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Visual 

Optics, Lectures in Optics Volume 4 by George Asimellis 
(PM291) 
Errata to first printing 
 
 
 

The first printing of this book has errata on pages 74, 100, 112, 
374, 462, 511, 517, and 687, as indicated on the following 
corrected pages. 
VISUAL OPTICS

2.4.2.3 Pupillary Response

Pupillary response or pupil light reflex is a physiological response that leads to a change in
the pupil diameter (size). While the pupil diameter (PD) is about 3.5 mm, the pupil constricts
under a bright light to 1.5 or 2 mm in diameter and expands under dim light up to 8 mm.

Pupil constriction and dilation can be brought about by the contraction of the sphincter
and the dilator pupillae, two antagonistic autonomic (reflex) muscles. The sphincter muscle
(σφιγκτήρας), innervated by the parasympathetic nervous system, is a circumferential muscle
that forms a ring around the iris edge; its contraction leads to pupil constriction. The dilator
muscle (διαστολέας), innervated by the sympathetic nerve system, forms radially from the iris
edge into the ciliary body; its contraction leads to excitation of the radial fibers of the iris, which
leads to an increased pupillary aperture.

Figure 2-42: Pupillae muscles driving pupil response.

Pupil size may be pharmacologically induced: It may constrict (miosis) in response to


agents such as opiates/opioids or anti-hypertension medication. The pupil may dilate
(mydriasis) by anticholinergic agents and amphetamines that block the responses of the ciliary
muscle during accommodation (cycloplegia, § 7.1) and also act on the sphincter muscle,
producing mydriasis. A pharmacologically mydriated pupil remains dilated even in bright light.
Anticholinergic and alpha-1 adrenergic agonists are used as mydriatic agents.
The highlighted sentence
has been amended as
written here.

Figure 2-43: Scheimpflug images taken before (left) and after (right) pharmacologic mydriasis.158

158
Razeghinejad MR, Lashkarizadeh H, Nowroozzadeh MH, Yazdanmehr M. Changes in ocular biometry and anterior chamber
parameters after pharmacologic mydriasis and peripheral iridotomy in primary angle closure suspects. J Optom. 2016; 9(3):189-95.

2-74
VISUAL OPTICS

The clinical presentations of photokeratitis include ocular pain, tearing, conjunctival


chemosis, blepharospasm, and deterioration of vision typically several hours after exposure. The
presentation can be transient (recessing as the epithelium regenerates)212 but can also be long
term.213 Chronic UV-B exposure is associated with abnormal cornea conjunctiva growth such as
pterygium.214, 215 UV exposure may lead to the irrevocable loss of corneal endothelial cells,216
since these non-regenerating cells are very susceptible to UV radiation.217

corrected
label:

Figure 2-68: Absorption of UV bands by various components of the human eye.

The crystalline lens of the eye strongly absorbs UV, mainly due to its longer optical path
(being much thicker than the epithelium). UV absorption by the lens is associated with cataract
development: Studies suggest that doubling the lifetime of UV-B exposure increases the risk of
cortical and posterior subcapsular cataract by 60%;218 other studies conclude that individuals with
a high, long-term UV-B exposure have over 3× increased chance of developing a cortical cataract.

While the UV radiation is strongly absorbed (1% remaining) before reaching the retina,
even this small fraction, if phototoxic, is of concern.219, 220, 221 Lens removal by cataract surgery
leads to an increase in the UV that reaches the retina if the IOL does not effectively block it.222

Willmann G. Ultraviolet keratitis: from the pathophysiological basis to prevention and clinical management. High Alt Med Biol.
212

