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验光配镜操作技术     

    在这个科技飞速发展、设备日益更新、技术不断进步的今天,只有努力的学习,掌握更多的理论和实践经验,才能使自己的知识技能与时代同步,才能成为一名合格的,称职的验光师,才能更好的为屈光不正患者服务,正确回答他们的咨询,解除他们痛苦和疑虑。下面的一些验光经验和操作技巧,希望你能学会。

   

一、掌握透镜中和原理  

1、球镜片中和方法

    是用一度数相同,符号相反的镜片将其度数中和,透过两个合并在一起的镜片观察物象不动的方法。

    首先观察镜片是凸透镜还是凹透镜。凸透镜中心厚周边薄,透过镜片看物体放大,轻摆镜片看物体逆动;凹透镜中心薄周边厚,透过镜片看物体缩小,轻摆镜片看物体顺动;如果是凸透镜则用负球镜片中和至轻摆镜片时透过镜片看物体不动,所用的负球镜片度数即该凸透镜镜片的屈光度;如果是凹透镜则用正球镜片中和至轻摆镜片时透过镜片看物体不动,所用的正球镜片度数即该凹透镜镜片的屈光度。


2、柱镜片中和方法

    正柱面透镜中心厚两边薄,负柱面透镜中心薄两边厚,柱面镜透过镜片看一直线时轻摆镜片直线扭动。

  柱镜片中和的方法。首先将该镜片的轴向确定,用球镜片将一个轴向的度数中和,继续增加球镜度数至另一垂直轴向的度数也被中和。首先被中和的一轴向的度数为球镜度数,两轴向中和度数之差为柱镜的度数,柱镜的轴位在屈光度小的轴向。


3、怎样查找镜片的光学中心

  将镜片端平,透过镜片看一直线或灯管。当在镜片中看到的直线与镜片两端边缘以外看到的直线连成一线时,此直线即是通过镜片光学中心的直线。当直线未通过镜片的光学中心时,在镜片中所看到的直线与镜片两端边缘以外所看到的直线是错位的。延通过光学中心的直线画一横线。然后,将镜片旋转90度,在与前一直线相垂直的方向,用上述方法寻找通过光学中心的直线,延通过光学中心的直线再画一横线。两条相互垂直的直线相交点即该镜片的光学中心。


例一:

    一顾客手持一小块镜片残片要求能按原镜度配制镜片,该镜片系2cm见方边缘不规则碎片。无法使用焦度计测量。透过镜片观察物体缩小,判定为近视镜片,用+5.00DS中和,透过镜片观察物体逆动,说明该近视镜片的屈光度小于-5.00DS;用+4.50DS中和透过镜片观察物体顺动,再加+0.25DS透过镜片观察物体不动,则该近视镜片屈光度为-4.75DS。

学会镜片中和方法可以在没有焦度计的情况下判定眼镜片的屈光度。那么既然有了焦度计为什么还要学会镜片中和原理呢?在以下几种情况下可以使用镜片中和方法:

1)店内偶尔停电无法使用仪器测量;

2)镜片破损无法用仪器测量且佩戴者又不在现场;

3)镜片磨损严重,镜片中心表面处于非透明状态无法用仪器测量。

注:此方法不适用于没有边缘的柱镜残片,因为无法判定其轴位。

 

 

二、掌握隐形眼镜和框架眼镜的度数换算公式

    在培训验光师的过程中,笔者发现许多隐形验配师不会进行隐形眼镜和框架眼镜的度数换算。仅凭查表取得数据,更多的人则凭经验,因为大部分隐形配戴者的屈光度属常用度数。而一旦遇到特殊度数,在不查表的情况下怎样获得准确的配镜度数呢?我曾问我所培训的学员,-16.00DS框架眼镜屈光度,如何换算隐形度数,答案各有不同!有的人竟然回答适当减上几百度就行了!下面的换算公式简单易记:  

1000/(1000/D)+VD

D=框架屈光度  VD=12(镜距) 

例二:

验光处方:R -16.00DS 

          L -12.00DS 

注意:16.00D即16D 千万不可以按1600D 换算 

   R 1000/(1000/16)+12=13.42 

   L 1000/(1000/12)+12=10.49 

隐形处方:R -13.50DS

          L -10.50DS

 

三、学会使用验光镜片箱中的辅助镜片

    许多验光师每天都在使用验光镜片箱,却只会运用球镜片和柱镜片,对于其他辅助镜片不甚了解。而学会使用辅助镜片可以为我们提供更多的参考信息,有助于提高验光的准确度。

   

