Keratometry The objective measurement of the curvature of the anterior surface of the cornea o Cornea acts as a highly convex

x spherical mirror o Uses reflective properties of the cornea in order to measure its radius of curvature o Each manufacturer uses an assumed corneal index of refraction to convert radii to diopters B&L uses 1.3375 o One position keratometer: variable doubling (B&L) Both principle meridians are perpendicular to each other o Two position keratometer Rotate the instrument for the secondary meridian Allows measurement if the two principal meridians are not at right angles to each other Clinical uses: o Objective method for determining curvature of the cornea, amount and direction of corneal astigmatism, quality and stability of the corneal refracting surface Examples: progressive myopia, keratoconus, degenerative anomalies, and pre-surgical workup for cataract surgery (helps determine power of IOL) o Contact lens fitting Base curve selection in RGP and hydrogel lens fitting Over keratometry can help detect CL surface irregularities or poor wetting qualities Monitor corneal changes produced by wear o Establish baseline data Should be performed on all new patients Patient may later want CLs or may develop an injured/diseased cornea o Detection of irregular astigmatism Keratoconus: a corneal dystrophy where the center of the cornea thins and bulges Results in steep curves, high astigmatism, and distorted mires Pterygium Corneal scarring o Refractive estimate in unresponsive patients, children, amblyopes, aphakia or high ametropia, patients with media opacities and/or poor quality retinoscopic reflex and difficult refractions/unreliable subjective data o Determine the nature of ametropia Axial Example: high myopia with 40D K reading Refractive Example: high myopia with 49D K reading o Post-surgical management of keratoplasty or cataract surgery Limitations o Area measured is a 0.1mm annular ring with a 3.0mm diameter

o One position keratometers assume that meridians of least and most cylinder are orthogonal (perpendicular) o Assumed corneal index may cause problems when comparing Ks from different instruments o Autokeratometers do not evaluate the quality of the cornea Procedure o Turn instrument on and clean forehead and chin rests o Focus the eyepiece Turn fully counterclockwise to blur reticule (toward plus) Relaxes accommodation Turn eyepiece clockwise until reticule is FIRST seen in sharp focus Note: Incorrect focusing can produce significant error (up to 0.2mm radius) o Position patient comfortably and align canthus marker using instrument height control o Place the reflection of the mires in the center of the pupil Account for all 3 axes (x, y, and z) X: instrument pivot Y: instrument height adjustment Z: instrument focus and headrest tilt control o Instruct patient to keep both eyes open, look at the reflection of your eye in the instrument, and it is okay to blink o Occlude left eye o Align the crosshairs in the center of the lower right-hand circle Means the optical axis and the visual axis of the eye are the same o Focus the lower right-hand circle to obtain superimposed image and lock instrument o Locate the principal meridians Make the plus signs parallel by rotating the instrument and then overlap the plus signs with the horizontal axis wheel Align the minus signs with the vertical axis wheel KEEP ONE HAND ON THE FOCUSING KNOB o Record both horizontal and vertical measurements (in eighths of a diopters) Record flatter/steeper @ steeper meridian Record clarity of mires: clear or distorted ALWAYS record findings to 2 decimals (total of 4 digits) o Problems/Solutions Unable to locate keratometric mires instrument and/or patient not aligned properly Mire clarity is transient measure quickly after allowing the patient to blink Mire focus is transient ensure that patients forehead is secure against headrest Patient gaze is unsteady ensure that fellow eye is occluded H&V mires cannot be measured concurrently patient may have irregular astigmatism

Only 1 minus sign is visible patients eyelid is drooping (have them open wide) Only 1 plus sign is visible occluder is in the way Range of the B&L keratometer is 36.00 to 52.00 o Normal values are around 44.00 to 45.00 o To increase the range: Place +1.25D lens in front of aperture to extend range to 61D ADD 9 D Place -1.00D lens in front of aperture to extend range to 30D SUBTRACT 6 D Astigmatism o Irregular: principal meridians are not perpendicular to each other Produce distorted mires o Regular: principal meridians are perpendicular With-the-rule: more power in the vertical meridian (greatest curvature) and horizontal meridian is flatter Example: 45.00@090/43.25@180 Against-the-rule: more power in the horizontal meridian and vertical meridian is flatter Example: 42.50@115/44.87@025 Oblique: principal meridians lie between 20 and 70 and 110 and 160 o Corneal astigmatism is measured by the keratometer o Refractive (total) astigmatism is measured by retinoscopy and/or subjective refraction Corneal and refractive do not coincide due to: Physiologic lenticular astigmatism (usually ATR and varies with age) Effectivity changes o ~25% increase in astigmatism going from the corneal plane to the spectacle plane Corneal posterior surface curvature o K (corneal cylinder) Translate Ks into minus cylinder format Use the flatter meridian as the minus cylinder axis and the difference in power between the two meridians as the cylinder power Use Javals (modified) Rule to predict the correcting cylinder Only should be used with </=2.00DC ATR and </=3.00DC WTR Convert corneal astigmatism to refractive astigmatism o WTR: refractive= corneal + (+0.50 x 180) WTR gets better by 0.50 o ATR: refractive= corneal + (-0.50 x 090) ATR gets worse by 0.50 Corneal topography is used to provide a color map of the contour of the entire corneal surface o Used for corneal surgery (refractive and penetrating keratoplasty), degenerative corneal conditions (keratoconus), and contact lens fitting (orthokeratology)