2015; 16(4):277-82.
213
Guly HR. Snow blindness and other eye problems during the heroic age of Antarctic exploration. Wilderness Environ Med. 2012;
23(1):77-82.
214
Taylor HR. Ultraviolet radiation and the eye: an epidemiologic study. Trans Am Ophthalmol Soc. 1989; 87:802-53.
215
Li X, Dai Y, Xu W, Xu J. Essential role of ultraviolet radiation in the decrease of corneal endothelial cell density caused by
pterygium. Eye. 2018; 32(12):1886.
216
Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T. Safety of UVA-riboflavin cross-linking of the cornea. Cornea. 2007; 26(4):385-9.
217
Cullen AP, Chou BR, Hall MG, Jany SE. Ultraviolet-B damages corneal endothelium. Am J Optom Physiol Opt. 1984; 61(7):473-8.
218
Taylor HR. The biological effects of UV‐B on the eye. Photochem Photobiol. 1989; 50(4):489-92.
219
van Kuijk FJ. Effects of ultraviolet light on the eye: role of protective glasses. Environ Health Perspect. 1991; 96:177-84.
220
Zuclich JA. Ultraviolet induced damage in the primate cornea and retina. Curr Eye Res. 1984; 3(1):27-34.
221
Youn HY, McCanna DJ, Sivak JG, Jones LW. In vitro ultraviolet-induced damage in human corneal, lens, and retinal pigment
epithelial cells. Mol Vis. 2011; 17:237-46.
Longstreth J, de Gruijl FR, Kripke ML, Abseck S, Arnold F, Slaper HI, Velders G, Takizawa Y, van der Leun JC. Health risks. J
222

Photochem Photobiol B. 1998; 46(1-3):20-39.

2-100
VISUAL OPTICS

44) Back to Q 43. The examiner rotates the pen from (OS) eye appears to be shifted temporally. This
vertical to horizontal. The pen image, as formed suggests (select two) …
by reflection off the anterior cornea, … a) exodeviation OS eye
a) remains fixed b) esodeviation OS eye
b) enlarges horizontally c) probably normal OS eye
c) shrinks horizontally d) exodeviation OD eye
d) rotates along the direction of the pen e) esodeviation OD eye
f) probably normal OD eye
45) Where is the first Purkinje image formed, and what is
its size if a 10-cm-side-square white screen is held 25 48) Back to Q 47. For a different subject’s eye, the
cm in front of the eye? Purkinje reflex is shifted nasally in both eyes by
a) 3.79 cm inside the eye; size 1.5 cm about 0.4 mm. This suggests (select two) …
b) 3.79 mm inside the eye; size 1.5 cm a) exodeviation OS eye
c) 3.79 mm inside the eye; size 1.5 mm b) esodeviation OS eye
d) 3.79 mm outside the eye; size 1.5 mm c) probably normal OS eye
e) 25 cm outside the eye; size 1.5 mm d) exodeviation OD eye
e) esodeviation OD eye
46) Which Purkinje reflex image is weaker (dimmer) f) probably normal OD eye
and why?
The two 49) When the ambient light decreases from photopic
a) P1 because it is subject to just one reflection
highlighted b) P2 because the aqueous and the cornea have to scotopic, John’s pupil increases from 3 to 6
questions very similar refractive indices mm in diameter. This corresponds to _______ x
on this page c) P3 because it is absorbed by the aqueous more pupil area?

have been d) P4 because it is reflected off a concave interface a) 1.5×


b) 2×
reworded.
47) An examiner holds a bright penlight half a meter c) 4×
away from the subject’s eyes. The reflection on d) 8×
the right (OD) eye appears to be shifted just e) the same size because John has fallen in love.
slightly nasally, while the reflection on the left

Eye Axes, Angles, and Reference Points

50) The two axes that pass via the center of the pupil … d) nodal point
a) the optical axis e) fovea
b) the visual axis f) first Purkinje image
c) the fixation axis
d) the line of sight 53) The three points that the line of sight intersects
e) the pupillary axis are the …
a) fixation point
51) The three axes that pass via the fixation point are … b) vertex
a) the optical axis c) pupil center
b) the visual axis d) nodal point
c) the fixation axis e) fovea
d) the line of sight f) first Purkinje image
e) the pupillary axis
54) The two axes perpendicular to the cornea are the…
52) The three points that the visual axis intersects are a) optical axis
the … b) visual axis
a) fixation point c) line of sight
b) vertex d) pupillary axis
c) pupil center e) fixation axis

