LENSES IN OPHTHALMOLOGY

Two types A. Non contact 1. Planoconcave lens 2. Biconvex lens B.Contact 1. Goldmann three-mirror lens 2. Goldmann posterior fundus contact lens 3. Panfundoscopic lens 4. Mainster lens

In slit lamp biomicroscopy

A. Non contact
1.Hruby lens Incorporated onto slit lamp High negative power lens -58.6D A broad vertical slit beam is first rotated to illuminate the fundus from vertically a straight on oculars The lens is centered on the cornea a few mm away from the patients eye until fundus comes into view Image-upright and vertical Image quality not uniformly good ,blurred at the margins Used almost exclusively to view the posterior pole

2.Aspherical lenses 60D,78D,90D Real ,inverted ,high quality image High powered plus lens Higher power lenses provide wider fields of view at the expense of magnification

Feature

60D

78D X0.95 84deg 15mm 29mm

90D X0.75/0.77 94/95deg 12mm 19mm

Magnification X1.18 Field of view Focal length Clear lens aperture 76 deg 19mm 30mm

Condensing lenses in IDO

Feature 15D 20D

Magnification 4x 3x

Field of view 40 deg 45deg

Uses Examination of posterior pole General examination of fundus Shorter working distance Small pupils Small children

25D 30D

2.5x 2x

50deg 60deg

40D

1.5x

65deg

Some common characteristics of the laser lenses are: Concave posterior surface conforming to the corneal curvature and a flat or convex anterior surface Planar mirrors allowing observation of the anterior chamber angle or peripheral retina. A prism to allow visualization of the mid-periphery of the retina. A flange to stabilize the lens and prevent blinking Knurled edge to facilitate lens manipulation. Laser lenses generally consist of a conical polymethylmethacrylate or aluminium shell Glass anterior surface, lenticular elements and mirrors.

Retinal laser lenses

 Antireflection coatings are usually applied to each optical surface in a laser lens that reduces reflected white light The hazard distance is 7 meters for an uncoated lens and 1.6 meters for a coated lens. Most laser lenses use broad-spectrum, multilayer,antireflection coatings that reduce reflected light between 400 nm and 700 nm from approximately 4 % to less than 1%

Two types 1. Non contact 2. Contact a) Lenses with mirrors

a) Goldmann three mirror lens Mainster lens Panfundoscopic lens

b)

Lenses without mirrors

b) c)

Goldmann 3 mirror lenses.

Centre lens- 64 dioptre lensfor posterior pole Trapezoid mirror-retina slightly posterior to equator(73 deg) Half round mirror-peripheral retina from equator out to the ora serrata (67 deg) Thumb nail mirror-59degfor AC angle Contact surface diameter12mm

Yannuzzi of an earlier lens fundus It is a modification

model developed by Krieger in 1966 designed to facilitate macular photocoagulation. It has a concave corneal surface which is steeper and of greater diameter, so also has a better optics than a simple Goldman fundus lens. The concave corneal surface allows posterior lens pressure to be transmitted to the sclera without distorting the cornea. It produces an erect, virtual ophthalmoscopic image located in the anterior vitreous humor.

80 deg region of major vascular arcades 76deg-midperiphery and equator 67deg-peripheryand vitreous base 62deg-ora serrata and iridocorneal angle

Four mirror contact lens

Panfundoscopic lens
Rodenstock Meniscus lens coupled with a spherical lens located within the same lens holder housing Inverted,real,minified image Located well forward of the ant surface lens surface Wide angle view from fovea to equator Examination thru Poorly dilated pupil Photocoagulation than diagnostic purpose as image is small and periphery blurred

Mainster lens
1986 This lens has more field of view (58% Greater than Goldman) and a greater magnification. Field of view is 14% less than the Panfundoscope, The lateral and axial magnification are better which makes it useful for detecting retinal thickening. It has a biconvex, aspherical anterior lens element and a concave lens element to fit the corneal curvature. It produces an inverted, real image located in front of its biconvex aspheric anterior lens element

Mainster Standard lens

This lens is designed for focal and grid laser treatment from the posterior pole to the midperiphery. The field of view is 90deg/121deg. Image magnification is 0.96x. Laser spot magnification is 1.05x. High resolution, high magnification of image allows appreciation of subtle . intra-retinal details and retinal thickening. for diagnosis and treatment of macular oedema, branch retinal vein occlusion, choroidal neovascular membrane in age-related macular degeneration and presumed ocular histoplasmosis

Mainster wide field lens

This allows a very wide range of slit lamp magnification to be used. It has excellent ophthalmic resolution and image binocularity is maintained across the entire field of view. It is used for panretinal photocoagulation in proliferative diabetic retinopathy. The field of view is 118deg/127deg. Image magnification is 0.68x. Laser spot magnification is 1.50 x.

