How to Use a Focimeter

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 exam revision
 clinical skill
 refraction skills
 Focimetry

Introduction

Figure 1. Labelled Focimeter: click to expand the image

A focimeter (Figure 1) is a device used to determine the power of a lens. It is also known variously as
a lensometer or vertometer. It can determine the spherical power, cylindrical power, axis, prism and
the position of the optical centre of a lens. In Figure 1, the labelled parts of the focimeter are:

1. Eye piece
2. Reticule adjustment
3. Prism compensator
4. Lens marker
5. Gimbal (lens holder)
6. Eyeglass table
7. Magnifier
8. Axis adjustment knob
9. Filter control
10. Inclination control
11. Power drum
12. Eyeglass table control
 1. Get Comfortable
Position the focimeter at a comfortable angle for viewing by using the locking lever or inclination control
at the side of the instrument (Figure 1, label 10) to adjust the tilt of the focimeter. This is also a good
time to ensure the prism compensator is at 0.

2. Focus the Eyepiece

Figure 2: Reticule & line target as viewed through eyepieceIt is essential to focus the eyepiece for
your eye if someone else has used the focimeter before you. The video in the Multimedia Tab of this
article called 'Setting up a Focimeter' demonstrates how to focus the eyepiece. The steps are:

 Keep the focimeter power off.

 Rotate the eyepiece counter-clockwise until the reticle is blurred. A white card or piece of paper
held behind the eyepiece may make the reticle lines more visible.

 Turn the eyepiece clockwise until the reticle is just clear. The lensometer is now adjusted for
your eye. Note: Do not turn past the point at which the reticle is first clear.
 3. Check Power Calibration
Ensure the power calibration of your focimeter is accurate. This should be done occasionally.

 Turn the focimeter on.

 Turn the power wheel into the plus, then slowly decrease the power until the focimeter target
(sphere and cylinder lines as seen in Figure 2) is sharply focused. Do not oscillate the wheel
back and forth to find the best focus. The power wheel should read zero if the instrument is in
proper calibration.

 If the power wheel does not read zero, re-focus the eyepiece and re-check the calibration. If the
power wheel still does not read zero, the error must be compensated for on all future
measurements made with the lensometer, or the lensometer needs maintenance. (Note:
algebraically subtract the calibration error from the power measurement to compensate for
calibration errors.)

4. Position the Spectacle Frame

 Turn the spectacles so that the front of the spectacles is facing towards you. The temples (the
arms of the spectacle frame) should be pointing away from you.

 Put the spectacles on the frame table. The bottom rim of the spectacles should rest on the
frame table.

 Clamp the spectacle lens to keep it pressed against the lens rest. Note: always start with the
right lens (for consistency)

 Look through the eyepiece and move the spectacles side-to-side and up-and-down until the
target is in the centre of the black graticule.

 Change the height of the frame table to keep the frame horizontal in this position (that is, with
the bottom rims of the spectacle against the table to make sure one side does not drop down)
5. Mark the Optical Centre

 When the lens is positioned as above - where the centre of the focimeter target is over the
centre of the graticule - then you are at the optical centre of the lens. Note: if there is a ground
prism in the lens, despite movements of the lens up-and-down or side-to-side, the focimeter
target will not be centred over the graticule - so there is no optical centre of such a lens.

 Mark the optical centre. Focimeters usually have an ink well and marking pins. When the lens
is centred correctly, you can use the marking pins to put a mark (usually small dots) on the lens
surface. If the vertometer does not have an ink well or marking pins, you can use a marking
pen (felt tipped pen) to mark the optical centre of the lens yourself. You will need to make the
mark on the lens directly over the lens rest.

Figure 3. Focimeter Target: as focussed for a spherical lens

6. Determine the Right Lens Power

 With the right lens positioned at its optical centre, turn the power wheel to a high plus reading.

