{"id":1585,"date":"2010-12-06T12:34:24","date_gmt":"2010-12-06T12:34:24","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/stenopeic-opening\/"},"modified":"2023-10-23T16:57:03","modified_gmt":"2023-10-23T15:57:03","slug":"examination-by-means-of-a-stenopeic-opening","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-eyes-and-vision\/vision-and-colour-vision\/examination-by-means-of-a-stenopeic-opening\/","title":{"rendered":"Examination By Means Of A Stenopeic Opening"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\">To investigate <span style=\"text-decoration: underline;\">refractive error<\/span>, vision is examined by means of a <span style=\"color: #33cccc;\"><strong>stenopeic opening<\/strong><\/span><em><strong> [Figure 12]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/123324265?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">The patient stands <span style=\"text-decoration: underline;\">5m away<\/span> from the <span style=\"color: #33cccc;\"><strong>visual acuity chart<\/strong><\/span>. One eye is covered and the stenopeic opening is held in front of the other eye.<\/span><\/li>\n<li><span style=\"color: #003366;\">The examination continues until the patient is unable to read a line correctly. From here, move to the next line using the above mentioned method. Repeat this until the patient again is incapable of correctly naming two-thirds or more of the indicated symbols.<\/span><\/li>\n<li><span style=\"color: #003366;\">Make a note on the card: VODcc or sc = &#8230; + SO = &#8230; where SO means stenopeic opening.<\/span><\/li>\n<li><span style=\"color: #003366;\">Repeated for the other eye.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1577\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-12v2.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-12v2.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-12v2-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 12<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">If the patient\u2019s symptoms are caused by a <span style=\"text-decoration: underline;\">refractive error<\/span>, you will notice a marked <span style=\"text-decoration: underline;\">improvement<\/span> in vision when the stenopeic opening is applied.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Near Vision<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">Near vision should be determined when the patient has symptoms related to <span style=\"color: #33cccc;\"><strong>reading<\/strong><\/span>, and when examining people <span style=\"color: #33cccc;\"><strong>over the age of 40<\/strong><\/span>. Provide the patient with a reading card and ask them to read the text that <span style=\"text-decoration: underline;\">reduces<\/span> in font size. The patient is allowed to keep the card at a distance comfortable for them. The last text that can be read without difficulty indicates the near vision.<\/span><\/p>\n<hr \/>\n<hr \/>\n<p><span style=\"color: #003366;\">A <span style=\"color: #33cccc;\"><strong>point-shaped light source<\/strong><\/span> emits light that diverges in all directions. If the distance between the observer and light source is far enough, the angle between the light rays is so small that the diverging light rays can be considered <span style=\"color: #33cccc;\"><strong>parallel<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>refractive media<\/strong><\/span> of the eye form a positive, i.e. <span style=\"color: #33cccc;\"><strong>converging lens<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">This property refracts parallel light rays to the focal point of the lens. A second property is that light rays which enter the middle of the lens will continue to travel without being refracted <em><strong>[Figure 13]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>For the following illustrations, these abbreviations are used:<\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">B\u00a0 = Light Source<\/span><br \/>\n<span style=\"color: #003366;\">B&#8217; = Picture<\/span><br \/>\n<span style=\"color: #003366;\">F\u00a0 = Focal Point Of The Lens<\/span><br \/>\n<span style=\"color: #003366;\">h\u00a0 = Horizontal<\/span><br \/>\n<span style=\"color: #003366;\">v\u00a0 = Vertical<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1578\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-13.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-13.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-13-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 13<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Emmetropia<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>retina<\/strong><\/span> can be seen as a <span style=\"text-decoration: underline;\">projection screen<\/span>. When this projection screen is located exactly at the focal point of the lens, each point-shaped light source will form a point-shaped image on the screen. This is the case in an <span style=\"color: #33cccc;\"><strong>emmetropic eye<\/strong><\/span> <em><strong>[Figure 14]<\/strong><\/em>. The length of the eye axis and the strength of the refractive media are in accordance with each other.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1579\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-14.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-14.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-14-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 14<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Myopia<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">If the retina is located <span style=\"text-decoration: underline;\">behind<\/span> the focal point of the lens, a point-shaped light source is projected as a <span style=\"color: #33cccc;\"><strong>blotch<\/strong><\/span> on the screen. There is also occurrence of scattered light. This is a <span style=\"color: #33cccc;\"><strong>myopic eye<\/strong><\/span>. The refractive media refract too much, relative to the eye in which they are located <em><strong>[Figure 15]<\/strong><\/em>. The length of the eye axis is <span style=\"text-decoration: underline;\">too long<\/span> for the refractive media (<em>axis myopia<\/em>), or the refractive media are <span style=\"text-decoration: underline;\">too strong<\/span> for the length of the eye axis (<em>systemic myopia<\/em>).<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1580\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-15.