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Lecture VI Binocular Refraction

This document outlines a lecture on binocular refraction. It defines monocular refraction as performing subjective refraction with one eye occluded. Binocular refraction is done with both eyes open from the start. The document discusses techniques for binocular refraction including fogging one eye to maintain peripheral fusion. The advantages of binocular refraction are that it provides a normal visual environment and allows greater relaxation of accommodation. Limitations include when acuities or vision is markedly unequal between eyes or one eye is strongly dominant.

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henok biruk
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753 views

Lecture VI Binocular Refraction

This document outlines a lecture on binocular refraction. It defines monocular refraction as performing subjective refraction with one eye occluded. Binocular refraction is done with both eyes open from the start. The document discusses techniques for binocular refraction including fogging one eye to maintain peripheral fusion. The advantages of binocular refraction are that it provides a normal visual environment and allows greater relaxation of accommodation. Limitations include when acuities or vision is markedly unequal between eyes or one eye is strongly dominant.

Uploaded by

henok biruk
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Lecture six

Binocular
refraction
09/25/20
Gizachew T.
1
Out line

 Definition of monocular refraction


 Revise binocular tests on monocular
refraction.
 Definition of binocular refraction
 Clinical indications of binocular refraction
 Binocular Refraction: Techniques
 Advantages of binocular refraction
 Limitations of binocular refraction
09/25/20 Gizachew T. 2
Monocular Refraction
• Monocular refraction - Performing the whole
subjective refraction under monocular
conditions by occluding the other eye .
• Binocular tests on monocular refraction:
–Binocular balancing
–Binocular plus addition

09/25/20 Gizachew T. 3
Binocular Balancing: revision
• Used to balance the accommodative effort in the
two eyes by uncovering any extra hyperopia which
becomes manifest when the patient is binocular.
• The fogging lens will dissociate one eye from the
other, while maintaining peripheral binocular vision
and fusion.

09/25/20 Gizachew T. 4
Binocular Refraction
• Binocular refraction - is a method of determining
subjective refraction, monocularly, under binocular
conditions from the start of subjective refraction.

09/25/20 Gizachew T. 5
Clinical Indications for Binocular Refraction

1.Refractive Considerations
– Hyperopic Anisometropia
– Antimetropia
– Latent Hyperopia
– Pseudomyopia
2. Visual Acuity Considerations
– Anisooxyopia - a difference in corrected visual acuity between
the eyes.

09/25/20 Gizachew T. 6
3. Ocular Motility Considerations
– Significant Phoria
– Any cyclophoria
– Latent Nystagmus

09/25/20 Gizachew T. 7
A. Binocular Refraction: Techniques
I. “Fogging” or Humphriss immediate contrast
(HIC) technique
1. Should be performed following a good
retinoscopy:
2. Check that each eye has good and equal acuity
after retinoscopy
3. One eye is fogged using either + 0.75 or +1.00
DS and the other eye is briefly covered to check
that this eye is fogged
09/25/20 Gizachew T. 8
3. The idea fogging is to reduce the acuity in this
eye to about 6/12, at which point central vision
is inhibited, but peripheral fusion and binocular
vision is maintained
4. The first (unfogged) eye is then refracted in the
normal way.
5. When the end point is reached the eye that was
fogged will be refracted in the same way by
fogging the other eye.

09/25/20 Gizachew T. 9
6. If the +1.00 DS does not reduce the acuity
enough, add more plus until it does
7. After refracting the second eye, remove the
fogging lens and no further tests are required

09/25/20 Gizachew T. 10
II. The “Hack Humphriss” Technique

A useful method which is a combination of


binocular and monocular refraction
1. To refract the RE, occlude the LE
2. Refract the RE monocularly
3. Apply the +1.00 blur test. If the VA is
reduced to 6/12 or so, leave the +1.00 in,if
not, adjust the fogging lens until it does.

09/25/20 Gizachew T. 11
5. Refract the LE with the RE fogged,
i.e. Binocularly
6. Apply the +1.00 blur test to the left
eye
7. Check the finial sphere balance of
the RE binocularly with the +1.00
DS still in place before the LE

09/25/20 Gizachew T. 12
Binocular vs. Monocular Refraction
Advantages
1. Provides a normal visual environment – no
occlusion
2. allows greater relaxation of accommodation
3. In the presence of peripheral fusion and
binocular vision accommodation and
convergence are kept in a stable relationship,
- i.e. no induced phoria and changes in
accommodation through occlusion.
09/25/20 Gizachew T. 13
3. Static accommodation will equal in two eyes,
and helps Px to relax accommodation to full
extent
4. Cylinder axis may change from monocular >
binocular refraction, as eyes may take up
Cyclophoria position under monocular
conditions
5. Rotational phorias (cyclophorias), if present,
will not reduce the final binocular VA

09/25/20 Gizachew T. 14
5. Normal pupil size and light levels
- equal illuminance to both eyes = equal pupil
size.
- Pupil size is part of 3rd nerve route, may
effect accommodation
6. No separate binocular balancing is needed –
this saves time
7. Where latent nystagmus is present, it will be
reduced

09/25/20 Gizachew T. 15
Limitations:
Binocular refraction should not be used where:
a. Acuities are markedly unequal
b. Poor VA in both eyes
c. Or one eye is strongly dominant
- In such cases, occlude the better eye, refract the worst eye.
- Then refract the better eye with the worst eye fogged.

09/25/20 Gizachew T. 16
Any question????

09/25/20 Gizachew T. 17

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