REFRACTION AND BINOCULAR VISION 2

SHE Level 2
SCQF Credit Points 20.00
ECTS Credit Points 10.00
Module Code M2B521593
Module Leader Gunter Loffler
School School of Health and Life Sciences
Subject Vision Sciences
Trimester
  • A (September start)-B (January start)

Summary of Content

This module will build on knowledge gained in "Refraction and Binocular Vision 1", and will introduce students to a range of topics including patient communication and record keeping, contrast sensitivity, ocular aberrations and retinal image quality, the optical principles of methods of objective refraction, fixation disparity, and the clinical management of heterophoria. The development of the visual system will be studied along with the neurophysiological basis of stereopsis and the infra- and supra-nuclear control of eye movements. Students will be introduced to further techniques for assessing a patient's refractive and binocular status and, in practical sessions, emphasis will be placed on how individual techniques may be combined to form a clinical routine.

Syllabus

-360 Lectures b7 Binocular refraction b7 Binocular balancing: Humphriss methods, polarisation, Turville infinity balance, prisms b7 Anisometropia b7 Presbyopia and determination of the near addition b7 Alternative retinoscopy techniques (forehead fixation, Mohindra's and dynamic retinoscopy) b7 Cycloplegic refraction b7 Modifications to clinical routine for refraction of children, patients with low vision and patients with learning difficulties b7 History and symptoms b7 Basics of patient communication and record keeping b7 Introduction to prescribing and clinical decision-making b7 Optical principles of retinoscopy b7 Optical principles and clinical use of optometers and auto-refractors b7 Introduction to contrast sensitivity and transfer functions b7 Retinal image quality, wave-optics and aberrations of the eye b7 Stimuli for ocular motor responses b7 Open-loop accommodation and vergence b7 Ocular motor adaptation b7 Microfluctuations of accommodation b7 Infranuclear control of eye movements b7 Supranuclear control of eye movements b7 Ocular motility: introduction to incomitancy b7 Clinical assessment of vergence function b7 Clinical measurement of accommodation, accommodative-vergence and vergence accommodation b7 Fixation disparity b7 Clinical measurement of fixation disparity b7 Introduction to the clinical management of heterophoria b7 Vergence adaptation: basic and clinical aspects b7 Neurophysiological basis of stereoscopic vision b7 Clinical assessment of stereoscopic vision b7 Oculomotor reflexes b7 Visual development and binocular visual development b7 Aniseikonia: theory and clinical aspects b7 Stereoscopes b7 Stereoscopic display technology and binocular visual function -360 Labs/tutorials b7 Retinoscopy: real eyes b7 Revision of best vision sphere and cross-cylinder, use of duochrome b7 Methods of binocular balancing and binocular refraction b7 Combining retinoscopy and subjective refraction b7 Taking a patient's symptoms and history b7 Measuring the near addition b7 Clinical assessment of control of heterophoria: NPC and fusional reserves b7 Clinical assessment of control of heterophoria: fixation disparity b7 Clinical assessment of stereopsis b7 Clinical assessment of accommodation and accommodative-vergence b7 Putting it all together: development of a clinical routine

Learning Outcomes

:On completion of this module, students should be able to:- Carry out a routine clinical examination to assess the refractive and binocular status of a pre-presbyopic or presbyopic patient- Demonstrate an understanding of the topics that should be covered when taking a patient's symptoms and history- Demonstrate an understanding of how the normal clinical routine may be modified when examining children, patients with low vision and patients with learning difficulties- Demonstrate a knowledge and understanding of the optical principles of retinoscopy, optometers and autorefractors- Demonstrate a knowledge and understanding of retinal image quality and the basis of the human contrast sensitivity function- Demonstrate a knowledge and understanding of the neurophysiological basis of stereopsis- Demonstrate a knowledge and understanding of the infra- and supra-nuclear control of eye movements - Demonstrate a knowledge of the development of the visual system and an understanding of the factors that may lead to abnormal development- Demonstrate a basic understanding of the clinical management of heterophoria and fixation disparity

Teaching / Learning Strategy

This module comprises a programme of lectures, tutorials and practical laboratory sessions. Tutorials will provide students with the opportunity to consolidate the theoretical knowledge gained in lectures. During laboratory sessions, students will practise a range of techniques for assessing refractive and binocular status, and will learn how to combine these to form a clinical routine for the examination of a patient.

