Clinical Optometric Procedures: Interpupillary Distance Measurement (Ipd)
OPTOMETRY · SEMESTER 2 Clinical Optometric Procedures: Interpupillary Distance Measurement (Ipd) Visual Optics and Assessment START READING NOTES Contents of This Topic Clinical Optometric Procedures: Interpupillary Distance Measurement (Ipd) INTRODUCTION DISTANCE PD MEASUREMENTS NEAR PD MEASUREMENTS MONOCULAR PD MEASUREMENTS Clinical Optometric Procedures: Interpupillary Distance Measurement (Ipd) CHAPTER 9 – INTERPUPILLARY DISTANCE MEASUREMENT (IPD) This chapter will include a review of: Distance PD measurements Near PD measurements Monocular PD measurements INTRODUCTION The Interpupillary distance (IPD) measure is also referred to as the pupillary distance (PD). The determination of this measurement is an important part of the ophthalmic prescription and the refraction routine. The use of the PD measurement begins when refracting the patient with the trial frame or phoropter. Thereafter, it is indicated on a prescription form for the ordering of spectacle lenses. The specification of this measurement is essential in order to place the optical centers of lenses in their required position, which in most cases lies in front of the patient’s line of sight or pupil centers. The entrance pupil of the eye determines the size and location of the bundle of light that enters the eye to stimulate the retina. By definition, the PD is the horizontal distance in millimeters between the entrance pupils of the 2 eyes for a given viewing distance (Fig. 9.1). Practically, it is the distance between the centre of the pupil of one eye and the centre of the pupil of the other eye. The PD will not be the same for all people and is measured for distance and near fixation. Figure 9.1 Interpupillary distance of a patient’s eyes. The distance PD is placed at the optical centers of the spectacle lenses before the entrance pupils of the eyes when patients are looking in primary gaze. The distance PD is related to the amount of binocular convergence required by a patient for bi-foveal fixation. Patients with larger distance PDs have greater demands for convergence to a near target than patients with smaller PDs. There are several factors one must take into consideration when measuring the PD of a patient. They include: Binocularity of the patient (is strabismus/tropia present?) Is there any facial asymmetry Are the irises too dark to determine the pupil center International Centre for Eyecare Education These factors would contribute to the method that is used to determine the PD measurement. For example, if the pupils are too dark, and there is no facial asymmetry and the patient is binocular, one may use other reference points as opposed to using the center of the pupil. One may in this case, use the limbal edges as the reference points to take the measurements. If there is facial asymmetry or a strabismus present, the lenses will be placed such that the optical center of the lens is coincident with the entrance pupil of the eye. In this case, the practitioner would need to take a monocular PD measurement. DISTANCE PD MEASUREMENTS Instrumentation Millimeter ruler (accurate) Procedure 1. The practitioner and the patient must be positioned directly in front of each other (at eye level) at an arm’s length away (± 40cm). 2. The patient is directed to fixate the practitioner’s left open eye, while the examiners right eye is closed. 3. Align the zero mark on the millimeter rule with the temporal limbus of the patient’s right eye (Fig. 9.2a) (The limbal reference point is used when it is difficult to precisely locate the center of the entrance pupil in a clinical situation). Some refraction manuals suggest that the practitioner use the pupillary margins as the reference points, however, this is provided that the pupils are symmetric (Fig. 9.2b). The practitioner can also align the PD rule with the pupil center of the patient’s right eye to pupil center of the patient’s left eye (Fig. 9.2c). Figure 9.2 (a) IPD temporal limbal alignment; (b) IPD temporal pupil margin alignment; IPD pupil center alignment 4. The practitioner then closes his left eye and opens his right eye and directs the patient to bi-foveally fixate the practitioner’s open right eye. 5. The examiner then notes the position on the ruler that corresponds to the nasal limbus of the patient’s left eye (or pupil center of the patient’s left eye). 6. This measurement is noted as the distance PD (Fig. 9.3). International Centre for Eyecare Education Figure 9.3 IPD measurement using pupil center alignment. 7. The procedure may be repeated to ensure alignment of the ruler and accuracy of the measurement. 8. While the patient is not actually directed to a distance target, it should be noted that the patient’s fixation of the practitioner’s eye is not enough to deviate the patient’s eyes from the straight ahead position by an amount that would significantly alter the measurement. 9. In cases where a patient has an alternating strabismus, the measurement is taken in a similar manner, except that the patient’s non-fixating eye is occluded during the alignment process. In this way, the practitioner is confident that the patient will be viewing through the optical center of the lens if that particular eye is fixating a distance target (Fig. 9.4). Figure 9.4 PD measurement in a case of an alternating strabismus, each eye fixating at a time with the non-fixating eye being occluded. NEAR PD MEASUREMENTS Procedure 1. The position of the patient and the examiner is as per the distance measurement. 2. The patient is directed to view the tip of the examiner’s nose (or some other near target), thereby causing the patient to converge slightly. 3. Align the zero mark on the millimeter rule with the temporal limbus of the patient’s right eye (or pupil center of the patient’s right eye) while the examiner’s right eye is closed. 4. The examiner closes his left eye and opens his right eye and notes the position on the ruler that corresponds to the nasal limbus of the patient’s left eye (or pupil center of the patient’s left eye). 5. This measurement is noted as the near