1)针孔镜片 

    在镜片箱内配有若干个针孔镜片。它是一个中央有1mm圆孔的黑色镜片。根据小孔成像的原理,它是用来增加物像在视网膜上的清晰度以提高视力的,对眼睛的屈光检查有一定帮助。主要用于初步判定患者视力减退是否与屈光不正有关。如遇到视力不易提高的眼睛,可以将针孔镜片置于患眼之前(另眼遮挡),让患眼通过针孔去观察视力表。如加针孔镜片后视力有明显改善,则说明该患眼存在屈光不正,可以通过进一步的验光操作得以提高视力。如果加针孔镜后视力无大变化,一般说来不存在或不仅仅存在屈光不正的问题,可以初步推测多半系其他眼病所致。

   

2)裂隙镜片 

    它是一个中央有一25mm长、2mm宽裂隙的黑色镜片。它的用途有: 

1、初步判定有无散光

    对于那些用单光镜片不能获取最佳视力的.可在被检眼前置裂隙镜片.并将另一眼遮盖。然后缓慢转动裂隙片,如果裂隙在不同方向时视力也不同,则可判定该眼有散光。如用裂隙镜片视力无较明显的变化则可判定该眼无散光存在。 

2、确定各方向的屈光度

    在裂隙片后加适当球镜片,直到矫正视力满意为止,然后再将镜片旋转90,用同样方法在裂隙镜片后面加适当球镜片,直到矫正视力达满意为止。这样我们便可分别确定受检眼在两个互相垂直经线上各自的屈光度。我们可以用相互垂直经线上屈光度小的那个度数做球镜,二者之差即为柱镜,散光轴随度数小的那个。 

例三:

    受检眼裂隙在180°方向矫正镜片为一1.00 DS,在90°方向为一2.00DS。那么则以一1.00 D为球镜,二者之差一1.00 D为散光,散光轴向随一1.00 DS时裂隙的方向,即180°。这样受检眼眼镜处方应该是-1.00 DS /-1.00 DC×180。   

 

3)马氏杆 

它是一白色有透明园柱棒的镜片,在双眼视功能检查中是重要的和必不可少的工具。马氏杆可以用做水平、垂直隐性斜视;旋转隐性斜视;不等像的检查。马氏杆检查隐斜,需半暗室,不要使其它光源进入视野内。步骤:验光室,令患者端坐验光椅上,两眼调准PD,戴上矫正镜。

1、取马氏杆置右眼前。投放点状视标或打一束点状光,距离5米。将马氏杆条状放水平,通过马氏杆看点状光会看成垂直带状光柱。左眼不放置马氏杆,通过镜片看点光源仍是点状光。 

    观察的结果有三种可能:

a.光带穿过点状光,即无隐斜。   

b.光带与光点分离,光带在右,光点在左。说明患眼是内隐斜。在左眼前递增B0棱镜,递增的过程中,光带和光点逐渐靠近,直到竖直光带穿过光点。此时所加棱镜度即为内隐斜量。   

c.竖直光带左,点光在右。是外隐斜。在左眼前逐渐增加BI棱镜,使光带和光点渐渐接近,直到光带穿过光点。所加的棱镜度即为外隐斜的值。 

  

2,上隐斜的检查 

    马氏杆园柱棒竖直放置在右眼前。投射点状光。两眼同时观察视标。右眼通过马氏杆会将点状光看成一水平光带,左眼看的仍然是点状光。

    观察结果有三种可能:   

a,水平光带穿过点光,两眼均无上隐斜。

b,水平光带在下,光点在上。说明右眼上隐斜。在右眼前置BD棱镜,或左眼前加BU棱镜。逐渐由少到多递增棱镜,直到水平光带穿过光点。此时所加的棱镜度即是右上隐斜的度。

c,水平光带在上,光点在下。为左眼上隐斜。在左眼前递增BD三棱镜,或在右眼前递增BU棱镜,直到水平光带穿过光点。所加棱镜即是左上隐斜度。   

    上隐斜也属于双眼视异常范畴。右眼上隐斜,左眼一定是下隐斜;反之,左眼是上隐斜,右眼一定是下隐斜。 

棱镜的标记就是记录棱镜底所在位置。如果是上下内外,可以标记为底朝上(BU)、底朝下(BD)、底朝内(BI)和底朝外(BO)。 

例四:

     某大学生前来验光,主诉:两个眼睛一起看东西时总是两个,而且两个物象相距很远。

 验光:将双眼视力矫正至最佳

处方:R -6.00DS/-1.00DCX180 

      L -7.00DS/-1.00DCX180 

    使用组合验光台 马氏杆置右眼前,透明园柱棒水平。令其注视5米点光源。主诉光带与光点分离,竖直光带左,点光在右。说明是外隐斜。在左眼前逐渐增加BI棱镜至10Δ(基底朝内))光带穿过光点。

处方:R -6.00DS/-1.00DCX180 5ΔBI

      L -7.00DS/-1.00DCX180 5ΔBI

 

4)学会用棱镜分离法做双眼调节平衡

    棱镜片即镜片箱中标有Δ的镜片有1Δ~10Δ之分.用棱镜分离法做双眼调节平衡比分别遮盖单眼比较视力清晰度更准确直观。方法是:

1、投放一横行视标。两眼雾视后的视力的上一行视标,为横行视标的基准。如双眼雾视视力为0.6,则选0.5横行视标。


2、右眼前置棱镜3ΔBU(底朝上)将0.5横行视标向下位移、左眼前插3ΔBD(底朝下)将视标向上移。一横行視标被双眼看成两横向平行视标。如果横行视标不能分为两排,再增加棱镜量。 


3、验光师提问患者,上面一排视标与下面一排视标比较,哪一排稍清楚些?

