KERATOMETRY

Moderator -Dr Dhananjay

Presentor-Dr Sunanda Majumder
KERATOMETRY (OPHTHALMOMETRY)

Kerato = Cornea
Metry = Measurement
DEFINITION

Keratometry is measurement of curvature of the anterior

curvature of central 2-3mm of cornea.
PRINCIPLE

The Keratometer assumes that the cornea is a perfect, thin, dry &
inelastic sphere and calculates the corneal power using following
principles:
The cornea is a convex refracting surface.
In order to find the refracting power of the cornea, we need to
reflect an object of a known size at a known distance to the corneal
surface.
Keeping the distance between the eye and keratometer fixed, the
corneal radius is directly proportional to the size of the reflected
image which is nothing but the 1ˢᵗ purkinje image and indirectly
proportional to the size of the object.
Keeping the distance between the eye and
keratometer fixed, the corneal radius is directly
proportional to the size of the reflected image
which is nothing but the 1ˢᵗ purkinje image and
indirectly proportional to the size of the object.
For a convex mirror,
i/o = v/u
i - image size
o - object size
v - image distance from the mirror
u - object distance from the mirror
When object at infinity, i/o = f/ u
i/o = R/2u
So, R = 2ui/o
The corneal power is calculated based on snell’s law of refraction:

D= n₂-n₁/R

D – Dioptric power of cornea

n₁ – Index of refraction of 1ˢᵗ medium (air-cornea)
n₂ – Index of refraction of 2ⁿᵈ medium (cornea-aqueous)
R – Radius of cornea in metres
Doubling Principle:
Biprisms introduced into the optical system so that 2 images are
formed .
Lower edge of one image coincides with upper edge of the other.
If eye moves – both moves
The prism is moved until the images touch each other.
↓
Depending on the position of prism – if distance , doubling ↑
Parts of Keratometer
A. Focusing Knob
B. Rotating Grip for Locating the Axis
C. Chin Rest
D. Locking Knob
E. Elevating Knob
EP. Eyepiece
G. Head Rest Adjusting Knob
H. Occluding Shield
HR. Head Rest
J. Chin Rest Adjusting Knob
K. Leveling Sight
M. Horizontal Measuring Drum
N. Vertical Measuring Drum
S. Axis Scale
Optical system of Keratometer (BAUSCH &
LOMB KERATOMETER)
INSTRUMENT CALIBERATION

Instrument is calibrated before use

White paper held in front of objective lens & a black line is focused
sharply on it
Keratometer is then calibrated with steel balls
Steel ball of known radius of curvature is placed before
keratometer & its value is set on the scale or dial
Mires are focused by clockwise & anticlockwise movement of
eyepiece through trial & error
When mires are in focus, the calibration is complete.
PATIENT ADJUSTMENT

Seated in front of the instrument.

Chin on chin rest & head against head rest.
Eye not being examined is covered with occluder.
Chin raised or lowered till patient’s pupil & projective knob are at
the same level.
 Focusing of mires :
Mire is focused in the centre of cornea

Patient’s view of mire The central image is doubled, indicating that

instrument is not correctly focused on the corneal image of
the mire
 To measure curvature in horizontal To measure curvature in vertical
meridian plus signs cental & left images meridian minus signs cental & upper
are superimposed using images are coincided using
horizontal measuring control. vertical measuring control.
In presence of oblique
astigmatism, two plus signs will
not aligned. Entire instrument
rotated till they
are aligned.
Spherical Cornea
No difference in power between meridian
Mires seen as perfect sphere.

Irregular anterior Corneal surface

Irregular mires
Doubling of mires.
Astigmatism
Difference in power between 2 principle meridian.
Horizontally oval mires in WTR astigmatism.
Vertically oval mires in ATR astigmatisms.
Oblique astigmatism – principle meridia between 30⁰-60⁰ & 120⁰-150⁰.

