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VISION

The following topics will be covered in this laboratory class:

1. Visual Acuity: measurement of visual acuity using Snellen’s charts.

Calculation of angle subtended at retina, and number of cones required.
2. The Fields of Vision: perimetry; blind spot experiments.
3. Accuracy of Stereoscopic Vision: measurement of accuracy of monocular
and stereoscopic vision by method of parallax.
4. Range of Accommodation: calculation of power of accommodated and
unaccommodated eye.
5. Colour Vision: detection of colour-blindness using Isihara Charts and
Farnsworth D-15 Colour Vision Test
6. Ophthalmoscopy: examination of the optic disc, both normal and in common
disease states, using the Adam-Rouilly model.

Learning Objectives: after completing this lab class, you should be able to:

1. Measure the visual acuity of a subject, using Snellen’s charts.

2. Calculate the smallest angle which must be subtended at the retina by an
object in order to be seen clearly, and the number of cones required, in this
subject.
3. Describe how to accurately map a subject’s field of vision using a perimeter.
4. Explain why each eye has a ‘blind spot’, and describe a simple experiment
to demonstrate this blind spot.
5. Draw a diagram showing the normal field of vision for each eye (including
the blind spot).
6. Describe how to measure the accuracy of both monocular and stereoscopic
vision.
7. Calculate the focal length and refractive power of the normal,
unaccommodated eye focused at infinity, given that the length of the optric
system of the eye is ~ 17 mm.
8. Determine the near point of a subject with normal vision.
9. Calculate the focal length and refractive power of the normal, fully
accommodated eye i.e. focused at the near point, and calculate the range of
accommodation for this subject.
10.Describe how to detect colour-blindness and identify the specific defect of
colour vision.
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1. Visual Acuity.
It is well recognised that the accuracy of perception of objects by the eye
depends on the size of the object and the distance it is from the observer, and
that the smaller the object the closer it must be if it is to be clearly seen. These
two factors, size and distance, can be combined in one measurement, namely
the angle which the object subtends at the optical centre of the eye (see Fig. 1
below).

It is seen that the three objects of different sizes (a, b and c), at the distances
shown (A, B and C), all subtend the same angle () at the eye, and form an
image of the same size (d) on the retina, which is 17 mm behind the optical
centre of the eye’s refracting system. Pairs of points separated by these
distances (a, b and c), and viewed at distances A, B and C from the eye, would
therefore all stand an equal chance of being perceived as separate points by the
eye. We can thus say that:

a b c d
    tan θ
A B C 17mm

The capacity of the eye for perceiving objects clearly is called the visual acuity,
and from what has been said it is apparent that this could be expressed
quantitatively as the smallest angle an object must subtend at the eye in order to
be perceived as a separate object. Other factors such as colour of object,
background, movement, etc. also play an important part in determining the
accuracy of perception, and for this reason the term visual acuity is specifically
limited to stationary objects on a specific background, usually black against
white.
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Snellen's Types.

The most convenient method of measuring and expressing this visual acuity is
by means of the test charts called Snellen's Types. Each chart has a number of
lines of print of different sizes. These are numbered from largest to smallest,
beginning with 60. The subject stands / sits 6 metres distant from the chart.
One eye is covered, and he/she is asked to read out the letters, beginning with
the largest type. The smallest type which he/she can read at 6 metres is
determined and the visual acuity is expressed as a fraction whose numerator is
the distance from the observer to the chart and the denominator is the number of
the smallest type which can be read correctly. Thus a visual acuity of 6/6
means that at a distance of 6 metres the subject can just read the type numbered
6 but not that numbered 5. If no type can be read at 6 metres, he/she is brought
nearer until the largest type can be read. If the farthest distance at which he/she
can read this is 4 metres, for example, the visual acuity is 4/60. This process is
repeated for the other eye.

Significance of the fraction expressing visual acuity:

If the letters on the chart are examined, it will be seen that in order to identify
them, it is necessary for the eye to be able to recognise as a separate object one
whose thickness is one fifth the total size of the letters. For example, in the
letter E below (Fig. 2), each of the horizontal strokes and each of the spaces
between them is one fifth of the total size of the letter. If you take the size of
type which can be read and measure one fifth of this, this distance, divided by
the distance of the observer from the type, is the tangent of the smallest angle
which the object must subtend at the eye in order to be seen. For the ‘6’ row of
letters on the chart, the height of the letters is 8.87 mm, and the critical height is
thus 8.87 / 5 = 1.774 mm or 0.001774 m.