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-15.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-15-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 15<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Hypermetropia<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">If the retina is located in <span style=\"text-decoration: underline;\">front<\/span> of the focal point of the lens, a point-shaped light source is also projected as a <span style=\"text-decoration: underline;\">blotch<\/span> on the screen. There is also occurrence of scattered light. This is a <span style=\"color: #33cccc;\"><strong>hypermetropic eye<\/strong><\/span>. The refractive media refract <span style=\"text-decoration: underline;\">too little<\/span>, relative to the eye in which they are located. The length of the eye axis is <span style=\"text-decoration: underline;\">too short<\/span> for the refractive media (<em>axis hypermetropia<\/em>), or the refractive media are <span style=\"text-decoration: underline;\">too weak<\/span> for the length of the eye axis (<em>systemic hypermetropia<\/em>). This applies to the <span style=\"text-decoration: underline;\">non-accommodated eye<\/span>. <\/span><\/p>\n<p><span style=\"color: #003366;\">Because we are capable of increasing the refraction of our refractive system through accommodation (<em>we make use of this when looking at closer objects<\/em>), a not too severe hypermetropia can be compensated by adults by means of accommodation. Because the accommodating capacity of the eye is already engaged when looking in the distance, it will already be used to maximum capacity when looking near.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">When the accommodation capacity decreases from the age of forty, patients will also develop problems looking into distance<em><strong> [Figure 16]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1581\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-16.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-16.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-16-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 16<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Presbyopia<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">When looking at closer objects, the light source (<em>object that is looked at<\/em>) is so close that the eye no longer considers the entering light source as being parallel; it is now seen as being <span style=\"color: #33cccc;\"><strong>divergent<\/strong><\/span>. This means that the eye needs to accommodate to project the focal point onto the retina. When growing older, the <span style=\"text-decoration: underline;\">accommodation capacity<\/span> of the eye <span style=\"text-decoration: underline;\">decreases<\/span>. The eye can no longer be made refractive enough to sufficiently converge the divergent rays that need to be processed, to obtain a sharp image on the screen of the retina. This is called <span style=\"color: #33cccc;\"><strong>presbyopia<\/strong><\/span> <strong><em>[Figure 17]<\/em><\/strong>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1582\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-17.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-17.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-17-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 17<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Astigmatism<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">The refractive media should form a globe-shaped structure with equal curvature in all directions. It is characterised by one, single focal point. In some patients, this is not the case and one meridian has a deviating curvature. This means it will have a different optical effect than that of the polar opposite meridian. This results in <span style=\"text-decoration: underline;\">two focal points<\/span> in two directions, perpendicular to each other.<\/span><\/p>\n<p><span style=\"color: #003366;\">The retina can, however, be located in just one plane. In this plane, the image is projected sharply. In contrast, in the polar opposite plane it is not. The outcome of this is that the patient will see, for example, vertical lines in focus but horizontal lines blurred. This is known as <span style=\"color: #33cccc;\"><strong>astigmatism<\/strong><\/span> <em><strong>[Figure 18]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1583\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-18.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-18.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-18-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 18<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Effect Of The Stenopeic Opening<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">When we look through a stenopeic opening, a large part of the incoming rays responsible for the scattered light is stopped. Because of this, the projection image on the retina becomes sharper. That is why there is an improvement in vision in the case of a refractive error <em><strong>[Figure 19]<\/strong><\/em>.<\/span><\/p>\n<p><span style=\"color: #003366;\">Vision will also improve in the case of a peripheral blurring of the refractive media. Here, it is because the scattering of light by the blurring is no longer occurring.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1584\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-19.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-19.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-19-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 19<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>To investigate refractive error, vision is examined by means of a stenopeic opening [Figure 12]. Procedure The patient stands 5m away from the visual acuity chart. One eye is covered and the stenopeic opening is held in front of the other eye. The examination continues until the patient is unable to read a line correctly. [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[44],"tags":[134],"class_list":["post-1585","post","type-post","status-publish","format-standard","hentry","category-vision-and-colour-vision","tag-the-examination-of-the-eyes-and-vision"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Examination By Means Of A Stenopeic Opening - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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