Keratoconus
Pulsating mires (inclination & jumping of mires on attempt to adjust the
mires).
Minification of mires in advanced cases (K>52D) due to increased
amount of myopia.
Oval mires due to large astigmatism.
Irregular, wavy & distorted mires in advanced keratoconus.
BAUSCH & LOMB KERATOMETER
Range – 36.00 to 52.00 D
Normal values – k1-41.00 to 43.00 D, k2-42.00 to 45.00 D
To increase the range – Place +1.25 D lens in front of aperture to extend
range to 61 D
(ADD 9 D)
Place -1.00 D lens in front of aperture to extend range to 30D
(SUBTRACT 6 D)
TYPES OF KERATOMETER

Kerameter can be classified based on:

1) Principles of keratometer
i) Javal-Schiotz Keratometer
ii) Bausch & Lamb Keratometer and von Helmholtz
Keratometer

2) Depending upon the need to rotate the prism

i) One position keratometer
ii) Two position keratometer
3) Depending on working
i) Automated
ii) Manual
AUTOMATED KERATOMETERS

Focuses reflected corneal image on to

an electronic photosensitive device,
which instantly records the size &
computes the radius of curvature.
Target mires are illuminated with
infrared light, & an infrared
photodetector is used.
ADVANTAGES

Compact device
Very short time consuming
Comparatively easy to operate
No doubling device is needed.
Measures angle size in many meridians so it computes angle as well
as power in many meridians.
Absence of annoying glare of brightly illuminated mires.
Do not calculate clarity of cornea
CLINICAL USES OF KERATOMETERS

1.Helps in measurement of corneal astigmatic error.

2.Helps to estimate radius of curvature of the anterior surface of
cornea - Use in contact lens fitting.
3.Monitors shape of the cornea – Keratoconus, Keratoglobus.
4.IOL power calculation.
5.To monitor pre- & post-surgical astigmatism.
6.Used for differential diagnosis of axial versus curvatural
anisometropia.
LIMITATIONS OF KERATOMETRY

Measurements of keratometer based on false assumption that

cornea is a symmetrical spherical or spherocylindrical structure,
with 2 principal meridia separated from each other by 90⁰.
Measures refractive status of small central cornea (3-4 mm)
Loses accuracy when measuring very flat or very steep cornea.
Small corneal irregularities preclude use of keratometer due to
irregular astigmatism.
One-position instruments assume regular astigmatism.
Distance to focal point is approximated by distance to image.
SOURCES OF ERROR IN KERATOMETRY
The von Helmholtz Keratometer

The von Helmholtz keratometer uses two rotating glass a —plates

to achieve doubling of the image, A beam of light which has passed
thiough a graticale shone on to the patient's cornea where an
image I of the graticule is formed by reflection.
The reflected light passes back into the instrument through two
parallel-sided glass plates X and Y which are inclined to each other.
These plates displace the Light laterally as it passes through them,
thus giving rise to two virtual images of I, I’ and I” which are viewed
through a telescope. The angle of inclination of the glass plates is
varied by the observer until the edges of I’ & II’’ touch.
The distance between their centres then equals the diameter of I,
from which the corneal curvature can be calculated. In fact, the
instrument is calibrated in terms of corneal radius of curvature and
of dioptric power of the cornea.
The instrument can be rotated to allow measurement of
astigmatism in a similar manner to the Javal-Schiotz keratometer.
Javal-Schiotz keratometer
The Javal-Schiotz keratometer uses an object of variable size. The
object consists of a pair of mires, A and B, mounted on curved side
arms which project each side of the viewing telescope.
Each mire consists of a small lantern with a coloured window. One
mire is step shaped while the is rectangular. The space between
the mires ab is the object size used in the measurement.
The arms on which the mires are mounted can be rotated about the
axis of the telescope so that readings can be made in any meridian.
Doubling of the image formed by reflection at the cornea is
achieved by a Wollaston prism which is incorporated in viewing
telescope. A Wollaston prism consists of two rectangular quartz
prisms cemented together. Quartz is a doubly refracting substance,
that is, it splits a single beam of incident light to form two polarised
emergent beams. By cementing two quartz prisms together with
the optical ‘grain’ of the crystal at right angles, it is possible to
separate the two emergent beams by a fixed angle, while the
dispersion produced by the first prism is neutralised by that of the
second prism allowing sharp images to be formed.
In order to measure corneal curvature the distance between the
mires is adjusted until the doubled images touch.
The instrument is calibrated in terms of corneal radius curvature
and in terms of dioptric refracting power of the cornea. The mires
are designed so that each step of mire A is equivalent to one
dioptre of corneal power.
Thus if the inner images of a and b are aligned correctly in one
corneal meridian but overlap by one and a half steps in the meridian
at 90° to the first, 1.5D of corneal astigmatism is present.
When an astigmatic cornea is examined, the two images are
displaced vertically in all but the two principal meridians of the
cornea. Thus the axis of astigrnatism as well as its magnitude can
be measured. The mires of the Haag-Streit Javal-Schiotz
Keratometer incorporate a horizontal line to facilitate vertical
alignment.
THANK YOU