The tangent of the angle 1o is 0.01748. For angles smaller than this it can be
assumed with no appreciable error that the tangent is proportional to the angle
expressed in degrees, e.g. the tangent of a one minute angle equals
approximately 0.01748 X 1 / 60 = 2.9 x 10-4.
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From this you can express the visual acuity by the actual angle subtended at the
eye by the smallest object which can be perceived. Furthermore, if you take the
distance from the optical centre of the ‘lens’ system of the eye to the retina as
17.0 mm, you can calculate what distance on the retina corresponds to the
visual angle obtained. The value obtained should be compared with the
diameter of the individual cones. (3µm at fovea).

Example: visual acuity = 6 / 6 => critical height of object = 0.001774 m, and

distance = 6 m. Thus, tan = 0.001774 / 6 = 0.000295 i.e. the smallest angle
subtended at the retina is approximately 1 minute (see above).
The corresponding distance on retina, d, = 0.000295 x 0.017 = 0.00000503 =
5.03 microns.

Experiment.

Working in pairs and using the Snellen’s chart located on the laboratory wall,
determine the visual acuity of your partner, expressing the result as a fraction.
Calculate the corresponding visual angle as described above.
If your partner has a visual acuity less then 6/6 can you bring it to this value by
the use of his/her spectacles? What refractive error has he/she got?

Visual Acuity
Right eye
Left eye

Visual Angle:

Refractive error:
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Landolt's Broken Circles.

Sometimes instead of letters, various shapes are used for the determination of
visual acuity. A test of this kind is Landolt's Broken Circles. The subject is
asked to say in what part of the circle the gap occurs. The expression of the
result is exactly on the same principle as with Snellen's Types.
Astigmatism.

In some cases a high degree of visual acuity cannot be obtained with any
strength of convex or concave lens. This may be due to astigmatism, a
condition where rays of light in different planes are not brought to the same
focus on the retina; in fact the lens system of the eye does not have a point
focus. (This may be due to an uneven corneal surface, for example).
Astigmatism is looked for by means of a chart called the astigmatic fan, which
is a system of radially radiating lines. A person with astigmatism cannot see all
the lines in focus at the same time, e.g., if the vertical lines are sharply focussed
the horizontal ones are blurred. One gets an idea of the subjective sensation by
inserting a cylindrical lens and looking at the astigmatic chart.
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2. The Fields of Vision.

The field of vision of an eye refers to the area of the outside world in which
objects can be seen by that eye. The rough method (of confrontation) is useful
clinically and will disclose gross changes. Fields of vision can more accurately
be ‘mapped’ or plotted by means of a perimeter. To use the perimeter, the test
eye is kept stationary (looking at a white spot on the apparatus), and the head is
kept stationary by resting the chin on a support. The other eye is closed. An
object (usually a small white disc) is moved into the field of vision from the
periphery, along the inside wall of the rotating semicircle (see illustration
below), and the subject indicates when he first catches sight of it. The point
where this occurs is marked on the perimeter chart. This process is repeated
from various angles, and a map of the field of vision is completed.

INSTRUCTIONS FOR LAFAYETTE PERIMETER

Set circular dial at 0. The arm is horizontal when commencing test, and figures
are in the upright position. Give the subject a comfortable seat and place
cheekbone against the black plastic support so that their left eye is directly
centred in the fixation mirror. Have the subject keep their right eye covered
during the experiment. Bring in wand from test side until subject indicates
stimulus patch can be seen. The point where this occurs is marked on the
perimeter chart. Rotate the perimeter arm through 150 ° using the scale on the
perimeter chart until one reaches the starting point again. Plot the field of vision
for the left eye in one person and the right eye in another, starting off from the
test side for both eyes. Use a different coloured spot for each trial, with some
rotary motion. Make 2 plots:
(1) The point where the subject first becomes aware of the presence of the
stimulus.
(2) The point where the subject is able to identify the colour of the stimulus.
PERIMETRY POSITIONING
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Charts for Lafayette

Perimeter
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BLIND SPOT ILLUSTRATION

Experiments.

A) Location of blind spot:

1) Hold this manual at arms length, directly in front of your eyes, and observe
the cross and the solid circle illustrated above. Arrange the height of the
manual so that both are at eye level.
2) Close your left eye. Focus your right eye on the cross. Keeping the right eye
focused on the cross, bring the manual slowly toward you until a position is
reached where the circle disappears. At this point the image of the circle is
falling on the optic disc in the retina i.e. the circle is positioned in the blind spot
of your right eye.