患有有三种不同的回答:

a、两行视标同等清楚或模糊。认为双眼己调节平衡;

b、上一行视标清晰、下一行视标模糊。说明双眼未平衡。左眼矫正视力好于右眼,验光师在患者左眼前按+0.25D递增,直至右左眼等清。双眼平衡。

C、下一行視标清晰、上一排視标模糊。证明右眼矫正视力比左眼好,在右眼前按+0.25D递增,达两眼等清。双眼平衡。


4、如果两眼始终不能同等清晰或模糊。如:右-3.00DS;左-3.50DS。上一排比下一排清,在左眼前加+0.25DS,下一排比上一排清,就要做优势眼的检查,保持优势眼的视力略好于非优势眼。


5、两眼除去棱镜,先后投放视力表再投红绿视标,做双眼mpmva检查(最高正片获最好视力或最低负片最好视力矫正)。再做红绿双色试验,达终结点。

a、双眼平衡的操作过程中必须注意双眼同时均看到視标,且始终保持在雾视状态。

b、双眼平衡的终结点是双眼看视标同等清晰,此时双眼调节已降为零,除去双眼棱镜。

  

四、熟练运用镜片联合方法完成验光终结操作

 

    在实际操作过程中,并不是每个人都能熟练的掌握镜片联合方法,有的验光师则一边验光,一边用笔计算,即影响验光速度,也令被检者对验光师的操作技能产生质疑。

    有这样一个镜片联合秘诀,可以代替所有的镜片联合公式,而且简单易学,即:"本身不变作球镜,变号变轴作柱镜。"详解为:"两柱镜联合,或一球镜与两柱镜联合,以柱镜度数小的为准,本身符号、度数不变作球镜,如果是球柱镜联合则与原球镜联合,变号变轴作柱镜与原柱镜联合"。

    这里所谓变轴即变90度,不足90加90,超过90减90。 

具体应用方法:

以-4.50DS/ -2.00DC×180/+0.50DC×90为例:

以柱镜度小的+0.50DC×90为准,+0.50本身符号度数不变做球镜,

即: +0.50DS与原球镜-4.50DS联合为-4.00DS;

+0.50DC×90。变号轴为-0.50DC×180,

与原柱镜-2.00DC×180 联合为-2.50DC×180。

该处方化简为一球柱镜联合的处方

即:-4.00DS /-2.50DC×180。

 

    要顺利准确地完成验光操作,镜片联合是贯穿始终的操作程序。验光师就是通过不断地使用镜片联合的过程,加以与被检者的密切沟通和配合来获取验光之最佳效果的。在镜片联合中,相互垂直的两轴向符号度数相同即为球镜;复性散光,一球镜与两柱镜联合,绝对值小的柱镜与原球镜同号加异号减,与原柱镜同号减异号加;混合散光,绝对值小的柱镜与原柱镜同号则球柱镜同减;与原柱镜异号则球柱镜同加。

 

1、复性散光联合与原柱镜同号异轴的低度柱镜,其结果等于在加球镜的同时减柱镜,此操作简称:加球减柱。

例4:-5.00DS/-1.50DC×90/-0.50DC×180

    用与原柱镜同号且低于原柱镜度(一般用0.50DC或0.25DC)的柱镜在与原柱镜轴位相垂直的轴向上试加,看是否球镜加小了而柱镜加大了。根据相互垂直的两轴向符号度数相同即为球镜这一原理,将两轴向共同拥有的-0.50D,提取出来做球镜(也叫找球镜),与原球镜-5.00DS联合为-5.50DS.两柱镜之差-1.00DC×90。符号度数不变作为新柱镜.

即: -5.00DS/-1.50DC×90/-0.50DC×180

=-5.50DS/-1.00DC×90 

 

2、复性散光联合与原柱镜异号异轴的低度柱镜,其结果等于在减球镜的同时加柱镜。

此操作简称:减球加柱。

例5:-4.00DS/-1.00DC×90/+0.50DC×180

    用与原柱镜异号且低于原柱镜度(一般用0.50DC或0.25DC)的柱镜在与原柱镜轴位相垂直的轴向上试加,看是否球镜加大了而柱镜加小了。

    方法:在与绝对值小的柱镜相垂直的轴向上,制造两个和绝对值小的柱镜度数相同的柱镜,其新造的两柱镜联合结果等于零。

(-0.50DC×90/+0.50DC×90)。用其中的一个柱镜与相垂直的轴向上的另一个与其符号度数相同的柱镜相联合。以满足在两轴向提取共同度数做球镜之条件(+0.50DC×180/+0.50DC×90=+0.50DS),将提取的球镜+0.50DS与原球镜-4.00DS联合(-4.00DS/+0.50DS=-3.50DS)将新造的没有提取的柱镜 -0.50DC×90 与原柱镜 -1.00DC×90联合作为新的柱镜(-1.00DC×90/-0.50DC×90=-1.50DC×90)。

