Keratometry  The objective measurement of the curvature of the anterior surface of the cornea o Cornea acts as a highly convex

spherical mirror o Uses reflective properties of the cornea in order to measure its radius of curvature o Each manufacturer uses an assumed corneal index of refraction to convert radii to diopters  B&L uses 1.3375 o One position keratometer: variable doubling (B&L)  Both principle meridians are perpendicular to each other o Two position keratometer  Rotate the instrument for the secondary meridian  Allows measurement if the two principal meridians are not at right angles to each other  Clinical uses: o Objective method for determining curvature of the cornea, amount and direction of corneal astigmatism, quality and stability of the corneal refracting surface  Examples: progressive myopia, keratoconus, degenerative anomalies, and pre-surgical workup for cataract surgery (helps determine power of IOL) o Contact lens fitting  Base curve selection in RGP and hydrogel lens fitting  “Over keratometry” can help detect CL surface irregularities or poor wetting qualities  Monitor corneal changes produced by wear o Establish baseline data  Should be performed on all new patients  Patient may later want CLs or may develop an injured/diseased cornea o Detection of irregular astigmatism  Keratoconus: a corneal dystrophy where the center of the cornea thins and bulges  Results in steep curves, high astigmatism, and distorted mires  Pterygium  Corneal scarring o Refractive estimate in unresponsive patients, children, amblyopes, aphakia or high ametropia, patients with media opacities and/or poor quality retinoscopic reflex and difficult refractions/unreliable subjective data o Determine the nature of ametropia  Axial  Example: high myopia with 40D “K” reading  Refractive  Example: high myopia with 49D “K” reading o Post-surgical management of keratoplasty or cataract surgery  Limitations o Area measured is a 0.1mm annular ring with a 3.0mm diameter

o One position keratometers assume that meridians of least and most cylinder are orthogonal (perpendicular) o Assumed corneal index may cause problems when comparing K’s from different instruments o Autokeratometers do not evaluate the quality of the cornea  Procedure o Turn instrument on and clean forehead and chin rests o Focus the eyepiece  Turn fully counterclockwise to blur reticule (toward plus)  Relaxes accommodation  Turn eyepiece clockwise until reticule is FIRST seen in sharp focus  Note: Incorrect focusing can produce significant error (up to 0.2mm radius) o Position patient comfortably and align canthus marker using instrument height control o Place the reflection of the mires in the center of the pupil  Account for all 3 axes (x, y, and z)  X: instrument pivot  Y: instrument height adjustment  Z: instrument focus and headrest tilt control o Instruct patient to “keep both eyes open, look at the reflection of your eye in the instrument, and it is okay to blink” o Occlude left eye o Align the crosshairs in the center of the lower right-hand circle  Means the optical axis and the visual axis of the eye are the same o Focus the lower right-hand circle to obtain superimposed image and lock instrument o Locate the principal meridians  Make the “plus” signs parallel by rotating the instrument and then overlap the “plus” signs with the horizontal axis wheel  Align the “minus” signs with the vertical axis wheel  KEEP ONE HAND ON THE FOCUSING KNOB o Record both horizontal and vertical measurements (in eighths of a diopters)  Record flatter/steeper @ steeper meridian  Record clarity of mires: clear or distorted  ALWAYS record findings to 2 decimals (total of 4 digits) o Problems/Solutions  Unable to locate keratometric mires instrument and/or patient not aligned properly  Mire clarity is transient measure quickly after allowing the patient to blink  Mire focus is transient ensure that patient’s forehead is secure against headrest  Patient gaze is unsteady ensure that fellow eye is occluded  H&V mires cannot be measured concurrently patient may have irregular astigmatism

Only 1 minus sign is visible patient’s eyelid is drooping (have them open wide)  Only 1 plus sign is visible occluder is in the way  Range of the B&L keratometer is 36.00 to 52.00 o Normal values are around 44.00 to 45.00 o To increase the range:  Place +1.25D lens in front of aperture to extend range to 61D  ADD 9 D  Place -1.00D lens in front of aperture to extend range to 30D  SUBTRACT 6 D  Astigmatism o Irregular: principal meridians are not perpendicular to each other  Produce distorted mires o Regular: principal meridians are perpendicular  With-the-rule: more power in the vertical meridian (greatest curvature) and horizontal meridian is flatter  Example: 45.00@090/43.25@180  Against-the-rule: more power in the horizontal meridian and vertical meridian is flatter  Example: 42.50@115/44.87@025  Oblique: principal meridians lie between 20° and 70° and 110° and 160° o Corneal astigmatism is measured by the keratometer o Refractive (total) astigmatism is measured by retinoscopy and/or subjective refraction  Corneal and refractive do not coincide due to:  Physiologic lenticular astigmatism (usually ATR and varies with age)  Effectivity changes o ~25% increase in astigmatism going from the corneal plane to the spectacle plane  Corneal posterior surface curvature o Δ K (corneal cylinder)  Translate K’s into minus cylinder format  Use the flatter meridian as the minus cylinder axis and the difference in power between the two meridians as the cylinder power  Use Javal’s (modified) Rule to predict the correcting cylinder  Only should be used with </=2.00DC ATR and </=3.00DC WTR  Convert corneal astigmatism to refractive astigmatism o WTR: refractive= corneal + (+0.50 x 180)  WTR gets better by 0.50 o ATR: refractive= corneal + (-0.50 x 090)  ATR gets worse by 0.50  Corneal topography is used to provide a color map of the contour of the entire corneal surface o Used for corneal surgery (refractive and penetrating keratoplasty), degenerative corneal conditions (keratoconus), and contact lens fitting (orthokeratology) 

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