Why are we normally not aware of the blind spots in our eyes?
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In the Blind Spot experiment above, when the circle lies in the blind spot, the
brain “fills in” a blank white space, and the page looks uniformly white. Is this
always what we perceive in place of the blind spot?

These next experiments explore what the brain ‘fills in’ to the perceived visual
scene, in place of the missing information from the blind spot.

B) Blind spot and visual perception:

Card A

(1) Hold card A with the green panel to the right and the yellow panel to the
left. Fix the right eye on the spot in the middle of the yellow panel. Move
the card towards or away from you until the cross disappears. What do
you now perceive in place of the cross? What colour is the blank area
where the cross used to be?

(2) Now turn card A around by 180 º so that the green panel is on the left, and
fix the right eye on the cross in the middle of the green panel. Move the card
towards or away from you until the spot in the yellow panel disappears. What
do you now perceive in place of the spot? Is it still a blank area?
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3. Measurement of Accuracy of Stereoscopic Vision:

The apparatus consists of three vertical rods which are observed through a hole
in a screen; the screen is placed a few inches from the rods and arranged so that
only the centre parts of the rods are visible through the hole. The two outer
rods are fixed, and the centre one can be moved along a scale to lie before or
behind the line of the fixed rods, by a measured amount. Thus any error of
stereoscopic vision can be measured.

Experiment.

a) The subject sits ~ 1.5 m from the screen with both eyes open. The
observer moves the middle rod until it appears to the subject to lie in the
same plane as the two outer rods; the observer reads the error from the
scale. Take six readings, and calculate the average error; express this as a
percentage of the distance of the rods from the subject.

b) Repeat the experiment using one eye only, and calculate the percentage
error.

How does the accuracy of monocular vision compare with that of stereoscopic
vision?
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4. Range of Accommodation.
For a convex (positive) lens:

d1 d2

1/d1 + 1/d2 = 1 / f, where f = focal length of lens

Refraction of light by the eye may be treated approximately as if the whole

dioptric system consists of a single, fictitious, spherical refracting surface,
between the cornea and lens, with the retina at a distance of about 17mm (0.017
metre). In the normal subject the far point of distinct vision is at infinity. Thus,
for the unaccommodated eye, d1 = infinity (∞), d2 = 0.017 m, and f is
calculated from:
1 / ∞ + 1 / 0.017 = 1 / 0.017 i.e. the focal length of the ‘lens’ system is 17 mm.

Power (dioptres) of the eye is defined as 1 / f, where f is in metres.

Hence the power of the unaccommodated eye is approximately 60 dioptres.

Near Point: One eye is closed. The end of a metric scale is placed close to the
other eye and an object (here a piece of printed matter to be read) is slid along
the scale towards the subject until it just appears blurred. This distance is the
distance of the near point from the eye. The distance in a 20 year old is likely
to be approximately 10 cm (0.1 m).
Thus, for the fully accommodated eye, d1 = 0.1 m, d2 = 0.017 m and f is
calculated from:
1 / 0.1 + 1 / 0.017 = 1 / 0.0145 i.e. f = 14.5 mm.
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The power of the fully accommodated eye is thus 1 / 0.0145 or ~ 69 dioptres.

The range of accommodation in this example is thus ~ 9 dioptres.

Experiment.

Select a subject whose vision is apparently normal and assume therefore that
their far point of distinct vision is at infinity.
a) Determine their near point of distinct vision, as described above;
b) calculate the refractive power of the fully accommodated eye;
c) calculate his / her range of accommodation.
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5. Colour Vision.
The phenomena of colour vision may be interpreted in terms of the existence of
three types of colour sensitive receptors in the retina, responding to red, green
and blue light. The sensation of white is regarded as being due to
physiologically equivalent stimulation of all three receptors. Colour-blindness
was first described by Jospeh Huddart of Maryport in 1777 in a letter to Joseph
Priestley and he also noted the hereditary features of this condition.
Classification of Colour-Blindness

I. Trichromats II. Dichromats III. Monochromats

Normal Protanopes
Protanomalous Deuteranopes
Deuteranomalous Tritanopes
Normal and anomalous trichromats both require the three primary colours to
match the whole range of spectral colours, but the anomalous employ ratios
which differ from those used by normal subjects. Protanomalous subjects are
less sensitive to red and correspondingly use more red in matching.
Deuteranomalous subjects, on the other hand, require more green to match than
do normal subjects. Protanopes (dichromats) are insensitive to red and match
the spectrum as they see it with green and blue; deuteranopes are insensitive to
green and match the spectrum as they see it with red and blue. Monochromats
occur so rarely as to be ignored.