即:-4.00DS/-1.00DC×90/+0.50DC×180

=-4.00DS/-1.00DC×90/+0.50DC×180/(-0.50DC×90/+0.50DC×90)

=-4.00DS/(-1.00DC×90/-0.50DC×90)/(+0.50DC×180/+0.50DC×90)

=-3.50DS/-1.50DC×90

 

   此例中新造度数的目的只是为了讲解,即:(在相互垂直的两轴向寻找可以提取的共同度数,或化不同度数为相同度数以便于提取球镜),明白我们是怎样在两轴向提取共同度数做球镜的。而在实际操作过程中,我们只需记住镜片联合之秘诀就可以快速得出联合的结果。

 

3、绝对值小的柱镜与原柱镜同号之混合散光

    用与原柱镜同号且低于原柱镜度(一般用0.50DC或0.25DC)的柱镜在与原柱镜轴位相垂直的轴向上试加,看是否球镜柱镜度数都有加大了。

此操作简称:减球镜,减柱镜

 

例6:-1.50DS/+2.00DC×50/+0.50DC×140

    此例中 +2.00DC×50/+0.50DC×140 两轴向共同拥有 +0.50D,根据相互垂直的两轴向符号度数相同即为球镜这一原理,将+0.50D提取出做球镜为+0.50DS 与原球镜 -1.50DS 联合(-1.50DS/+0.50DS=-1.00DS)将剩余的+1.50DC×50作为新柱镜。

联合结果发现,球镜和柱镜都减小了。

即:-1.50DS/+2.00DC×50/+0.50DC×140

   =-1.00DS/+1.50DC×50

 

4、绝对值小的柱镜与原柱镜异号之混合散光

   用与原柱镜异号且低于原柱镜度(一般用0.50DC或0.25DC)的柱镜在与原柱镜轴位相垂直的轴向上试加,看是否球镜、柱镜度数都加小了。

此操作简称:加球镜加柱镜

例7:+1.00DS/-2.00DC×85/+0.50DC×175

   此例中在 -2.00DC×85轴向制造两个柱镜,其两柱镜联合结果等于零。(-0.50DC×85/+0.50DC×85)因 +0.50DC×85/+0.50DC×175,两轴向共同拥有+0.50D,根据相互垂直的两轴向符号度数相同即为球镜这一原理,将 +0.50D 提取出做球镜为 +0.50DS 与原球镜+1.00DS联合(+1.00DS /+0.50DS=+1.50DS)

将剩余的-0.50DC×85与原柱镜-2.00DC×85联合(-2.00DC×85 /-0.50DC×85=-2.50DC×85)作为新柱镜。

联合结果发现,球镜和柱镜都增加了。

即:+1.00DS/-2.00DC×85/+0.50DC×175

= +1.00DS/-2.00DC×85/(-0.50DC×85/+0.50DC×85)/+0.50DC×175

= +1.00DS/(-2.00DC×85/-0.50DC×85)/(+0.50DC×85/+0.50DC×175)

=+1.50DS/-2.50DC×85

 

   常规验光包括初始验光、精确验光、终结验光三个阶段。而如何完美地完成这三个阶段的操作却需要长期实践经验的积累。笔者所介绍的验光操作终结程序,是在常规验光方法(包括蜂窝测试、散光盘测试、红绿测试、棱镜分离等)之外的补充操作。因为仅凭常规方法,往往不能得到准确的验光终结数据。有时各种测试操作完毕,视力矫正仍不理想。这主要体现在验配散光的操作上。因为一般验光师,最终的操作大多是一个单加单比的过程,球镜、柱镜的单加单减,散光轴位的调整等。如果加减球镜、加减柱镜、调整轴位均不奏效,即认为验光该结束了,尽管被检者的视力矫正不理想也无计可施了。

    验光操作终结程序的关键,是能够在加一只镜片的同时,获得加球减柱;减球加柱,加球加柱,减球减柱的双重效果,而一般的验光操作是不可能双手各执一镜片同时操作的。这就是一般验光方法不能获得最佳验光结果的原因所在。笔者个人感觉,若要获得加球减柱;减球加柱,加球加柱,减球减柱的四大双重效果,运用验光操作终结程序比运用交叉柱镜更快捷,方便。掌握并熟练的运用这一操作方法有助于我们在验光过程中达到加一个镜片同时解决球柱镜两个问题之目的。达到验光操作的完美终结。


    In growing the rapid development of science and technology, equipment updates, technology continues to progress today, only to learn, master more theoretical and practical experience, in order to make their knowledge and skills in step with the times, in order to become a qualified, qualified optometrists, to better service for patients with refractive errors, correct answer their consultation, relieve their suffering and doubts. Following some optometry experience and skills, I hope you can learn.