2-112
VISUAL OPTICS

6.7 AMETROPIA QUIZ

Depth of Field

1) What is the dioptric depth of field if the proximal a) –12.5 cm


limiting position is 20 cm in front of Daniéli’s eye and b) –20.0 cm
the distal limiting position is 50 cm in front of her eye? c) –37.5 cm
a) 2.0 D d) –50.0 cm
b) 2.5 D e) –62.5 cm
c) 3.0 D
d) 5.0 D 7) Back to Q 6. Where is the proximal point?
e) 8.0 D a) –12.5 cm
b) –20.0 cm
2) The conjugate object point (two correct) … c) –37.5 cm
a) focuses exactly on the retina d) –50.0 cm
b) provides the same retinal quality as optical e) –62.5 cm
infinity
c) produces a real image with half the 8) Back to Q 6. Where is the conjugate point?
resolution of the proximal point a) –12.5 cm
d) produces a virtual image with the same b) –20.0 cm
resolution as the distal point c) –37.5 cm
e) is dioptrically located halfway between the d) –50.0 cm
proximal point and the distal point e) –62.5 cm

3) Back to Q 1. What is the vergence of the 9) Back to Q 6. What is the linear depth of field?
conjugate object point?
a) 12.5 cm
a) –2.0 D b) 20.0 cm
b) –2.5 D c) 37.5 cm
c) –3.0 D d) 50.0 cm
d) –3.5 D e) 62.5 cm

4) Back to Q 1. What is the linear depth of field? 10) Gilda is fixating on a point 50 cm in front of her
a) 20 cm eye. The proximal point of the depth of field is 40
b) 28 cm cm in front of her eye. Where is the distal point?
c) 30 cm a) 10 cm
d) 50 cm b) 26.6 cm This question has been
e) 70 cm c) 30 cm reworded.
d) 50 cm
5) Back to Q 1. Where is the location of the e) 60 cm
conjugate object point? f) 66.6 cm
a) –20 cm
b) –28 cm 11) Back to Q 10. What is the linear depth of field?
c) –30 cm
a) 10 cm
d) –50 cm
b) 26.6 cm
e) –70 cm
c) 30 cm
d) 50 cm
6) If the dioptric depth of field of Giorgio’s eye is
e) 50 cm
±3.0 D and the conjugate point vergence is
f) 66.6 cm
– 5.0 D, where is the distal point?

6-374
VISUAL OPTICS

32) Nausicaa is wearing her proper contact lens d) 2 D; 1 MA


correction (recall, she is a +3.00 hyperope), while
hanging Odysseus’ clothing 50 cm away. What is 38) Back to Q 37. When expressed in [Δ], what is
her accommodative demand? Laertes’ convergence effort (approximately)?
a) +1.92 D a) 2Δ
b) +2.00 D b) 4Δ
c) +2.14 D c) 6Δ
d) +3.00 D d) 8Δ
e) +5.00 D e) 12Δ
f) +7.00 D The decimal point has been
added. 39) Calypso, an uncorrected +2.00 hyperope, is
33) What would have been Nausicaa’s spectacle lens fixating on a medial plane target placed 50 cm in
correction at a 12 mm vertex distance? front of her eyes. What is the accommodative
a) +2.00 D demand [D] and the convergence effort [MA]?
b) +2.89 D a) 4 D; 2 MA
c) +3.00 D b) 1 D; 1 MA
d) +3.11 D c) 1 D; 2 MA
d) 2 D; 1 MA
34) Wearing the spectacle correction identified in Q 33,
what would be Nausicaa’s accommodative demand 40) Which hero experiences increased convergence
when she gazes 50 cm from her corneal plane? demand when wearing his/her spectacles instead
a) +1.92 D of wearing his/her contact lenses and fixating at
b) +2.00 D the same distance?
c) +2.14 D a) Nestor (+4.00 hyperope)
d) +3.00 D b) Calypso (+2.00 hyperope)
e) +5.00 D c) Tiresias (–2.00 myope)
d) Arete (–4.00 myope)
35) Diomedes, a +1.25 hyperope, is fitted with a
+0.75 D contact lens. What is his accommodative
41) Which of the following myopic heroes
demand when viewing a target 10 cm from his
experiences increased accommodative demand
corneal plane?
when he/she is wearing his/her contact lenses?
a) 9.75 D
a) Tiresias (–2.00 myope)
b) 10.0 D
b) Arete (–4.00 myope)
c) 10.5 D
c) Penelope (–5.00 myope)
d) 11.25 D
d) Achilles (–6.00 myope)
36) Which hero demands more accommodation [D]
than the same numerical convergence [MA] when 42) Eurymachus is a +7.00 D hyperope with a 15.0 D
viewing the same fixation point 40 cm in front of amplitude of accommodation. What is his near
their eye, placed on the medial plane? point when he is not wearing correction?
a) Nausicaa (+3.00 hyperope) a) 15 cm
b) Odysseus (emmetrope) b) 14.2 cm
c) Circe (–1.50 myope) c) 12.5 cm
d) Penelope (–5.00 myope) d) 8 cm