Volk Quadraspheric lens

The preferred wide field fundus laser lens for diagnosis and treatment of the retina. The four aspheric surfaces also employ highefficiency antireflection coatings thereby improving lens performance by reducing astigmatism across the entire field of view. It also enhances visualization through a small pupil. It produces an inverted and reversed image. Its sleek 28.6mm diameter housing provides a definite advantage over competitive wide field lensesfor peripheral retinal viewing, reflection displacement and ease of use. The laser spot magnification is 1.97x the image magnification is 0.51x.

Abraham iridectomy lens

Abraham iridectomy YAG laser lens that consists of a modified Goldmann type fundus lens with a 7.50 mm diameter +70 D plano-convex lens bonded to the anterior surface. It has an anodized light metal rim, that gives a firm grip on the lens. The +70 D button lens helps in condensing the laser energy, so that the procedure can be carried out at lower power settings.

Paymen Capsulotomy YAG Laser Lens

paymen capsulotomy YAG laser lens. These are used as devices for ND-YAG laser posterior capsulotomy and anterior vitreolysis. Features: The +30D lens condenses the laser energy

1.Goniolens-Direct

Koeppe-prototype diagnostic goniolens. Richardson-SchafferSmall Koeppe lens for infants

 Barkan-prototype surgical goniolens Swan Jacob-surgical goniolens for operating room. Thorpe-surgical and diagnostic goniolens for operating room. Layden-for premature infant gonioscopy Worth goniolens-Anchors cornea by partial vacuum. Sieback goniolens-tiny goniolens which floats on the cornea

Indirect Goniolens
Two basic designs Goldmann type and Zeiss type

Goldmann type
Truncated cone shaped device which utilizes mirrors to reflect light from iridocorneal angle into the direction of observer

 3 mirror lens gives both an erect virtual image of the fundus as well as indirect view of angle as in a mirror. The small curved front surface does not rest on the cornea ,but instead it vaults over it with a lubricating fluid filling the gap Border of front surface rest on sclera

 Centre lens- 64 dioptre lensfor posterior pole Trapezoid mirror-retina slightly posterior to equator(73 deg) Half round mirror-peripheral retina from equator out to the ora serrata (67 deg) Thumb nail mirror-59deg- for AC angle Contact surface diameter12mm

Goldmann type

 View obtained is less than that of Koeppe lens Can be used with the patient sitting upright Single mirror lens with antireflective coating-laser trabeculoplasty,enables a wider view of angle 4 mirror lens available

 Modified Goldmann type lens

Radius of curvature 8.4mm Does not need viscous bridge Anti reflection coating Can be used for laser trabeculoplasty

 Uses similar method to Goldmann But employs prism in place of mirror 4 symmetrical prisms tilted at 64 deg. allow visualization of iridocorneal angle in 4 quadrants simultaneously. Smaller contact surface diameter [9mm]rests on cornea without requiring lubricating fluid. Allows indentation gonioscopy

Zeiss type

 Original model mounted over a holding fork(unger holder) Newer models with attached holding handle-

Zeiss type

 Posner 4 mirror-modified Zeiss with attached handle Sussmann-hand held Zeiss type Thorpe 4 mirror-4 mirror at 62 degrees,requires fluid bridge

 4 mirrors 2 at 59 degrees 2 at 62 degrees With a convex lens over one mirror of each set

Ritch trabeculoplasty lens

4 mirror lens at 62 degres 30 D convex lens in a hollow tunnel Can be used as a diagnostic gonioprism Useful in trabeculoplasty and iridectomy

Trabeculens

Feature

4 mirror lens

Central 30deg Mirror 120 deg Magnifica < x1 tion Image Ant vit location Image Erect mirror image Field of view

Mainster Volk ultra field super quad XL 140 deg 160deg

Volk quadrasp heric 130deg

0.53 Air

0.52 Air

0.53 Air

Complet Complete Complete e inversion inversion inversion

Feature

4 mirror lens Direct

Optics

Mainster Volk ultra field super quad XL Indirect Indirect 30mm 30mm

Volk quadras pheric Indirect 26mm Concave convex ant surface ++

Aperture 30mm dia Lens

Planoco Concave Concave ncave+m convex convex irror ant ant surface surface +++ +++

Surface + reflection