 Ophthalmic Dispensing II

 Credit hour : 2

 Course code : 431

 For 2nd year optometry students

Alemayehu D.
(BSc, MSc in clinical optometry)

09/23/20 1
 Anisometropia and aniseikonia
 High Myopia
 High Hyperopia
 Paediatric dispensing
 Progressive lens fitting
 Occupational lenses
 Safety eye wear
 Glazing
 Clinical Dispensing and fitting of spectacles in

general clinic
 Demonstration

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 At the end of this session you be able to:

◦ Define anisometropia and aniseikonia

◦ List cause of anisometropia and aniseikonia

◦ List types of aniseikonia

◦ Differentiate clinical significance od anisometropia

◦ Analysis challenges of dispensing anisometropia

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 Definition

 Cause

 Types

 Challenges

 Case analysis

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 What is anisometropia?

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 Anisometropia:
◦ Unequal power of two eyes
◦ Cause unequal retinal image size and shape
◦ 0.25 difference is anisometropia
◦ Affects all age group regardless sex, ethnicity
◦ Can be spherical or meridional anisometropia
◦ But need sooner correction for young children. Why?

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 No need for correction
◦ Anti-metropia
◦ If one eye is dominant and no longer binocular with sensible
anisometropic lenses
 Spectacles
◦ Mainly our focus
 Contact lenses
◦ For aniseikonic correction
◦ To maintain binocularity
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Refractive Surgery

◦Changing corneal shape

Intraocular surgery

◦High refractive error e.g. myope remove lens

◦ Implant IOL

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 Walking on the grass will cure poor eyesight

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 Spectacle does not eliminate problems from anisometropia.

Why?
◦ Characteristics of lenses
 Magnification/minification
 Prismatic effect
 Spectacle magnification:

◦ Is magnification of image in single eye with and with out correcting

lenses
◦ Is not the magnification b/n two eyes 09/23/20 1
 Spectacle magnification (SM): is ratio of
Retinal image size in corrected eye
Retinal image size in same uncorrected eye
 There are two factors that contributing to SM:
◦ Shape factor (t, n &F1) like telescope
 Has no net power on it but can cause change in magnification
◦ Power factor (d & F’v)
 They contribute independently
 There contribution is expressed as:

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 SM= (shape factor) * (power factor)
◦ (1/1-t/nF1) (1/1-hF’v)
 Where
 t- thickness of the lens in meter
 n-refractive index
 F1- front surface power
 F’v- back surface power
 h- distance from back vertex of lens to entrance pupil

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 SM= 1
1 - dF
 Where
 d -is distance from back vertex of lens to eye’s
entrance pupil (approximately 3mm behind cornea)
and

 F -is the power of the thin compensating lens.

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 RE: -8.00Ds and LE: -5.00Ds
 For the above prescription if spectacles are to be prescribed with a
vertex distance is 0.013 m and the entrance pupil is 0.003m
behind the vertex of the cornea,
 d = 0.013 + 0.003 = 0.016 m.

 Using the above formula

 for the right eye (─ 8.00Ds) SM = 0.886 = 0.886 – 1 = ─ 0.114 =
─ 11.4% (loss).

 For the left eye (─ 5.00Ds) SM = 0.926 = 0.926 – 1 = ─ 0.074 =

─7.4% (loss)

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 The right eye suffers a ─11.4% magnification (11.4% minification)
while

 The left eye suffers a ─7.4% magnification (7.4% minification)

relative to the eyes uncompensated retinal image size.

 This shows a 4% difference in retinal image sizes.

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 What is the Contact lens magnification for the
above Rx?

 OD: -8.00Ds

 OS: -5.00Ds

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This can be calculated by using Prentice’s Equation for thin
lenses;
P = cF
where
 P is the prismatic effect, c is the distance in centimeter from
the optical centre of the lens and F is the power of the lens.

 The patient may complain about double vision or

uncomfortable upon vertical directions of gaze. Why mostly in
vertical gaze?

 What normally happens is that the patient will tell you that if
he holds reading material at eye level while looking straight
ahead, the vision is more comfortable. 09/23/20 1
 If for example the patient drop there position of gaze to 10 mm below
the optical center:
◦ OD: -8.00Ds
◦ OS: -5:00Ds, what is the prismatic effect

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 This is also a common complaint with astigmatic
anisometropic patients where the powers differ along
the vertical meridians.

 More head movement would have to be encountered.

 The obvious choice would be to select small and

narrow frames.

 However, this is not always possible because some

patients have large faces.

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 Be in group and discuss on:

 What lens materials you need to

consider?

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 Magnification caused by the anisometropia. (different
refracting states of the eyes).

 Aniseikonia (different retinal image sizes) due to the two

different magnifications produced by the lenses.

 Possible diplopia (double vision) on vertical positions of

gaze (if spectacles are to be prescribed) due to the
prismatic effect caused by the two different
compensating lenses.

 Lens materials.

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 What do you want to know before prescribing
anisometropic?

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 Recognition of anisometropia

◦ Type of prescription
 Spherical
 Astigmatism
 Age of the patient

◦ Amblyopic treatment
 Past visual history

◦ Hx of past glasses - Binocularity

◦ Alternatively - Dominance eye
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 Visual demand of the patient

◦ Binocularity ( stereopsis)
 Working environment
 Ocular status

◦ Any medial opacity

◦ Active disease that reduce vision
 Systemic condition
◦ Diabetic mellitus
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 Tolerance
◦ require a compensating prism at the off-centre visual point of their
lenses
◦ Why some subjects doesn't complain for significant anisometropic
eye glasses?
 Some anisometropic subjects, however, are able to adapt to the differential
prism and exhibit no symptoms.
 Some will just suppress, especially at higher levels.
 Others, at lower levels, may have good fusional reserves and tolerate the
differential prism.
◦ Subjects with marked anisometropic amblyopia benefit from prism
compensation even though vision is monocular.
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 Choice of lens
 Eliminating or reducing the differential prism responsible for

the diplopia when viewing through the NVP of the lenses can
be done through the following methods:
◦ Slab-off
◦ Different round bifocal segment sizes
◦ Franklin split
◦ Prism controlled bifocals
◦ Cemented or bonded bifocal segments.

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 E.g. Meridional anisometropia
 Rx before cataract removal from the left eye:
 R +3.00/-1.00x10 VA 6/6-1 add +2.50. 

L +2.75/-1.00x45 VA 6/36 add +2.50

◦ Rx following left lens implant:
 R +3.25/-1.00x10 VA 6/6-1 add +2.75
 L +2.25/-2.25x175 VA 6/6-1 add +2.75
 Assuming a near visual point (NVP) of 10mm below the optical centre

◦ Think of vertical imbalance

◦ So compare before and after?

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Any questions?

Thank you for your

attention!

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