
Standard Keratometry
Spherical Cornea
Readings
● no difference in power between
K Readings the 2 principal meridians
Range of keratometry power: 36D to 52D ● mires seen as perfect sphere
Normal Values: 42D to 44D

Astigmatism

● difference in power between the

2 principal meridians
● Horizontal oval mires in WTR
astigmatism
● Vertical oval mires in ATR
astigmatism
● Oblique astigmatism – principal
meridians between 30°- 60° &
120°-150°

Irregular anterior corneal surface

● Irregular mires
● Doubling of mires

In the average eye, keratometry readings are

in the range of 43 to 44D

When comparing to the fellow eye,

keratometry readings and corneal cylinder
should be within 1D

Keratometry readings less than 40D and

more than 47D are unusual and should be
double checked

Corneal Versus Refractive
Astigmatism
Refractive astigmatism, also called total
astigmatism, as determined by retinoscopy
or by subjective refraction, is made up of
both corneal and internal astigmatism
Internal astigmatism is due to such factors
as the toricity of the back surface of the
cornea and tilting of the crystalline lens with
respect to the optic axis of the cornea
Total astigmatism can be predicted base on
the amount of corneal astigmatism by using
the formula
At = 1.25 (Ac) + (-0.50 D cyl x 90º)
At = 1.25 (Ac) + (+0.50 D cyl x 180º)
Javal's Rule is used to predict the total
astigmatism the patient will manifest on
refraction based on keratometry readings
Theory
theory behind Javal's Rule is that the
average crystalline lens has -0.50D of
against the rule astigmatism. If this is
combined with the astigmatism due to the
cornea, we should be able to predict the
refractive astigmatism
“With the Rule” Corneal Astigmatism (X
180)
TA = (1.25) Corneal Astigmatism (X 180) +
Lenticular Astigmatism (+0.50 X 180)
Example
K readings = 44.50 @ 180 / 45.50 @ 090
TA = (1.25) (-1.00Dcyl x 180) + (+0.50
Dcyl x 180)
= -1.25 Dcyl x 180 + 0.50 X 180
TA = -0.75 Dcyl x 180
For “Against the Rule” Corneal
Astigmatism (X 090)
TA = (1.25) Corneal Astigmatism (X 090) +
Lenticular Astigmatism (-0.50 X 90)
K readings = 45.50 @ 180 / 44.50 @ 90
O
TA = (1.25) (-1.00 Dcyl x 090) + (-0.50
Dcyl x 90)
= -1.25 Dcylx 090 + -0.50 Dcyl x 90
TA = -1.75 Dcyl x 90
Summary
When the corneal astigmatism is WTR, the
crystalline lens "cancels" part of the corneal
astigmatism
When the corneal astigmatism is ATR, the Cover Page: The first page is a cover sheet
crystalline lens adds astigmatism and the with the candidate’s name, address,
total astigmatism is greater than the corneal telephone number, e-mail address, case
astigmatism report title

When the cornea is spherical, the eye should Abstract

manifest -0.50D ATR This case details the prescribing of a
pair of spectacles, contact lenses and
customized goggles on a patient who
Increasing and Decreasing reports a significant amount of myopia and
glare. Possible options, benefits as well as
the range of Corneal disadvantages over the type of lenses and
modality of contact lenses are explored.
Readings Further, this report discusses myopia and
glare in depth.
Increasing the range
Keywords: Myopia and Glare
Add + 1.25D sph lens to extend the range to
61D
Introduction:
This adds 9.00D to the power range (Your paper should begin with a 1-2
paragraph introduction that provides
K reading x 1.185 background information on the topic of the
case report)
(Discussion on myopia and glare in detail
Decreasing the Range for this case with reference materials stated)

Add - 1.00D sph lens to extend the range to Case Presentation

30D A 23 year-old male who presented to the
clinic on March 8, 2017 complained of blurry
This subtracts 6.00D to the power range vision on both eyes and glare whenever he
is engaged in outdoor sports (biking,
K reading x .840
swimming and climbing). The patient’s last
eye examination had been 18 months prior
to his presentation. His past ocular history
was unremarkable, except for significant
myopia. He reported wearing eyeglasses
Creation of a Case since age 18 and had 3 pairs since then. He
denied any previous injury, surgery, or
Report significant disease in either eye. His past
medical history was wholly unremarkable
and noncontributory. He reported taking no
Case Report medications, and he denied any general or
medication allergies. His social history
defined him as a non-smoker, and light
social drinker. His family history was ● Recommendation for follow-up care
unremarkable and he had no known and re-examination
allergies.

Assessment and Diagnosis

(Clinician assesses and evaluates
the data to establish a diagnosis or
diagnoses (you may do differential
diagnosis)
Myopia based on:
● Chief complaint
● UVA at distance
● VT # 4 (Static retinoscopy)
● Automated refraction
● VT # 7 (Subjective refraction)

Plan
1. Optical correction
2. Patient Education
Communication with the patient at the
conclusion of the comprehensive adult eye
and vision examination should include
review and discussion of examination
findings and anticipated outcomes based
upon the recommended courses of action.
Patient counseling and education may
include:
● Review of the patient's visual and
ocular health status in relation to
his/her visual symptoms and
complaints
● Discussion of refractive correction
that provides improved visual
efficiency and appropriate eye
protection
● Explanation of available treatment
options, including risks, benefits, and
expected outcomes
● Recommendation of a course of
treatment with the reasons for its
selection and the prognosis
● Discussion of the importance of
patient compliance with the
treatment prescribed