 Slowly decrease the power (reduce the plus by turning the power wheel) until the target lines
just become clear (Figure 3).
a. If the Lens is a Sphere:

 All the target lines will come into focus at the same time (Figure 3)

 Simply read off the power drum to determine the spherical power

b. If the Lens is Astigmatic:

 Only some of the lines are clear at a given power (Figure 4)

 Turn the power wheel to a high plus reading and slowly decrease the power until some of the
target lines just become clear.

 Turn the axis wheel until the three parallel target lines are straight and unbroken.

Figure 4. Astigmatic lens with one meridian in

focus

 The number on the power wheel at this point is the most positive meridian of the lens. This
will be the spherical power when you write the astigmatic lens prescription.

 Slowly turn the power wheel to decrease the power until the other line is clear. The number on
the power wheel will now tell you the power of the least positive meridian of the lens.

 Find the cylindrical power of the lens: this is the difference in powers, ie the more positive
power subtracted from the more negative power (negative cylinder)

 Find the axis of the cylinder. The axis of the cylinder is the direction of the second power
reading, ie the least positive power. The direction of this line is measured by aligning the
graticule and looking at the axis numbers on the graticule inside the eyepiece.
  Example: Reading 1 is +3.00D x 90 and Reading 2 is +2.00D x 180. The lens is: +3.00/-1.00 x
180

7. Determine the Left Lens Power

 Without changing the height of the lens table, clamp the left lens in position

 Centre the lens by moving it left-and-right as appropriate

 There should be no need to move the lens up-and-down: the focimeter target should be
vertically aligned with the graticule at the table height used for the right lens. If it is not, then
there is vertical prism between the lenses, which can be measured by the markings on the
graticule.

 Once aligned at the optical centre, mark the optical centre of the left lens and measure the
power of the left lens using the same steps as for the right lens above.

8. Determine the Prism

a. Vertical Prism
  Figure 5. Base-down prism 1 dioptreAs mentioned above, the
vertical prism is determined by keeping the lens table at the same height on swapping from
right lens to left lens

 If the focimeter target (the green cross) is not centred vertically about the reticule, then there is
vertical prism present
o If the focimeter target is below the horizontal then there is base-down prism
o If the focimeter target is above the horizontal then there is base-up prism
 The size of the prism can be read from the reticle markings

 Note: this method determines the total vertical prism between the two lenses. In order to
determine the precise contribution of the left and right lenses to the total prism it is necessary to
know the position of the patient's pupils relative to the optical centres of each lens. In practice,
the total vertical prism is usually divided evenly between the two lenses

b. Horizontal Prism

To determine horizontal prism from decentration: Figure

6. Horizontal prism 1.5 dioptres, base-in for the left lens
 Mark the optical centres of each lens

 Determine the patient's inter-papillary distance (IPD)

 Mark the left lens at the IPD distance away from the optical centre of the right lens

 Clamp the left spectacle lens on the lens rest so that the PD mark that you made on the lens is
over the centre of the lens rest.

 Measure the horizontal prism and direction using the reticule. This is the total horizontal
prism. Remember that:
o if the target is to the left (nearer the right lens) the prism is base-in
o if the target is to the right (away from the right lens) the prism is base-out
 Note: this method determines the total horizontal prism between the two lenses. In order to
determine the precise contribution of the right and left lenses to the total prism it is necessary to
now the position of the patient's pupils relative to the optical centres of each lens. In practice,
the total horizontal prism is usually divided evenly between the two lenses.

9. Determine the Near Add

 Turn the spectacles around. The near addition is a measure of the front vertex power - as
opposed to the distance prescription which is a measure of back vertex power. It is therefore
necessary to turn the spectacles around so that the arms of the spectacles point towards you

 Measure the power of the distance section and compare this to the power of the near section -
the difference is the near addition

 For astigmatic lenses, simply compare one meridian in the distance to the equivalent meridian
in the near - again the difference is the near add
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