   

A master lens and principle

1, a ball lens and method

    With same degree, opposite in sign to the lens will be the degree of neutralization, and through the two merged together lens to observe the object does not move.

First observed lens is a convex lens or a concave lens. Convex lens center thickness around the thin, is seen through the lens magnified objects and light lens see objects inverse dynamic; concave lens periphery is thin thick, is seen through the lens of objects to narrow, light lens see objects along dynamic; if it is convex lens with negative spherical lens and to light lens through the lens to see object, the negative spherical lens degree of the convex lens refractive degree; if it is a concave lens is used is spherical lens and light to put the lens through the lens to see object. The ball is lens degree of the concave lens refractive degree.


2, cylindrical lens and method

    Is the center of the cylindrical lens thickness on both sides of the thin cylindrical lens, negative center on both sides of thin thick, cylindrical mirror through the lens to see a linear light straight twist pendulum lens.

Cylindrical lens and method. The axial direction of the lens with spherical lens will determine an axial degree of neutralization, continue to increase the spherical degree to another vertical axial degree has been neutralized. The first is an axial neutralization degree spherical degree, and the degree of the difference between the two axial cylinder degree, axial cylinder in the axial direction of small refraction.


3, how to find the optical center of the lens

The lens is a straight line or even, see through the lens tube. When the straight line is connected with the straight line which is seen at both ends of the lens of the lens, the straight line is a straight line through the optical center of the lens. When the straight line is not through the optical center of the lens, the straight line which is seen in the lens and the edge of the two ends of the lens is displaced. The extension of a straight line through the optical center of the draw a line. Then, the lens is rotated 90 degrees, in the direction perpendicular to the front line, using the method of searching for a straight line through the optical center, the extension of a straight line through the optical center and then draw a horizontal line. Two mutually perpendicular straight line intersection point namely the optical center of the lens.


One case:

    A customer holding a small piece of lens fragments can according to the degree of primary mirror prepared lenses, the lens 2cm square edge irregular fragments. Unable to use the measurement of the focal length meter. Through the lens observe objects shrink, judge for myopia lens, neutralized with +5.00DS. Through the lens observe object inverse dynamic, indicating that the lens myopia dioptric less than -5.00DS; neutralization with +4.50DS through the lens observe objects along dynamic, coupled with the +0.25DS through the lens observe objects real, the myopia lens dioptric for -4.75DS.

    The lens neutralization method can determine the refractive degree of the spectacle lens without the degree of focus. So why do we have to learn lens and the principle of the lens when there is a coke? In the following circumstances can use lenses and methods:

1) shop in the occasional power outages can not use the instrument measurement;

2) lens damage can not be measured by the instrument and the wearer is not in the field;

3) lens wear is serious, the lens central surface is in a non transparent state can not be measured with the instrument.

Note: this method does not apply to the edge of the mirror without column pieces, because they can not determine the axial.

 

Two, master degree of conversion formula of contact lenses and glasses

    In optometry training division in the process of, the author found that many invisible fitters will not stealth glasses and frame glasses degree of conversion. Only by the look-up table to obtain the data, more people with experience, because most of the wearer's invisible refractive degree is a commonly used. Once the encounter special degree, how to obtain the accurate degree of glasses in the table under the situation? I asked my trainees, -16.00DS glasses dioptric, how to convert different degrees of contact, answer! Some people actually answered hundreds of proper reduction on the line! The conversion formula is simple and easy to remember:

1000/ (1000/D) +VD

The framework of D= VD=12 (dioptric lens distance)

In two cases:

Prescription: R -16.00DS

L -12.00DS

Note: the 16.00D 16D do not press 1600D conversion

R 1000/ (1000/16) +12=13.42

L 1000/ (1000/12) +12=10.49

Contact: R -13.50DS prescription

L -10.50DS


Three, learn to use the auxiliary lens lens box in optometry

    Many of optometrists have a day are in the use of trial case lenses, but only by spherical lens and cylindrical lens. For other auxiliary lenses do not quite understand. Learn to use auxiliary lens can provide more valuable information for us, help to improve the accuracy of optometry.

   

1) pinhole lens

    The lens box is provided with a plurality of pinhole lenses. It's a black lens with a 1mm hole in the center. According to the principle of pinhole imaging, it is used to increase the object image clarity in the retina to improve eyesight, has certain help to the eye's refractive examination. Mainly used for the preliminary determination of whether the patients with decreased visual acuity and refractive error. If the eye is not easy to improve the visual acuity, the pinhole lens can be placed in the eye (eye occlusion), so that the eye through the pinhole to observe the visual acuity chart. Such as pinhole lens visual acuity improved significantly, the patient eye refractive errors, by further optometry operation can improve visual acuity. If after a pinhole visual acuity without big changes generally to does not exist or is not only the existence of refractive error, can be speculated that most of the system due to other diseases.

