VISION PRACTICAL
Objectives-tests of visual function
1. Testing of visual acuity
2. Testing near point
3. Astigmatism
4. Color perception
5. Retinal examination
6. Perimetry
PARTS OF THE EYE
1. Visual acuity
The ability to see two points or two lines as two separate points or
lines.
For this to happen, the two rays of light must have a minimum
separation of 5 minutes of an arc on the retina.
Tests include Snellen’s chart, C chart, E chart
Each eye is tested separately. The subject stands 6M form the chart
and tries to read the letters. Visual acuity is expressed as distance
from the chart over the last row read correctly (at least 3 letters).
Snellen’s chart (6m=about 20ft)
Numerator represents the distance that the patient is standing from
the chart.
Denominator represents the distance that a person with normal
eyesight should be able to clearly visualize.
Normal vision is 20/20 or 6/6.
A larger denominator signifies myopia.
Pathology
Myopia/short-sightedness: light rays focus in front of the retina. May
result from too long an eyeball or too much refractive power. Distant
objects are therefore not seen easily. However, when an object is
brough closer, they may use accommodation to see the object.
Correction; Concave lenses to reduce the refractive power of the lens.
Hyperopia/Far-sightedness: Caused by an eyeball that is too short, or
lens system that is too weak thus reduced refractive power. Corrected
using a convex lens to strengthen the refractive power.
NB Normal visual acuity is referred to as emmetropia.
2. Astigmatism
Is a refractive error of the eye that causes the visual image in one
plane to focus at a different distance from that of the plane at right
angles.
Results from too great a curvature of the cornea in one plane of the
eye.The cornea is irregular/oval shape. Normal is spherical.
Think of the normal eye being an upright egg, and an astigmatic eye
being a horizontal egg.
Can’t self correct because the light rays are not being focused in one
central place, but in different areas. Blurry image is seen.
Test of astigmatism
Modern methods of measuring this include topography.
Area of astigmatism can also be measured using an astigmatism fan
chart.
The subject is asked to state if all the lines in the chart are
straight/curved and short/long. If some lines are uneven, then, that is
the area with the plane of astigmatism.e.g. if the blurriness is in the
900 plane, then the astigmatic plane is vertical. If the blurriness is in
the 1800 plane, then the astigmatic plane is horizontal.
Cylindrical lenses to bring
the object into focus.
Astigmatism
3. Near point
Measures accommodation.
Near point is the closest point from the eye which an object can be
seen. Closer than that, the object cannot be visualized clearly.
Accommodation is the ability of the eye to adjust its focus to see
objects at different distances. It's achieved by changing the shape of
the eye's lens to bring images into focus on the retina.
This is done by ciliary muscles and suspensory ligament.
Measured in dioptres, i.e. 1/distance in meters.
The far point of accommodation is the farthest point an object can be
placed along the eye's optical axis and still be focused on the
retina. It's also known as the point at which an image is clearest away
from the eye.
The far point of a normal human eye is infinity, but for practical
purposes, it's considered to be 20 ft (6 m). The far point of a myopic
eye is closer than 6 m, while the far point of a hypermetropic eye is
behind the retina.
Near point is usually about 8-12cm.
Near point
Measured by use of a ruler and a piece of paper with writing. The
paper is moved farther away until the subject is able to see clearly.
This is known as near point.
Presbyopia-loss of accommodation due to aging of the eye caused by
degeneration of lens proteins. Tend to be far sighted in most cases.
Commonly occurs in older people.
Corrected using convex/bifocal lenses, with the upper segment
focused for far-seeing and the lower segment for near seeing, i.e.
reading.
4. Color perception
Two types of photoreceptors are present in the eye, i.e., cones and rods.
Cones are responsible for color perception. Different cones are sensitive to
different colors of light.
The eye detects color when red, green and blue( primary colors)
monochromatic lights are appropriately mixed in different combinations.
Anomaly-weakness in a color pigment.
Anopia-missing color pigment(color blindness)
Color blindness is a X-linked genetic disorder, and thus occurs almost
exclusively in the males. This is because, in females, the other X
chromosome is almost always normal, thus the subject is usually a carrier.
Most common is the red green color blindness.
In males the gene is always passed from the mother.
Red-protanopia, protanomaly.
Green-deuteranopia, deuteranomaly.
Blue-tritanopia, tritanomaly.
Monochromats-one cone system.
Dichromats-have 2 cone systems.
Trichromats-have all three cone systems.
Ishihara charts used to measure
colour blindness
5. Perimetry
Tests field of vision.
Only test that assess for the peripheral visual field.
Field of vision refers to the part if the external world that can be seen when
one fixes a gaze at one point.
The nasal side is called the nasal field of vision, while the lateral side is
known the temporal field of vision.
To diagnose blindness in a specific portion of the retina, one charts the field
of vision using a process known as perimetry.
Charting is performed by having the subject look with one eye towards a
central spot directly in front of the eye while the other eye is closed. A small
dot of light is then moved back and forth in all areas if the field of vision
and the subject indicates when the object can and cannot be seen. The field
of vision is then plotted in the perimeter chart.
Perimetry
In all perimetry charts, a blind spot caused by lack of cones and
rods over the optic disc is found about 15 degrees lateral to the
central point of vision.
Scotoma (scotomata);
Blind spots in other areas of the field of vision. May be caused by
glaucoma, allergic reactions in the retina, or toxic conditions such as
lead poisoning or excessive use of tobacco. Mainly due to retinal
detachment from the colloid layer,
Retinitis pigmentosa;
Portions of the retina degenerate, and excessive melanin is deposited
in these areas. Usually causes blindness in the peripheral field of
vision, then gradually moves centrally.
With scotomata…
6.Retinal examination
Involves examining the retina to see if there is any physical defect or
damage. Done using an opthalmoscope/ fundoscope/retinoscope.
You should be able to see;
Optic nerve
Veins
Arteries
Macula
Fovea
Optic disk, optic cup
Retinal examination
R-R-R RULE: right hand-examiners right eye-subjects right eye.
Room should be dark.
Presence of particles in the aqueous ad vitreous humor indicate
pathology. Also cloudiness in the cornea.
Bulging of the optic disk/cupping of the optic disk-increased
intraocular fluid(glaucoma).
Shrinking of the optic disk-reduced intraocular pressure.
Retinal neovascularization-overproduction of retinal blood vessels.
