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505 views69 pagesGood optics review for ophthalmology boards

Jan 30, 2010

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Good optics review for ophthalmology boards

Attribution Non-Commercial (BY-NC)

505 views

Good optics review for ophthalmology boards

Attribution Non-Commercial (BY-NC)

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Board Review

Optics

Lightbehaves like wave and particle

Physical optics – wave properties of light

matter (wave and particle characteristics)

Physical Optics

Physical Optics

Amplitude: height of wave crest / maximum value attained

by electric field

Frequency: number of wave crests passing a fixed point

per second

Photon Energy

Wavelength x Frequency (λ x ν) = c

λ is inversely proportional to v

Wavelength: blue < red

Frequency: blue > red

Energy: blue > red

Electromagnetic Spectrum

Interference

Constructive interference:

crests of two waves coincide

Destructive interference:

crest of one wave coincides with trough of other

wave

Coherence:

measure of the ability for two light waves to

interfere

Interference: Applications

Laser inferometry:

Evaluates retinal function in pt w/ cataract

Laser beam split into 2 beams

Beams overlap on retina, producing interference

fringes, thus you know retina is functioning

Antireflective coatings

Antireflective Coating

Polarization

Plane-polarized

(linearly polarized) light:

waves that all have the

electric field in the

same plane

Polarized sunglasses

Stereopsis testing

Haidinger brush

phenomenon

Diffraction

Bending of light rays when they encounter an

obstruction

Diffraction limits visual acuity when the pupil

size is less than 2.5mm

Diffraction

What is the optimal pinhole aperture?

1.2 mm

Any smaller would greatly increase diffraction

and limit the amount of light into the eye

Because of diffractive effects, pinhole vision

is rarely better than 20/25

Scattering

Isolated molecules absorb light and re-radiate

it at same wavelength but different direction

Causes glare (cataracts, AC flare, corneal

haze)

Rayleigh Scattering

Due to scattering of very small particles

Sky appears blue because of greater scattering of

shorter wavelengths

Lasers

LightAmplification by Stimulated Emission of

Radiation

Which of the following features of laser light

enhance its intensity?

Directionality

Coherence

Polarization

Monochromaticity

Laser-Tissue Interaction

Name 3 ways lasers damage tissue:

Photocoagulation (Argon)

Photodisruption (Nd:YAG)

Photoablation (Excimer)

Geometrical Optics

Geometrical Optics

Refractive Index:

n = speed of light in vacuum

speed of light in material

n is always > 1

n1 sin θ1 = n2 sin θ2

Refraction

A fisherman attempts to

spear a fish as shown

at right.

at the fish, in front of

the fish, or behind the

fish as he sees it?

Refraction

He should aim in front of the

fish.

When a light ray passes

from a medium with a

higher refractive index to a

medium with a lower

refractive index, it is bent

away from the normal.

refractive index to a higher

refractive index, light is bent

toward the normal.

Total Internal Reflection

Vergence

A measure of the

spreading (or coming

together) of a bundle of

light rays.

Vergence

The reciprocal of the distance, in meters,

from the object point or to the image point.

Units = m-1 = diopters (D)

Vergence

Plus lenses are

biconvex and add

+ vergence

biconcave and add

- vergence

Thick Lenses

6 “cardinal points”

2 principal points / planes (H and H’)

2 nodal points (n and n’)

2 focal points (F and F’)

Focal points

Primary (Anterior) focal point

Focal points

Secondary (Posterior) focal point

Focal Length

Distance from lens to each of its focal points.

Focal length in meters:

F = n/D

F = 1/D in air

F = 1/60 = 0.017 m = 17mm

F’ = 1.33/60 = 0.0222m = 22mm

Vergence Formula

U + D = V

vergence of Amount of vergence vergence of

light entering added to the light by light leaving the

the lens the lens (power of lens

the lens)

Real or virtual?

light

Upright or Inverted?

Vergence

An object is located 20 cm to the left of a

-2.00 D lens. Where is the image located?

B) 50 cm to the right of the lens

C) 33 cm to the left of the lens

D) 14 cm to the left of the lens

Vergence

D) 14 cm to the left of the lens

100/-7 = -14cm

The intermediate image formed by the concave lens is

A) Real , inverted

B) Virtual, upright

C) Real, upright

D) Virtual, inverted

B) virtual, upright

Schematic Eye

Reduced Schematic Eye

F n F’

17 mm

power = +60 D

5.5 mm

17 mm 22.5 mm

Mirrors

Angleof incidence

= angle of reflection

Concave mirrors add plus vergence

Plane mirrors add zero vergence

Image space is reversed: image rays are on same

side as object rays

Mirrors

Central ray passes through center of curvature (C)

not through center of mirror.

real, inverted

virtual, upright

Mirrors

U+D=V

F=r/2

(r=radius of curvature)

Reflecting power

D=1/F=2/r

cornea?

2/.008 = 250D (-250D)

Magnification

Transverse Magnification

= Image height / Object height

= Image distance / Object distance

= Object vergence / Image vergence

Mag =U/V

trans

is the product of the individual magnifications.

Where is the intermediate

image?

+6 -4

50 cm 12.5 cm

+6 -4

-2 +4

50 cm 12.5 cm 12.5 cm

•What is the magnification?