   

2) slit lens

    It is a center with a 25mm long, 2mm wide slit of the black lens. It uses:

1, a preliminary determination of the astigmatism

For those with single lens can not obtain the best vision. In ophthalmic pre slit lens. And to cover the other eye. And then slow rotation of the cracks, if the cracks in different directions when the vision is different, it can be determined that the eye has astigmatism. If there is no obvious change in the visual acuity of the lens of the slit lens, it can be determined that there is no astigmatism in the eye.  


2, determine the direction of the degree of refraction

Fissure slices with appropriate spherical lens, until corrected visual acuity satisfactory so far, then lens rotated 90, with the same method in slit lens followed by appropriate spherical lens until corrected visual acuity was satisfied so far. In this way we can determine the tested eye in two mutually perpendicular warp their dioptric. We can mutually vertical meridian dioptric small the degree do mirror ball, the difference between the two is the cylindrical lens and axis of astigmatism with small degree one.  


Three case:

    The tested eye fissure in 180 degrees direction correction lens is a 1 DS, in the 90 degree direction for a 2.00DS. Then, with a 1.00 D mirror ball, two poor 1.00 D for astigmatism, astigmatism axial with the direction of fracture of 1.00 DS when, that is 180 degrees. This subject should be prescription glasses -1.00 DS /-1.00 DC * 180.    

 

3) Maddox rod

    It is a white, transparent, cylindrical lens, which is an important and indispensable tool in the binocular visual function test. Markov bars can be used to make horizontal and vertical recessive strabismus; rotational recessive strabismus; the examination of different images. Maddox rod check hidden ramps, half dark room, do not make other light into the field of vision. Step: make the patient sit optometry optometry room, chair, eyes adjust PD, wear corrective lenses.


1, take the right eyes. 

    Put on a point or a point of light, a light, distance of 5 meters. The Maddox rod strip horizontally, Maddox rod shaped light through the aspect as vertical strip pillar. The left eye does not place the martensite, and the light source of the lens is still light.

There are three possible outcomes:

A. light through the spot light, no esophoria.  

B. separation of light and light, light on the right and left on the spot. Show that the eye is implicit. Increase of B0 prism in the left eye, increasing process, and gradually close to the light spot, until the vertical band through the spot. At this time, the prism degree is the implicit skew.  

C. vertical band left, in the right light. Implicit skew. In the left eyes gradually increased BI prism, and the light spot is getting closer, until the light through the spot. The prism degree is the value of the external oblique.  


2, on the implicit check

The rods are placed in front of the right. Projection point light. Simultaneous observation of both eyes. Right through the Maddox rod will spot light as a horizontal band, the left eye can still spot light.

Results there are three possibilities:

A, the level of light through the light, his eyes are supreme esophoria.

B, the level of light in the next, on the spot. Right right right eye. In the right eye pre BD prism, or left front with BU prism. From less to more gradually increasing until the level of light spot through the prism. At this time, the prism is the right degree of implicit.

C, the level of light on the spot. To hide the left eye. Increased BD in the left eye before the three prism, BU prism in the right eye or increasing, until the level of light through the light spot. The prism is the left upper slope.  

On the implicit oblique also belong to the category of binocular vision. Right eye on the right eye, left eye must be under the implicit oblique; on the contrary, the left eye is on the right eye, right eye must be under the implicit oblique.  

The prism is the record of the position of the bottom of the prism. If you are on the inside and outside, can be marked as upside down, upside down (BU) (BD), (BI) and end up in the bottom out (BO).


Four case:

    Some students come to optometry, complaints: two eyes always see things in two, and two objects far away.

Optometry: binocular vision correction to the best

Prescription: R -6.00DS/-1.00DCX180

L -7.00DS/-1.00DCX180

    Using a combination of optometry Taiwan Maddox rod right eyes, transparent cylindrical rod level. Make it look at the 5 meter point light source. With separation of light and light, light in the vertical band left, right. The explanation is the implicit oblique. In the left eyes gradually increased to 10 (delta BI prism base in)) through the light spot.

Prescription: R -6.00DS/-1.00DCX180 5 Delta BI

L -7.00DS/-1.00DCX180 5 Delta BI

 

4) learn to use the prism separation method to do the balance of binocular adjustment

    Prism sheet that lens box bid lens Delta Delta - Delta. With a prism separation do binocular balance than respectively, to cover the monocular compared visual clarity more accurately and intuitively. Method is:

1, put on a horizontal visual standard. Visual acuity of the upper line of the visual acuity after the two eyes, as the reference standard for transverse visual. If the visual acuity was 0.6, the visual acuity was 0.5.