37) Laertes, an uncorrected –1.00 myope, is fixating 43) When not wearing correction, what amount of
on a medial plane target placed 50 cm in front of accommodation does Eurymachus use to fixate at
his eyes. What is the accommodative demand [D] infinity?
and the convergence effort [MA]? a) 0.00 D
a) 4 D; 2 MA b) 7.00 D
b) 1 D; 1 MA c) 8.00 D
c) 1 D; 2 MA d) 15.00 D

7-462
ASTIGMATISM

Note 2 : In several textbooks, we read: ‘The JCC lens is a spherocylindrical lens with twice as much
cylindrical power as spherical power.’ This description is not proper because there is no true spherical
power. It disregards the origin of the JCC, which is a low-power Stokes, purely astigmatic lens.

Clinical Pearl : JCC lenses are available with different powers (±0.12, ±0.25, ±0.50, ±0.75, ±1.00)
because individuals with poor visual acuity need to be presented with a greater Sturm interval (larger JCC
cylinder) to distinguish just-noticeable differences during the flip comparison. In general, the ±0.12 D JCC
can be used for visual acuity 20/15 to 20/20, the ±0.25 D for 20/25 to 20/30, the ±0.50 D for 20/40 to
20/60, and the ±1.00 D for 20/70 to 20/200. Typically, the ±0.25 JCC lens is built in to most phoropters.

In the primary JCC orientation (Figure 8-56), the +.50 mark (if present, in black or white) is
at the 12 o’clock position and reads left to right; the red –.50 mark is at the 9 o’clock position and
reads down to up. The marks are on the front surface (facing the examiner). In this orientation,
the optical lens cross form is +0.50 @ 180° (+0.50 D power along the horizontal meridian) / –0.50
@ 90° (– 0.50 D power along the vertical meridian). The JCC axis in this orientation is the horizontal
line. If this JCC lens is placed in front of a lensometer, its power reads –0.50 +1.00×090.

"cross" is changed to "crossed"


in the figure
Figure 8-56: (left) A ±0.50 JCC lens in its primary orientation, showing (second from left) the plus and
minus Rx forms, as well as (second from right) the optical lens cross and (right) the crossed-cylinder forms.
The +.50 and –.50 marks on the lens itself correspond to the crossed-cylinder, which is perpendicular to the
lens cross. The JCC is mounted in a round ring with its handle at 45° from the axis. A twirl of the stem
handle changes the cross-cylinder lens to the flipped position (Figure 8-57 left); the back surface is now the
front, and the marks are interchanged.

The JCC is used clinically to subjectively determine refractive astigmatism (cylinder power
and axis). The lens can be flipped by a simple twirl of the stem handle between the thumb and the
index finger. When flipped, the lens undergoes a rotation of 180° about the flip axis. As the back
surface is brought to the front of the examiner, the red and white marks trade places, and the
principal meridians alternative rapidly. When flipped, the positive power meridian, which is
horizontal in the primary orientation, becomes vertical; the negative power meridian, which is
vertical in the primary orientation, becomes horizontal. Effectively, the flip is akin to a swift 90° turn.