M = U/V = -2/+4 = -0.5

Where is the final image?

+6 -4

-2 +4 +8 +4

Simple Magnifiers

The (angular) magnification of a simple plus lens is

defined as the ratio of the size of the image produced by

the lens to the size of the object viewed at 25 cm

Magsimplemagnifier =D/4

Examples:

+ 8D lens is called a 2x magnifier

Direct ophthalmoscope

What is the angular magnification of a retinal image

using direct ophthalmoscopy in an emmetrope?

out of the eye and held at 25 cm)

Telescopes

Receives parallel rays from a distant object

and projects parallel rays out.

(i.e. an afocal system)

2 lenses : objective + eyepiece

object regardless of location.

telescope

Keplerian Telescope

Eyepiece: high-power plus lens

Separation: sum of focal lengths

Image: inverted, all light from objective is collected

Astronomical telescope

Gallilean Telescope

Eyepiece: high-power minus lens

Separation: difference between focal lengths

Image: upright, some light collected from objective is lost

Surgical loupes

Prisms: True or False?

The power in prism diopters is the number of

centimeters that light is displaced perpendicularly for

every centimeter that the light travels.

Prisms: True or False?

calibrated while held in

the angle of minimum

deviation.

Prisms

Real images created by prisms are deviated toward

the prism base.

Prentice’s Rule

Except at its optical center, a spherical lens

has prism at every point on it’s surface.

Δ =hxD

Δ = prism diopters

h = distance from optical center in cm

D = diopter power of the lens

Prentice’s Rule

If a patient with no

ocular misalignment

reads 1 cm below the

optical centers of his

single vision glasses,

with the different lens

powers as shown, what

prismatic effect is

induced?

Prentice’s Rule

The powers of the

lenses acting in the

vertical meridians are

used

the reading position =

4Δ of vertical prism

Will induce a left

hypertropia

Fresnel Prisms

Fresnel prisms are equivalent to side-by-side

strips of long, narrow, thin prisms.

fresnel prism

Fresnel Prisms

Used to avoid the weight of conventional

prisms.

Plastic Fresnel prisms are available as Press-

On prisms from 0.5Δ to 40Δ.

Visual acuity suffers by one or two lines with

higher power prisms because of glare and

chromatic aberration.

Bifocal Segments

ImageJump – prismatic power at top of bifocal

segment

Executive has no image jump

Image Displacement – total prism in reading

position

What type of add minimizes image

displacement with:

Plus lenses?

Round top

Minus lenses?

Flat top

Question

A patient with congenital nystagmus has a

null point measured to be 10° to the left of

fixation. The appropriate prism prescription

to rectify the induced head turn is

a. 10∆ BI OS, 10∆ BO OD

b. 10∆ BI OD, 10∆ BO OS

c. 20∆ BI OS, 20∆ BI OD

d. 20∆ BI OD, 20∆ BO OS

e. 20∆ BI OS, 20∆ BO OD

(Regular) Astigmatism

Curvature of an astigmatic lens has minimum

and maximum values, located in meridians

90° apart.

An astigmatic surface cannot bring light rays

to a point (stigma) of focus.

Instead two focal lines are formed.

Sturm.

Astigmatism

Each focal line is formed by the power of the lens

acting 90° away from the focal line.

Conoid of Sturm

Type of Astigmatism

Location Sphere Sphere + Cyl

Compound Vitreous - -

Myope

Simple One vitreous 0/- -/0

Myope One retina

Mixed Straddle Retina +/- -/+

Behind retina

Compound Behind retina + +

Hyperope

Maddox Rod

Jackson-Cross

Which of the following is a Jackson-Cross

cylinder?

A) +0.50-0.25 x 90

B) -1.00+0.50 x 180

C)+2.00-4.00 x 90

D)-4.00 +2.00 x 90

Accomodation

Theaccomodative amplitude of a 60 yr. old

healthy person is approximately:

1.50 D

Accomodativeamplitude:

age 40 = 6.0 44 = 4.5 48 = 3.0

>age 48 decreases by 0.50 every 4 yrs

<age 40 increases by 1.0 every 4 yrs

Kestenbaum’s Rule

A 72 yr. old patient with bilateral macular

degeneration has a distance acuity of 20/100. The

add required for this patient to read newspaper print

is:

A) +1.00

B) +3.00

C) +4.00

D) +5.00

E) +10.00

Contact Lenses

ObtainRefraction & K's

Choose base curve steeper than low K

Usu +0.50 D steeper to form tear lens

Prevents apical touch

Convert refraction to Minus cylinder form

Disregard the cylinder

Convert to zero vertex distance

Subtract +0.50 spherical tear lens from the

sphere value to obtain the final RGP sphere

Accounting for the tear lens in

RGPs

Flatter add plus FAP

Power of the “tear lens” is 0.25 D for every 0.05 mm

radius of curvature difference between contact lens

and cornea

Therefractive error of an eye is -3.00 D, the

K measurement is 7.80 mm and the base

curve chosen for the rigid contact lens is 7.95

mm. What is the anticipated power of the

contact lens?

CL power: -3.00 D + 0.75 D = -2.25 D (FAP)

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