Methods of Examining Colour Vision:

(A) Pseudo-isochromatic charts (Ishihara and Stilling).

These consist of a number of plates made up of coloured dots. The dots are so
arranged as to form figures in contrasting colours. The normal and the colour-
blind may read different figures (see chart below for examples).

The principle on which this works may be illustrated for the deuteranope, to
take an example as follows: The background may be composed of green dots,
and the figure to be read of orange dots. This difference of colour is not obvious
to the deuteranope, who therefore fails to see the figure which is seen by the
normal person. On the other hand he may see a figure not seen by the normal
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person. This is because the chart also contains a concealed figure formed by
dots in which the green and orange have been diluted with some blue. This
increases the apparent brightness to the deuteranope without altering
appreciably the colour for the normal. (Close examination of the individual
dots on the diagram will reveal this difference and enable the normal to make
out the number intended to be read by the colour-blind.)

The colouring of the plates is chosen so as to allow differentiation into the three
main groups of the colour blind. To perform the test, take examine each plate
in turn by good daylight at a distance of about two feet. Keep a record of what
you see in each plate and at the end check your results with the explanatory
notes provided.

(B) Farnsworth D-15 Colour Vision Test.

This consists of 15 coloured discs which must be sequentially matched by
colour. The resulting sequence is compared to the normal colour ‘circle’.
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HANDLE THE CAPS WITH CARE. AVOID TOUCHING THE COLOURED DISC.

Experiment:
Use a well illuminated place. Arrange the tray so that the pilot disc of blue
paper is at the left hand side. Place the other colour caps (15) in random order
on the bench.
The subject is asked to select the colour cap which is the closest possible match
to the pilot colour and the chosen cap is placed to the right of the pilot cap. The
subject then continues to choose caps which are the closest colour match to the
last one chosen. In this way the complete sequence of colours is built up. A
reasonable time is allowed and the subject may change his mind.
Results:
When all fifteen caps have been placed, close the lid and carefully invert the
box. Carefully re-open the box, exposing the numbers on the base of the caps.
Note the sequence of numbers and transfer this sequence to the test chart.
Transfer this data to the circle of dots, joining the numbers which have been
placed next to each other. The data from individuals with normal colour vision
yields a colour circle whereas individuals with a defect of colour vision exhibit
a 'confusion axis': the numbers are no longer connected in a simple ascending
order but jump to a number on the other side of the circle then back again. The
orientation of this axis (see test chart) depends on the nature of the defect.

NUMERICAL SEQUENCE OF COLOURS:

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6. Ophthalmoscopy.

This will be carried out using an opthalmoscope and the Adam-Rouilly models
available in the laboratory. This model allows examination of the normal optic
disc, as well as the characteristic appearance of the disc in common and/or
important disease states e.g. diabetes, hypertension, glaucoma.

The ophthalmoscope is much used by physicians, not only to inspect the optical
parts of the eye, but to examine the retina and its blood-vessels (e.g. for the
characteristic changes seen with hypertension or diabetes mellitus).

The optical system of the opthalmoscope is shown in this diagram:

Although lenses are provided in the ophthalmoscope head, these are only
necessary if the subject or the observer has an error of refraction that needs to
be corrected. In the ordinary way, the observer's and the subject's eyes provide
the
only optical system necessary, provided both "focus on infinity", and the
function of the ophthalmoscope is only to illuminate the subject's retina. The
observer uses his right eye to examine the subject's right eye, and vice versa.
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Below is a view of the retina as seen with an ophthalmoscope: optic nerve

fibres leave the eyeball at the optic disc to form the optic nerve. Note the blood
vessels
that can be seen entering and leaving the eyeball at the optic disc.

REVIEW QUESTIONS FOR VISION:

1. Show by means of a diagram how the image of the world is upside-down on

the retina.

2. Explain the optical significance of accommodation, convergence and

pupillary constriction when looking at a near object.

3. Write brief notes on (a) Dark adaptation and (b) Light adaptation. What
would be the consequences of interruption of the cervical sympathetic chain on
one side?

4. Comment on the shape of your visual field plotted on the perimeter. Indicate
on the chart the loss of vision from a lesion of the central part of the optic
chiasma.

5. Explain stereoscopic vision. What advantages are conferred by possessing

stereoscopic vision?
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Work Sheet
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