2, right fore prism 3 delta bu (towards the bottom on) 0.5 rampant as the standard downward displacement, left eye in 3 delta BD (upside down) will be seen to move in the direction of. A transverse optic standard was seen as the two lateral parallel. If the horizontal visual standard can not be divided into two rows, and then increase the amount of prism.  


3, optometrist questions were above a row as the standard and the bottom row as the standard, which row slightly clearly?

Suffering from three different answers:

A, two lines as the standard is equally clear or vague. Binocular adjustment balance;

B, on the line as the standard clear, the next line of standard fuzzy. Description binocular balance. The left eye vision correction in the right eye, optometrists increasing according to +0.25D in patients with left eye, right eye until clear. Binocular balance.

C, the next line as a clear, on a row of blurred vision. To prove that the right eye corrected visual acuity than the left eye is good, in the right eyes by +0.25D increments, up to two eyes, and so on. Binocular balance.


4, if the eyes can not be equally clear or vague. Such as: right -3.00DS; left -3.50DS. A parallelism under a row of Qing Dynasty, in the left eye and +0.25DS, a parallelism a row of clear, it is necessary to do examination of ocular dominance, keep the dominant eye eyesight slightly better on the non dominant eye.


5, the eyes to remove the prism, has put on the chart even cast red and green as the standard, do check the binocular mpmva (the highest positive won the best visual acuity or minimum negative best visual acuity correction). Do the Bi color test, final node.

A, binocular balance in the operation process must pay attention to both eyes at the same time to see the subject, and always remain in the fog as the state.

B, the end point of binocular balance is the same as the standard binocular vision, at this time the binocular adjustment has been reduced to zero, remove the binocular prism.

  

Four, skilled use of lens combination method to complete the operation end of Optometry

 

    In actual operation process, and not everyone all can skilled grasp the lens combination method, some optometrists while optometry, while pen computing, that is, the influence of velocity of optometry, also made by optometrist operation skills of examination question.

    Such a lens combination tips can replace all of lens combination formula, and easy to operate, namely: "itself is unchanged as a mirror, variable, variable axis of cylindrical lens. "Explanation:" two column lens combined with, or a mirror ball and two column lens combined with, subject to small column for eyeglasses, symbol itself, degree of intact for mirror ball, if it is spherical cylindrical lens combined with original spherical joint, sign changing variable axis of cylinder lens and prism combined ".

    Here the so-called variable axis that is 90 degrees, less than 90 plus 90, more than 90 minus 90.  

Concrete application method:

The 4.50DS/ -2.00DC * 180/+0.50DC * 90 as an example:

The +0.50DC * 90 is the standard, and the +0.50 itself is the symbol of the degree of the mirror,

Namely: +0.50DS and 4.50DS with the original ball mirror 4.00DS;

+0.50DC * 90. Changing the number axis is -0.50DC * 180,

Combined with the original column mirror -2.00DC * 180 -2.50DC * 180.

The formulation of a combination of a spherical cylindrical lens

Namely: 4.00DS /-2.50DC * 180.

 

    To complete the smooth operation of accurate optometry, lens combination is throughout the operation procedure. An optometrist is through constantly use lens combination process, with subjects close communication and cooperation to obtain refraction effect is the best. In lens combination and mutually perpendicular two axial symbol of same degree is spherical; compound astigmatism, a ball mirror and two column lens combined with, the absolute value of small cylindrical mirror and the original ball lens, with different number reduction, and original column lens with reduced difference; mixed astigmatism, the absolute value of small cylindrical lens and cylindrical lens with spherical cylindrical lens with reduced; with the original column lens are of opposite sign is spherical cylindrical lens with.

 

1, the complex astigmatism and the original column mirror with the same number of different axis of the low column mirror, the result is equal to the ball mirror at the same time reduce the column mirror, this operation abbreviation: plus ball minus column.

Example 4:-5.00DS/-1.50DC * 90/-0.50DC * 180

Used with the original cylindrical lens, and below the original column lens degree (general cylindrical mirror 0.50DC or 0.25DC) in column mirror phase axis perpendicular to the axial and try to see whether mirror ball with small and cylindrical mirror increased. According to the mutually perpendicular two axial symbol of same degree is the mirror ball this principle, two co axially with -0.50D, extracted out mirror ball (also called for the mirror ball), with the original mirror ball -5.00DS United -5.50DS. two cylindrical lens -1.00DC x 90. The symbol number is the same as the new column mirror.

: -5.00DS/-1.50DC * 90/-0.50DC * 180

=-5.50DS/-1.00DC * 90

 

2, combined with the complex astigmatism and the original column mirror of different axis of the low degree of column mirror, the result is equal to the ball at the same time reduce the ball mirror.

This operation is referred to as: minus ball plus column.


Example 5:-4.00DS/-1.00DC * 90/+0.50DC * 180

    With column mirror opposite and lower than the original column lens degree (general column mirror 0.50DC or 0.25DC) in column mirror phase axis perpendicular to the axial and try to add, see whether the mirror ball increased and column mirror and small.

