Orientasi

penggunaan
TRIAL LENS

Webinar, 23 & 28 Nopember 2022

NOVA J. PAMUNGKAS, A.Md.RO, SE, MM
 Portfolio
Nova Joko Pamungkas, RO, SE, M.MKes, lahir di Surabaya,
27 November 1975 seorang tenaga kesehatan OPTOMETRIS
yg saat ini Ketua Umum PP IROPIN

Pengalaman Berorganisasi:
§ Pengurus Pusat (PP) Iropin 1998-2002
§ Ketua Pengda Jawa Timur 2 Periode
§ Ketua Umum PP IROPIN 2021 - 2026

Pengalaman Kecakapan:
§ Team Penyusun Standar Pelayanan RO
§ Team Penyusun Item Development U-Kom & EK online
§ Team Penyusun S.O.P & Kredensialing RO
§ Team Penyusun Perda NO 14/2015 Tenaga Kesehatan
§ Team Penyususn PMK no 14/ 2021 Kegiatan Ijin Berusaha
§ Team Penyusun Per. Dir. BPJS Kesehatan 02/2020
§ Team Penyusun Standar Profesi Optometris Indonesia
§ Narasumber & Instruktur Workshop kegiatan ilmiah
§ Assessor Kredensialing RO/ Optometris

Pengalaman Kerja:
§ Dosen ARO Leprindo
§ Owner Optik Media
DASAR PEMIKIRAN

1
PMK 82 TAHUN 2020 Penanggulangan
Gangguan Penglihatan & Gangguan
Pendengaran

PMK 29 Th 2016 Penyelenggaraan

2 Pelayanan Kesehatan Mata di Fasilitas
Pelayanan Kesehatan

PERATURAN BPJS KESEHATAN 02 TAHUN

3 2020 Prosedur Penjaminan Pelayanan
Refraksi dan Kacamata di FKTP Dlm
Program Jaminan Kesehatan
Pemeriksaan Refraksi Subyektif
Refraksi Subyektif
n adalah suatu metoda
pemeriksaan Refraksi, dimana
hasil pemeriksaan tergantung pada respons Klien/ Pasien
terhadap tindakan/ intervensi pemeriksa

n Diperlukan tehnik & komunikasi 2 arah yg baik & benar

2.2.Phoropter
Phoropter
(Tampak depan)
(Tampak depan)

Sarana :
n Trial Lens Set + Trial Frame
n Phoropter
Bagan Trial Frame (Bingkai
Ujicoba)
1 10
9

7
8
5

6
Bagan Trial Frame (Bingkai
UjiCoba)
1. Pengatur Keseimbangan Trial Frame
2. Pengatur Pupil Distance (PD)
3. Skala PD
4. Pengatur sudut pantoscopic
5. Pengatur Axis
6. Tempat Lensa Ujicoba
7. Skala Axis (R = 180° - 0° : L = 180° -
0°)
8. Pengatur penahan dahi
9. Bend Down
10.Temple
Trial Frame (Bingkai Uji Coba)

