correction of anisometropia with - optometry...

Gustav Pöltner (c) OCCSEE 2016 14.04.2016

Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie (A) / VVG (HR) / FHG-Tirol (A) /Institut Miller (A) 1

CORRECTION OFANISOMETROPIA WITH

GLASSES AND CONTACT LENSES

DIPL.-ING.(FH) GUSTAV PÖLTNER, LECT.

VDC/O, ECOO

CL- INSTITUT – MILLER – INNSBRUCK / AUSTRIA

FH-GESUNDHEIT-TIROL – INNSBRUCK / AUSTRIA

HTL-KOLLEG-OPTOMETRIE, HALL IN TIROL / AUSTRIA

UNIVERSITY OF APPLIED SCIENCES – VELIKA GORICA / CROATIA

• Aniseikonia – measuring- andcorrektion methods

• Procedure after Gernet

• Centration of prismatic lenses

• Centration of of reading glasses withvertical Anisometropia

• Macropsy glasses2Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie (A) / VVG (HR) / FHG-Tirol (A) /Institut Miller (A)

ANISEIKONIA

ANISEIKONIA

• Ikone: picture

• Iso: similar

• Iseikonie: similar - picture

• Aniseikonia: disparate picture

• Anisometropie: Refractive difference

3Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie (A) / VVG (HR) / FHG-Tirol (A) /Institut Miller (A)

Bild: Hakentest /Aniseikoniatest ohne Vergrößerungsdifferenz

Bild: Hakentest /Aniseikoniatest mit 7% Vergrößerungsdifferenz



• Optical AniseikoniaDifference in the retinal picture size of both eyes

Difference in the eye lenght

Refractive differnece of the optical medias

• Retinal or anatomical AniseikoniaVariation of the different raster structure of both Retinas

• Functional AniseikoniaSensoric caused Aniseikonia

Disparate correspondence

Cortical and retinal compensation mechanism – to prevent Diplopia4Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie (A) / VVG (HR) / FHG-Tirol (A) /Institut Miller (A)

ANISEIKONIA

Figure 4 uncorrected pair of eyes

OD: -1,50 sph = -1,50 cyl 10°, OS -19,50 sph = -1,0 cyl 180°

25,16 mm

H H´

OD

32,54 mm

H H´OS


Figure Corrected with glasses

OD: -1,50 sph = -1,50 cyl 10°, OS -19,50 sph = -1,0 cyl 180°Calculated Aniseikonia 32,9%

32,54 mm

25,16 mm

OD

H H´

OSH H´

glasses - full correction




CONSEQUENCES OF THE ANISEIKONIA

• Aniseikonia disturbes the stereoptic view

• Aniseikonia disturbes the sensoric vision

• Aniseikonia generates motoric defective positions

• Horror fusionis


ANISEIKONIA

• < 1% measurably, but not appreciable

• 1% - 5% Incidence of the stereoptical view. Diplopia possible but not ever appreciable

• >6% maintains ever to incidence the binocular vision


ANISOMETROPIE• Isometropie = Status of the same distance refraction [5]

• DIN EN ISO 29187 „Disparate power of the two eyes with a difference of 2 dpt“

• Anisometropic difference: [5] ΔS´= S´2 – S´1

Anisometric difference (S´2 = mathematical vertex power of the stronger lens)

• Anisometropic difference - frequency (n=690) [6]

<1,00 dpt 91,2%

1,0 – 1,75 dpt 5,2%

2,0 – 2,75 dpt 2,0%

>3,00 dpt 1,6%9

Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie (A) / VVG (HR) / FHG-Tirol (A) /Institut Miller (A)



ANISOMETROPIE

• Refractive difference

• axial anisometropia

• refractive anisometropia


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ANISOMETROPIE / MERKSATZ:

• If the picture size of the more myopic eye is more big, do we have an predominant axial aniseikonia. – Has the more

myopic – or not so much hyperopic eye the smallerpicture size, do we have an predominant refractive

aniseikonia.


