Physiology Labs

Protocols
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Labs aim: Explore biology in context through brain and hands

Vision Lab

AIM of that lab:

• Understand common refractive disorders, principles of evaluation and correction

• Understand principles and use of ophthalmoscopy
• Understand some other tests for vision

REQUIRED KNOWLEDGE:

• Snell’s law, optical rays refraction (converging lens, concave lens, cylindrical lens,
toroidal lens, progressive (multifocal) lens, contact lens)
• Principles of ophthalmoscopy. Direct and indirect.
• Purkinje images
• Eye Anatomy. Eyeball, muscles, visual pathway, retina, aqueus humor
• Accomodation – principles, significance, presbyopia
• Weber-Fechner psychophysical law, optical transduction

TASKS, EVALUATIONS AND DESCRIPTIONS

1. Visual acuity, clarity of vision (Visus)

Visus checks the resolution of visual system (i.e. optical system, transduction,
pathway and image processing). It is very sensitive but not very specific test (be
familiar with terms sensitivity and specificity of diagnostic tests).
- think about formulation of principles describing the estimation of visual acuity
(visus) by means of Snellen optotypes. (if necessary see the corresponding chapters of
biophysics)
- try to formulate how you would explain the clinical significance of visual acuity test
- think about its significance in terms of „objective“ and „subjective“ measurement
(evaluation)

a. Visus
RIGHT LEFT

Inerpretation:

2. Estimation of Near point (NP) and Far point (FP)

- think about principles allowing the estimation NP and FP by means of Snellen’s

optotypes
- try to formulate the explanation of optometry principles, focus on optical
explanation (think why an additional lens is permitting the estimation of far point)
- formulate reasonable explanation of myopia, hyperopia in terms of optical point of
view and also in terms of clinical point of view
- what does accommodation range reflect?
- which parameter best reflects myopia/hyperopia? FP, NP, accommodation range,
Visus?
 RIGHT LEFT

PF NP FP NP

Interpretation:

3. Astigmatism

Astigmatism is the condition that is decreasing the visual acuity. Commonly this is
caused by the irregular curvature of the cornea and/or lens. It is estimated objectively
by means of ceratoscope (approximate, rough, indicative method) or by
ophthalmometer (an exact method). It can also be evaluated subjectively by
optometer.
- try to think about optical principles used to measure or to assess the astigmatism
(Purkinje pictures, convex/concave mirror, dot-to-dot vs. dot-to-bar optical
projections)
- understand differences between astigmatism of cornea, lens and total astigmatism
- try to formulate what is the difference between regular and irregular astigmatism
- explain principles how Optometer helps evaluating the total astigmatism

fd

Astigmatism

RIGHT LEFT

Horizontal Vertical Horizontal vertical

Cornea (D)
(Ophthalmometer)

FP (D) (optometer)

Inerpretation:

4. Ophthalmoscopy

Ophthalmoscopy is observation of the inside of the eye, mainly the posterior

portion of it – the retina and structures located on retina. It is common eye examination
method; however it is also performed frequently as part of general routine physical
examination (e.g. internal medicine, test done ahead of cerebrospinal fluid removal
procedure, etc.)

- try to understand the schemes attached, explaining the principle of direct

ophthalmoscopy, formulate the principles behind the operation of a direct
ohthalmoscope
- which simple pathologies can be identified by ophthalmoscopy, try to mention some?
- is this method subjective or objective ?, try to reason why !
- why is it vital to perform ophthalmoscopy prior to lumbar puncture?
- try to think about measures (arrangements, maneuvers) to test (evaluate) myopic or
hyperopic patients (doctors – observers)
- introduce several indications for performing ophthalmoscopy

Structure Observation Implication

Papilla

Retina

Retinal
artery

5. Perimetry

Perimetry tests the area (or scope) of peripheral vision by means of systematic
evaluation of visual field and its functionality. Drops (failures) in peripheral (even
central) vision are called scotomas and reflect ongoing pathology of the eye or visual
pathway.
 - think how to explain principles allowing estimation (collection) of map of
whole scope visual field functionality or visual field border-lines
- try to explain why the visual field scope (its extend) differs when different
colors and light source intensities are observed
- think and try to interpret the last picture showing various affections to the visual
field (e.g. physiological scotoma, bitemporal hemianopisa, etc.)

6. Binocular vision

The ability to perceive depth in the visual scene observed, interpreted as 3D vision
or stereoscopic vision. Depth perception comes from a variety of depth cues. In case
they come from both eyes, we speak about binocular stereoscopic vision. This is based
on sensory principles of disparity and optical phenomena referred to as parallax
(review these principles).
- look at the pictures beneath and try to explain horopter and try to distinguish it from
the term of diplopia in the context of stereoscopic vision.
- can we perceive depth with monocular vision?
- it the distance (distance to the scenes observed stereoscopically) of stereoscopic
vision limited ?

7. Color Vision

It is the ability to see light not only in terms of light intensity, but also to perceive
wavelengths of that light. It is based on functionality of different types of
photoreceptors in our retina (humans = trichromacy principle)

- read the principles behind the testing of color vision (see Ishihara Color
Vision Tests and physiological description and commentaries of these tests)
- try to understand basic principles deployed in color vision tests
 - think about simulation and dissimulation activities of tested individuals and
put them in the context of subjective and objective measurement

QUESTIONS:

Which refractive disorder/s cannot be corrected by regular lenses? Please explain.

Which refractive disorders you know?

Which parameter best reflects myopia/hyperopia? FP, NP, accommodation range,

Visus?

What does Accommodation range reflect?

Introduce several indications for performing ophthalmoscopy

What are the advantages of direct/indirect ophthalmoscopy?

Why is it vital to perform ophthalmoscopy prior to lumbar puncture?