8-511
ASTIGMATISM

c) @ 180°; it has the most plus corrective power d) +1.00 +4.00×160


d) @ 180°; it has the most corrective power e) –3.00 +4.00×070
f) –3.00 +1.00×070
25) Back to Q 22. What is the type of astigmatism? g) +1.00 +4.00×020
a) WTR compound hyperopic
b) WTR simple myopic 30) Back to Q 30. What is the minus Rx form?
c) ATR compound hyperopic a) +1.00 –4.00×070
d) ATR simple myopic b) +1.00 –4.00×020
e) WTR mixed c) +1.00 –4.00×160
d) +1.00 +4.00×160
26) Back to Q 22. What is Sturm’s interval? e) –3.00 +4.00×070
a) 1.00 D f) –3.00 +1.00×070
b) 3.00 D
c) 4.00 D 31) Back to Q 30. What is the type of astigmatism?
d) 5.00 D a) WTR compound hyperopic
b) WTR simple myopic
27) What is unusual about this lens cross +0.25 @ c) ATR compound hyperopic
10° / – 1.50 @ 80°? d) ATR simple myopic
a) Nothing is unusual! e) WTR mixed
b) Both power signs should be either – or +.
c) The meridians are not perpendicular. 32) Back to Q 30. Which meridian is the flat one?
d) The flat power cannot be +0.25. a) @ 20°
b) @ 70°
28) In compound myopic astigmatism, the most c) @ 160°
minus corrective power is along the … d) @ –20°
a) flat meridian
b) steep meridian 33) Back to Q 30. What is Sturm’s interval?
c) bisector between flat and steep a) 1.00 D
d) perpendicular to steep meridian b) 3.00 D
c) 4.00 D
29) What is the plus Rx form of this lens cross? d) 5.00 D

34) In this Rx (plano) –1.25×180, where is the vertical


focal line formed (state dioptric values)?
a) –1.25 D (in front of the retina)
b) 0.00 D (on the retina)
"counterclockwise" is c) +0.625 D (behind the retina)
a) +1.00 –4.00×070 replaced by "clockwise" d) +1.25 D (behind the retina)
b) +1.00 –4.00×020
c) +1.00 –4.00×160

Prescriptions and Forms


35) Sancho’s Rx is –2.50 – 1.00×180. The spherical 36) The spherical equivalent for Florisea’s Rx (+1.50
equivalent is … – 1.00×090) is …
a) –3.50 D a) –1.00 D
b) –3.00 D b) –0.50 D
c) –2.50 D c) +0.50 D
d) –2.00 D d) +1.00 D
e) –1.50 D
f) –1.00 D 37) During phoropter refraction examination, you just
added a –0.50 D cylinder. To maintain the circle

8-517
OPHTHALMIC LENS OPTICS

= –20.0 D. How far from point A does he have to c) +15.0 D


move so that light vergence becomes = –2.0 D? d) +13.33 D
a) 5 cm upstream e) +10.0 D
b) 5 cm downstream
c) 45 cm upstream 17) Fantine wears spectacle lenses +3.75 D @ 15 mm
d) 45 cm downstream vertex. What would be the contact lens (CL) power?
e) 50 cm upstream a) +3.50 D
f) 50 cm downstream b) +3.75 D
c) +4.00 D
12) Where is the source (in relation to point A) whose d) +4.25 D
vergence was measured as –20.0 D? e) +4.50 D
a) 5 cm upstream
18) Cosette’s Rx is –4.25 D @ 15 mm vertex. Rather
b) 5 cm downstream
unhappy (it runs in the family!), she, too, wants to
c) 45 cm upstream
switch to contact lenses. What should be the
d) 45 cm downstream
contact lens (CL) power?
e) 50 cm upstream
f) 50 cm downstream a) –3.75 D
b) –4.00 D
13) In a second experiment, Gavroche measures light c) –4.25 D
vergence at point C = +10.0 D. What will light d) –4.50 D
vergence be at a point that is 35 cm downstream e) –4.75 D
from point C?
19) Which two of the following spectacle Rx’s will
a) +2.22 D
produce the same refractive effect as Cosette’s
b) +2.86 D
original spectacle Rx –4.25 D @ 15 mm?
c) –2.86 D
d) –4.00 D a) –4.15 D @ 12 mm
b) –4.20 D @ 12 mm
14) In his third and final experiment, Gavroche c) –4.29 D @ 14 mm
measures light vergence at point E = –5.0 D. How d) –4.35 D @ 20 mm
far from point E does he have to move such that
light vergence becomes = –2.5 D? 20) Jean Valjean is wearing a +8.25 D contact lens
distance Rx. The streets in Paris are rather dusty
a) 5 cm upstream
and he is uncomfortable wearing his CLs, wishing
b) 5 cm downstream
to switch back to his spectacle Rx. Can we help
c) 20 cm upstream
him pick up the correct Rx?
d) 20 cm downstream
e) 40 cm upstream a) +7.50 @ 12 mm vertex
f) 40 cm downstream b) +7.50 @ 15 mm vertex
c) +8.50 @ 12 mm vertex
15) How far from the final point of –2.5 D vergence is d) +9.00 @ 10 mm vertex
the point source?
21) Monsieur Madeleine wears a spectacle of Rx
a) 5 cm upstream
+7.50 @ 12 mm vertex. Had he been wearing
b) 5 cm downstream
contact lenses (CL), what would their power be?
c) 20 cm upstream
d) 20 cm downstream a) +7.00 D
e) 40 cm upstream b) +7.50 D
f) 40 cm downstream c) +7.75 D
d) +8.00 D
16) At point A, 5.0 cm to the left of a lens, vergence is e) +8.25 D
The distance +4.0 D. At a point B, 1.0 cm to the right of this lens,
vergence is +25.0 D. What is the power of the lens? 22) Prisoner 24601 is undecided between a couple of
1.0 cm is frames to wear. Can you help him choose the
corrected (it a) +24.0 D
two that produce the same CL equivalent power?
b) +16.0 D
was 10.0 cm).