Aniseikonia test with 8,5% picture size difference




ANISEIKONIA-QUOTIENT

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AQ=1 + e * ARr

1 + e * ARl*

Ir

Il


AQ = Aniseikonia - quotiente = vertex distance (fill in in meters)ARr= Refraktive power ODARl= Refraktive power OSIr = length of the right eyeIl = length of the left eye

ANISEIKONIA-QUOTIENT

• Vs = 1 + e * Ar

• e = S´ to P (Gullstrand) = 1.348 mm bei Cl

• e = S´ to P (Tamajo) = 1.50 mm bei Cl

• e = S´ to P+Vertex Distance = 13.50 mm glasses (vd 12mm)


CONSEQUENCES FOR THE CLINICAL PRACTICE

• Axial anisometropia

• Refractive anisometropia

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AQ=

AQ=1 + e * ARr

1 + 0 * ARr

1 + e * ARl

1 + 0 * ARl

glasses: AQ unequal 1

Cl: vertex distance nearly 0, retinalpicture size nearly equal




CONSEQUENCES FOR THE CLINICAL PRACTICE

• Axial anisometropia with glasses

• Refractive anisometropia with contact lenses


Exampel:OD = -6,00 dptOS = -2,00 dptVertex distance = 13,0 mm

AQ=1 + 0,0145 * -6,00

1 + 0,0145 * -2,00= 0,940 = 1 - 0,94 = 6% difference

AQ=1 + 0,0015 * -6,00

1 + 0,0015 * -2,00= 0,9938 = 1 - 0,9938 = 0,0062% difference

25,16 mm

H H´

OD

32,54 mm

H H´OS

Figure : axial aniseikonia, corrected with contact lenses

OD: -1,50 sph = -1,50 cyl 10°, OS -19,50 sph = -1,0 cyl 180°OD Galifa 7,50 / -2,50 / 9,8 / Ne 0,6 / Alberta Vcc.: 1,0

OS Galifa 7,45 / -16,25 / 9,8 / Ne 0,4 / Alberta Vcc.: 0,6


• Anisometropia

• Measuring methods

• Options for correction




MEASURING METHODS OF ANISOMETROPIA

• Estimate at Hook-test / Aniseikonia-test

• Optical picture size assimilation with iseiconic glasses

• Mathematical method

• Phases contrast haploscop

• Variable magnification changer after Miller

• Compuvist, Visucat, Multivisus electronical picturesize assimilation. Result is in % percent picture sizedifference

• Different Eiconometers


Bild des Hakentest mit 8,5% Größendifferenz. Originaleinstellung des Hakentest


• Anisometropia

• Measuring methods

• Options for correction




ANISOMETROPIA CORRECTION

• 1. Iseiconic glasses

• 2. different base radii

• 3. different optical indeci

• 4. differnet vertex deepnesses

• 5. Combination out of 1,2,3,4

• Contact lenses RGP / soft



ANISEIKONIA GLASSES FOR LENGH ANISOMETROPIA


Figure test glasses with different vertex deepnesses

ANISEIKONIA GLASSES FOR LENGH ANISOMETROPIA


29Figure Iseiconic glasses with 4% bzw. 6% magnification



Figure Full correction with glasses

OD: -1,50 sph = -1,50 cyl 10°, OS -19,50 sph = -1,0 cyl 180°Calculated Aniseikonia 32,9%