o Trial Frame Universal

n Jarak Pupil (PD), Sudut
Pantoscopic, tinggi penyangga
hidung bisa disetel
o Trial Frame dgn PD tetap (Fixed
PD)
Trial Lens Set (Lensa Uji Coba)
o Corrected Lens
n Bentuk lensa
l Meniscus Plus
l Meniscus Minus
n Lensa dipasang pd Trial Frame dgn inisial
Power menghadap pemeriksa
n Lensa Minus dipasang pd mounting lens
warna merah
n Lensa Plus dipasang pd mounting lens
warna hitam/ hijau
o Un-Corrected Lens
n Bentuk lensa
l Bi-Convex (Lensa Plus)
l Bi-Concave (lensa Minus)
n Lensa bisa dipasang ter- balik2
n Warna Mounting Lens tdk dpt dipakai sbg
acuan
Asesoris Trial Lens Set
o Accessories :
n Occluder/ Blank/ Penutup
n Pin Hole Occluder/ Disc
n Slit Occluder (Stenopaic Slit)
n Cross Hair Lens
n Frosted Lens/ Maat Glass/
Kaca susu
n Colour Lens (Lensa berwarna)
l Red Lens
l Green Lens
l Cobalt Blue Lens
l Yellow Lens
l Dark Brown Lens
n Maddox Rod
n Lensa Polaroid
n Lensa Plano
Occluder/ Blank
o Pin Hole Disc merupakan
asesories pd Trial Lens Set
berupa lempeng cakram yg
ditempatkan didepan mata
agar :
n Menghalangi penglihatan
(Blank tidak transparan)
n Menghalangi penglihatan,
tetapi sebagian cahaya
masih bisa diteruskan
(Blank semi transparan)
o Sarana pendukung :
n Kartu Snellen (Optotype)
n Hitungan Jari
n Gerak Jari
n Lampu/ sumber cahaya
Pemeriksaan Visus/ Cover Test
pd anak-anak dgn Nistagmus

o Pemeriksaan Visus dilakukan

dgn kedua mata terbuka
o Biarkan anak dgn posisi kepala
yg abnormal sewaktu
pemeriksaan berlangsung
o Hindari penutupan mata dgn
occluder/ blank
o Lakukan penutupan mata dgn
Frossted Glasses (kaca susu)
atau dgn Fogging Lens
Pin Hole Disc (Keping Lubang Jarum)
o Pin Hole Disc merupakan asesories pd Trial
Lens Set berupa lempeng cakram tidak
transparan dan terdapat lubang kecil di
tengah2-nya
o Æ PH = 1 mm – 1,5 mm – 2 mm
o Æ PH ideal = 1.32 mm (Lebensohn, 1950)
o Æ PH < 1 mm akan mengakibatkan :
n Defraksi
n Illuminasi pd Retina menjadi berkurang a
penglihatan terkesan redup & kurang fokus
o Æ PH > Æ Pupil secara klinis tdk memberi
manfaat
o Æ Pupil Normal = 3 mm – 4 mm

Sarana pendukung :
o Kartu Snellen/ Optotype
Stenopaic Slit

o Opaque disc with narrow slit through which one

looks
o Consists of a rectangular aperture ranging from
0.5 mm to 1.0 mm in width and up to 15 mm -
25 mm in length.
o The width of the slit approximates that of a
Pinhole, and is assumed to limit the admission
of light to approximately one meridian.
o The Stenopaic slit acts in the manner of a
Pinhole to reduce the size of the blur circle in
the meridian at right angles to the slit, yet allow
the blur circle size to be unchanged in the
meridian coincident with the slit.
o Used as a test for Astigmatism
Cross Hair Lens

o Cross Hair Lens ditujukan untuk

mengukur Jarak Antar Pupil
(IPD)
o Cross Hair Lens diposisikan
didepan mata kanan & mata kiri,
tepat didepan Pusat Pupil mata
kanan dan pusat Pupil mata kiri
o Metoda pengukuran berdasarkan
Pupillary Axis (Anatomical Axis)
o Bisa digunakan untuk
idendifikasi posisi Ortho mata.
Red-Green Test
o Red-Green Test dilakukan
secara Monokuler, Pasien tdk
mengenakan Kacamata
Merah - Hijau
n Red-Green Test untuk
mengidentifikasi Status Refraksi
(Myop – Hipermetrop)
n Red-Green Balance Test

o Red-Green Test yg dilakukan

secara Binokuler, Pasien
mengenakan Kacamata
Merah - Hijau
n Untuk menentukan Status
Penglihatan Binokuler
Red - Green Lens yg dilakukan secara
Binokuler
o Red Lens Test

o Worth 4-Dot Test

o Schober Test

o TNO Stereopsis Test

Red Lens Test o Red-Lens Test
n The patient may report that
two lights in uncrossed or
crossed diplopia are seen,
depending upon the direction
of deviation
n Suppression is said to occur
when the patient reports only
a single light (usually the
white light) but occasionally
red depending upon the
density of the red filter and
the degree of the dominance
of the fellow eye
n The measured distance
between the double images
proves to be smaller than
expected from the magnitude
of deviation. This represents
unharmonious ARC
 Persepsi Serentak (Simultan Perception)
Pandangan Pasien
4 Lampu
o
Fusi= Pos
OD = OS