9-607
APPENDIX

ANSWERS TO QUIZ QUESTIONS

(Answers are provided only to odd-numbered questions.)

Chapter 1 Optics of the Eye

1) b 6) b 11) b 16) c and d 21) a


2) a 7) g 12) c 17) a and b 22) b
3) d 8) c 13) d 18) d
4) c 9) c 14) a 19) a
5) c 10) a 15) a and c 20) b

Chapter 2 Refractive Elements of the Eye

1) e 19) b 37) b 55) d and f 73) d


2) b 20) b 38) c 56) a and d 74) b
3) a 21) c 39) a 57) b and c 75) a
4) d 22) e 40) b 58) c 76) c
5) b and f 23) e 41) e 59) f 77) d
6) d 24) c 42) a 60) a 78) b
7) a 25) b 43) d 61) c 79) c
8) d 26) c 44) d 62) b 80) e
9) a 27) b 45) b 63) c 81) b
10) a 28) a 46) d 64) b 82) b
11) e 29) b 47) b and f 65) c 83) d
12) d 30) d 48) d and f 66) c 84) a, c, and d
13) b and c 31) a 49) c 67) a 85) c
14) a 32) d 50) d and e 68) b 86) b
15) a 33) a 51) b, c, and d 69) a 87) a, c, and f
16) b 34) d 52) a, d, and e 70) a and c 88) c
17) c 35) a 53) a, b, and c 71) d 89) a
18) e 36) a 54) d and f 72) a 90) b
Question 51 of Chapter 2 has three
correct answers instead of two.
Chapter 3 Visual Acuity

1) e 13) c 25) d 37) a and c 49) e


2) a 14) e 26) c 38) b and d 50) d
3) a 15) d 27) e 39) b 51) b
4) d and e 16) d, e, and f 28) c 40) a 52) c
5) a 17) c 29) a 41) d 53) e
6) a 18) d 30) c 42) b 54) b
7) b 19) a 31) b 43) c 55) a
8) d 20) b 32) c 44) a 56) c and d
9) c 21) a 33) c 45) d 57) d
10) c 22) c 34) c 46) b 58) b
11) d 23) d 35) a 47) d 59) d
12) a 24) c 36) d 48) a

Chapter 4 Optics of the Retina

1) e 12) c 23) b 34) b 45) b


2) a 13) a 24) c 35) c and d 46) d
3) c 14) d 25) b 36) a 47) b
4) b 15) c 26) d 37) c 48) c
5) b 16) d 27) c 38) a 49) a
6) c and d 17) c 28) d 39) a 50) d
7) a 18) c 29) d 40) d 51) b
8) b 19) a 30) a 41) b 52) b
9) b 20) a 31) a 42) b 53) c
10) a 21) c 32) c and d 43) c 54) a
11) b 22) a 33) c 44) d 55) c

687

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