Indicative Reading

-360b7 Abrams, D. (1993). Duke-Elder's Practice of Refraction (10th ed.). Churchill-Livingstone. b7 Ansons and Davies (2001) , Diagnosis and Management of ocular Motility Disorders Third edition, Blackwell publishing b7 Barnard, S. & Edgar, D. (1996). Pediatric Eye Care. Blackwell Science. b7 Benjamin, W.J. (2006). Borish's Clinical Refraction (2nd ed.). Butterworth Heinemann. b7 Buckingham, T. (1993). Visual Problems in Childhood. Butterworth Heinemann. b7 Edwards, K. & Llewelyn, R. (1988). Optometry. Butterworth. b7 Duke-Elder, S. & Wybar, K. (1973). System of Ophthalmology Volume VI: Ocular Motility and Strabismus. Kimpton. b7 Elliot, D.B. (2007). Clinical Procedures in Primary Eye Care (3rd ed.). Butterworth Heinemann. b7 Eskridge, J.B., Amos, J.F. & Bartlett, J.D. (1991). Clinical Procedures in Optometry. J.B. Lippincott. b7 Griffin, J.R. & Grisham, J.D. (2002). Binocular Anomalies: Diagnosis and Vision Therapy (4th ed.). Butterworth Heinemann. b7 Henson, D.B. (1996). Optometric Instrumentation (2nd ed.). Butterworth. b7 Jackson, A.J. & Wolffsohn, J. (2007). Low Vision Manual. Butterworth Heinemann. b7 Julesz, B. (1971). Foundations of Cyclopean Perception. University of Chicago Press. b7 Keirl, A. & Christie, C. (2007). Clinical Optics and Refraction. Butterworth Heinemann. b7 Leat, S.J., Shute, R.H. & Westall, C.A. (1999). Assessing Children's Vision: A Handbook. Butterworth Heinemann. b7 Leigh, R.J. & Zee, D.S. (2006). The Neurology of Eye Movements (4th ed.). Oxford University Press. b7 Macnaughton, J. (2005). Low Vision Assessment. Butterworth Heinemann. b7 Michaels, D.D. (1985). Visual Optics and Refraction (3rd ed.). Mosby. b7 Ogle K.N., Martens, T.G. & Dyer, J.A. (1967). Oculomotor Imbalance in Binocular Vision and Fixation Disparity. Lea and Febiger. b7 Rabbetts, R.B. (2007). Bennett and Rabbetts' Clinical Visual Optics (4th ed.). Butterworth Heinemann. b7 Reading, R.W. (1983). Binocular Vision: Foundations and Applications. Butterworths. b7 Rosner, J. & Rosner, J. (1990). Pediatric Optometry (2nd ed.). Butterworths. b7 Scheiman, M. & Wick, B. (1994). Clinical Management of Binocular Vision: Heterophoric, Accommodative, and Eye Movement Disorders. J.B. Lippincott. b7 Schor, C.M. & Ciuffreda, K.J. (1983). Vergence Eye Movements: Basic and Clinical Aspects. Butterworths. b7 Solomons, H. (1978). Binocular Vision: A Programmed Text. Heinemann. b7 Tunnacliffe, A.H. (1993). Introduction to Visual Optics (4th ed.). ABDO. b7 Von Noorden, G.K. & Campos, E.C. (2002). Binocular Vision and Ocular Motility (6th ed.). Mosby. b7 Zadnik, K. (1997). The Ocular Examination. W.B. Saunders.

Transferrable Skills

Use of diagnostic instrumentation, manual dexterity, interpretation of clinical data, verbal and non-verbal communication skills

Module Structure

Activity Total Hours
Tutorials (FT) 6.00
Independent Learning (FT) 102.00
Practicals (FT) 42.00
Assessment (FT) 14.00
Lectures (FT) 36.00

Assessment Methods

Component Duration Weighting Threshold Description
Coursework 1 n/a 40.00 35% ongoing practical assessments
Exam (Exams Office) 2.00 60.00 35% unseen written paper