    Method: in and the absolute value of the small cylindrical lenses perpendicular to the axial, making two and absolute value of small cylindrical lens with the same degree of a cylindrical lens, the coinage of two cylindrical lens combined results equal to zero.

(-0.50DC * 90/+0.50DC * 90). In one of the columns, the other one is the same as the one with the same sign in the axial direction. To meet the two axial extracting common degree do mirror ball (x 180/+0.50DC +0.50DC * 90=+0.50DS) in the extract of spherical +0.50DS and original ball mirror -4.00DS joint (-4.00DS/+0.50DS=-3.50DS) will be newly made no extraction column mirror -0.50DC x 90 and column mirror -1.00DC x 90 joint for the new column mirror (x 90/-0.50DC -1.00DC * 90=-1.50DC x 90).

That is: -4.00DS/-1.00DC * 90/+0.50DC * 180

=-4.00DS/-1.00DC * 90/+0.50DC * 180/ * -0.50DC (* 90/+0.50DC * 90)

=-4.00DS/ (-1.00DC * 90/-0.50DC * 90) / (+0.50DC * 180/+0.50DC * 90)

=-3.50DS/-1.50DC * 90

 

    Newly dioptric proportionality is to explain that: (look for common degree can be extracted in two mutually perpendicular axial, or of different degrees to the same degree in order to extract mirror ball) that we are in two axial extracting common degree do mirror ball. But in the actual operation process, we only need to remember the lens combination of the secret can quickly come to the results of the joint.

 

3, the absolute value of small cylindrical mirror with the same number of mixed astigmatism

    Used with the original cylindrical lens, and below the original column lens degree (general column mirror 0.50DC or 0.25DC) in column mirror phase axis perpendicular to the axial and try to add, to see if the spherical cylindrical lens degree have increased.

This operation is referred to as: ball mirror, minus column mirror

 

Example 6:-1.50DS/+2.00DC * 50/+0.50DC * 140

This two axial +2.00DC x 50/+0.50DC x 140 jointly owned +0.50D. According to the mutually perpendicular two axial symbol of same degree is the mirror ball this principle, +0.50D extracted spherical mirror +0.50DS and original ball mirror -1.50DS joint -1.50DS/+0.50DS=-1.00DS will remaining +1.50DC x 50 as column and the new mirror.

Joint results show that both spherical and cylindrical mirrors are reduced.

That is: -1.50DS/+2.00DC * 50/+0.50DC * 140

=-1.00DS/+1.50DC * 50

 

4, the absolute value of small cylindrical mirror with the original cylinder mirror of the mixed astigmatism

    With different original column lens, and lower than the original column lens degree (general column mirror 0.50DC or 0.25DC) in column mirror phase axis perpendicular to the axial and try to add, to see if the spherical and cylindrical lens degree with small.

This operation is referred to as the ball mirror

Example 7:+1.00DS/-2.00DC * 85/+0.50DC * 175

In this case two cylinder manufacturing in -2.00DC * 85 two cylinder combined axial, the result is equal to zero. (x 85/+0.50DC -0.50DC x 85) * 175 of X 85/+0.50DC +0.50DC, two axial joint has +0.50D. According to the mutually perpendicular two axial symbol of same degree is the mirror ball this principle, +0.50D extracted mirror ball +0.50DS and original ball mirror +1.00DS joint (+1.00DS + 0.50DS=+1.50DS

The remaining -0.50DC * 85 and -2.00DC * 85 cylinder joint (85 -2.00DC * /-0.50DC * 85=-2.50DC * 85) as a new column mirror.

Joint results show that both the ball and the column mirrors have been increased.

That is: +1.00DS/-2.00DC * 85/+0.50DC * 175

= +1.00DS/-2.00DC * 85/ (-0.50DC * 85/+0.50DC * 85 /+0.50DC * 175)

(-2.00DC = +1.00DS/ * 85/-0.50DC * 85) / (+0.50DC * 85/+0.50DC * 175)

=+1.50DS/-2.50DC * 85

 

    Conventional optometry optometry, optometry, including initial accurate optometry ending three stages. And how to perfect the operation of these three stages is the accumulation of long-term practical experience. The author introduced the optometry operation terminating program is supplement operations outside of the conventional optometry methods (including cellular test, scattered disc test, red green test, prism separation). Because only by conventional methods, often can not get accurate optometry end data. Sometimes all kinds of test operation is completed, vision correction is still not ideal. This is mainly reflected in the fitting astigmatism operation. Because general optometrists, final operation is mostly a single and a single qubit process, spherical and cylindrical lens single and single reduction, astigmatism axial adjustment. If the addition and subtraction mirror ball, plus or minus column mirror, adjust the axial not work that optometry in the end, although is the examination of visual acuity correction is not ideal also at the end of one's wits.


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