32,54 mm

25,16 mm

OD

H H´

OSH H´

Full correction with glasses


Figure Iseiconic glasses with different vertex distances

OD: -1,50 sph = -1,50 cyl 10°, OS -19,50 sph = -1,0 cyl 180°

32,54 mm

25,16 mm

OD

H H´

OSH H´

Iseiconic glasses with different vertex distances


25,16 mm

H H´

OD

32,54 mm

H H´OS

Figure 18 Correction with contact lenses and after IOL-OP

OD BIAS / Hecht 7,60 / -1,25 / 9,6 / Ne 0,6 / BoES Vcc.: 1,0

OS BIAS / Hecht 7,45 / -0,25 / 9,6 / Ne 0,6 / BoES Vcc.: 0,6

Correction with contact lenses




25,16 mm

H H´

OD

32,54 mm

H H´OS

Figure 19 Correction with contact lenses and after IOL-OP

OD BIAS / Hecht 7,60 / -1,25 / 9,6 / Ne 0,6 / BoES Vcc.: 1,0

OS BIAS / Hecht 7,45 / +5,50/ 9,6 / Ne 0,6 / BoES Vcc.: 0,6

Mono vision


Revers Gallilei-System to reduce the magnification on one side

25,16 mm

32,54 mm

OS

Figure 20 Correction with glasses and contact lenses and after IOL-OP

OD: -1,50 sph = -1,50 cyl 10° Achse Vcc.: 1,0

OS: Meine 6 / 8,6 / +6,5 / 14,0 Soft lens = Objektiv of the revers Galilei-system

Left-glas = Ocular -7,00 sph = -1,00 cyl 140° Achse Vcc.: 0,6

OD

H H´

H H´







ANISEIKONIA



PROCEDURE AFTER GERNET• Aphakia – Special procedure for system anisometropia

• Combination out of contact lenses and glasses

Cl.: Over correction with +4.0 dpt

Glasses: Minus glas with - 4.0 dpt

Refractive main line change with an revers Gallilei system


37

Procedure after GernetH H´


38


H H´




39


H H´


40


H H´


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Procedure after GernetCase study




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OD CL-RGP = 7,55 /+23,75 / 9,6 / 0,6 / Bo xo2

-4,75 2,50 cm/m B 90° 2,25 cm/m B 0°

OS -5,25 -0,75 160° 3,75 cm/m B 270° 2,25 cm/m B 180°

Addition:

OD +2,50 dpt

OS +1.25 dpt (= 1,25 cm/m B 270° )

44










ANISEIKONIA


DIE MESSUNGEN DER WINKELFEHLSICHTIGKEIT

Messglasses – OS mit und OD ohne Polfiltern


47

MEASURING FRAME – TESTING GLASSES

0.5 cm/m Divergence

1.0 cm/m Konvergence

0.5 cm/m vertical difference

0.50

0.25

0.250.25

0.25 DIN EN ISO 29187RAL-RG 915




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Base of deviation

„normal“ situation intest-frames

In the Phoroptersin „normal glasses“ (by correct centered PD)

Maximum od deviation

Wrong centered glasses (PD-mistake)Uncorrect inclination

Prisma only on one side

Minimum of deviation

glasses after PD correction


Rays must run in theminimum of deviation

PD correction

1 mm per 4 cm/m

decentration

against the prism

base


52

PUT IN THE PRISM GLASSES IN THE BASE DEVIATION ONLY

Base deviation

Measuring glasses(the letters and the

numbers must be seen)

OD corret OS uncorrect!

Measuring glasses in the base deviation–Base outside

Measuring glasses in the base deviation–Base intside




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CORRECT PRISM GLASSES MUST BE ALLWAYS USED IN THE BASE DEVIATION

Messgläser immer mit dem Fähnchen bzw. der Beschriftung nach vorne (sichtbar) einsetzen.






ANISEIKONIA

55

Reading glas centration byAnisometropia (Methode from Wolf)[8]

Multifical lenses have a vertical compensation prism (slab-off-Prisma)

Monofocal reading glassesCorrect centration of the hightCorrect vertical prism




56

Augendrehpunktsforderung

Z´OB

ZB

OB Nulldurchblickspunkt

ZB Zentrierpunkt


57

Vertical prism by standardnear-glas-centration

Z´


58

Different vertical prism powers bystandard near-glas-centration

Z´ OD

Z´ OS




59

CASE STUDY „+PLUS“

OD +3.25 sph = -0.50 cyl 0° A

OS +3.75 sph = -2.75 cyl 180° A


60

Case study „+Plus“

HBN

ZB

y VP

HBN = Hight of the near-view-point y = Hight of the standard centration for the long distance (ZB) VP = Vertical prism

Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie(A) / VVG (HR) / FHG-Tirol (A) /Institut Miller (A)

61


OD +3.25 sph = -0.50 cyl 0° AOS +3.75 sph = -2.75 cyl 180° A

Y = 26 mmHBN = 16 mmDiff = 10 mm




62


OD +2.75 sph = +0.50 cyl 90° AOS +1.00 sph = +2.75 cyl 90° A

P = S`90 * cP = (+2.75 - 1.00) * 1P = 1.75 cm/m


63


OD +3.25 sph = -0.50 cyl 0° A 1.75 cm/m B 90°OS +3.75 sph = -2.75 cyl 180° A


64


HBN

ZB


OD +3.25 sph = -0.50 cyl 0° A 1.75 cm/m B 90°OS +3.75 sph = -2.75 cyl 180° A

Gustav Pöltner (c) OCCSEE 2016 / HTL-Kolleg-Optometrie (A) / VVG (HR) / FHG-Tirol (A) /InstitutMiller (A)



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Correct near-glas-centration to get the same prismatic power in the vertical meridian

Z´ OD

Z´ OS

OD +3.25 sph = -0.50 cyl 0° A 1.75 cm/m B 90°

OS +3.75 sph = -2.75 cyl 180° A


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CASE STUDY „- MINUS“

OD -3.50 sph = -0.50 cyl 0°

OS -4.25 sph = -2.25 cyl 175°


67

Differnt vertical prismatic powers by standard near glas centration

Z´ OD

Z´ OS

R -3.50 sph = -0.50 cyl 0°

L -4.25 sph = -2.25 cyl 175° A




68

Case Study „- Minus“

HBN

ZB

y VP



69


OD -3.50 sph = -0.50 cyl 0°OS -4.25 sph = -2.25 cyl 175°

Y = 26 mmHBN = 16 mmDiff = 10 mm


70


OD -4.00 sph = +0.50 cyl 90°OS -6.50 sph = +2.25 cyl 85°

P = S`90 * cP = (-3.00 - -5.5) * 1P = 2.5 cm/m




71


OD -3.50 sph = -0.50 cyl 0° 2.5 cm/m B 270°OS -4.25 sph = -2.25 cyl 175°


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Equal vertical prism power by correct standard near glas centration

Z´ OD

Z´ OS

OD -3.50 sph = -0.50 cyl 0° 2.5 cm/m B 270°

OS -4.25 sph = -2.25 cyl 175° A







ANISEIKONIA




Macropsy glasses

Macropsy:

Psychologic „tele-effect“ by the view in the longdistance only

Function only by parallel eye position


75

Macropsy glasses for the near distance

Macropsy-reading glasses:

The parallel eye position weget with 6 cm/m prismwith base inside on botheyes

In combination with addition+2,50 dpt

Optional in combination

with passfilters

6 cm/m Base inside+2,50 dpt


MACROPSY GLASSES

Measuring frame with Macropsy prismBino 6 cm/m base inside




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MACROPSY GLASSES


+2,5 dpt additionPass-filter 450 nm


Pass-filter 450 nm bzw. 527 nm

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[1] Diepes, H.; / Refraktionsbestimmung[2] Stollenwerk, G.; Anisometropie: glasses oder Kontaktlinse?, Teil 1 DOZ 03/2013 DOZ-Verlag Heidelberg 2013[3] Stollenwerk, G.; Anisometropie: glasses oder Kontaktlinse?, Teil 2 DOZ 04/2013 DOZ-Verlag Heidelberg 2013[4] Pöltner, G.; Schulskriptum REFL2, HTL-Optometrie / Hall[5] Goersch, H.; Wörterbuch der Optometrie. 3. Aufl. DOZ Verlag Heidelberg 2004[6] Trotter, J.; Refraktionsbestimmung und Gläserauswahl bei Anisometropie. Sonderdruck der WVAO 1967;17:87-95 [7] Fahrner, D.; / Schulskripten[8] Wolf T. Höhenzentrierung von Nahglasses bei Anisometropie; DOZ 9/87[9] Duden, Das Wörterbuch medizinischer Fachausdrücke

Literatur:


correction of anisometropia with - optometry...

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