Hand-Held Worth 4-Dot 4 Lampu

o Fusi= Pos
OD = Dominan

o 4 Lampu
Fusi= Pos
OS = Dominan
•The patient views the target through a pair of red-green glasses and their optimal
prescription in the primary position of gaze. (Red before the right eye)
o Tujuan Pemeriksaan :
•Ask the patient how many lighted dots are seen
•The test can be performed with room lights either off or on.
n Apakah mata kanan & mata kiri melihat secara serempak Penglihatan Binokuler/ Fusi = Pos
•Do not show the patient the target before they are wearing the red-green glasses.
n Melihat secara bergantian Penglihatan Binokuler/Fusi = Neg 57

o Jarak Pemeriksaan :
n Jauh (6 Meter)
n Dekat (40 Cm)
o Penerangan Kamar Pemeriksaan Normal & Redup
 Identifikasi Diplopia dg Worth 4 Dot Test

o Pandangan Klien o Pandangan Klien

2 Lampu 5 Lampu
Fusi = Neg Fusi= Neg
Supresi OD Crossing

Atau Atau
o 5 Lampu
3 Lampu Fusi= Neg
o Fusi = Neg Un-Crossing
Supresi OS
Schober Chart

Dilihat oleh OD

Dilihat oleh OS

Schober Chart untuk

Orthophria
pemeriksaan
Esophoria
binokuler & Phoria
Exophria

Right Hyperphoria

Right Hypophoria
The TNO test for stereoscopic vision

TNO Test
o uses random-dot stereograms in
which the half-images have been
superimposed and printed in
complementary colours, like
anaglyphs.
o The test plates, when viewed with
red and green spectacles, elicit
stereopsis.
o There is a series of plates inducing
retinal disparities ranging from 15
to 480 seconds of arc.
o Consist of stereograms in which
the images presented to each eye
have been superimposed and
printed in complimentary color
 Perception of white spot light
through Cobalt Blue Glass

Status Refraksi Persepsi

Emmetropia Purple circle wiyh surrounding slight blue fringe

Myopia Red circle with surrounding blue/ violet periphery

Simple Myopic Astigmat Purple ellipse with 2 blue/ violet extremities

Compound Myopic Astig. Red ellipse with 2 blue/ violet extremities

Hyperopia Blue/ violet circle with surrounding red periphery

Simple Hyperopic Ast Purple ellipse with 2 red extremities

Compound Hyperopic Ast Blue/ violet ellipse with 2 red extremities

Mixed Astigmatism Purple circle or ellipse with 2 red extremities and 2

blue/ violet extremities perpendicularly
 Maddox Rod o Maddox Rod =
himpunan batangan
Silinder kuat
o Red Maddox Rod
Horisontal akan
membentuk garis
Merah Vertikal
o Red Maddox Rod
Vetikal akan
membentuk garis
Merah Horisontal

Bagaimana pemeriksaan fungsi makula

menggunakan Maddox rod?
Letakkan maddox rod scr monokuler lalu berikan cahaya senter
dg sudut horizontal dan tanyakan pada pasien apakah garis
tampak segaris dg sumber cahaya, maka pasiennya akan melihat
garis pada sudut vertikal (berbanding terbalik).
Ini utk mata normal.
Observasi Phoria (secara subyektif)
dgn Red Maddox Rod Horisontal

Red Maddox Rod Horisontal

o Pandangan Klien
Lensa Polaroid
Pemeriksaan Stereopsis

Titmus Fly Test

o Alat bantu :
n Km polaroid (3-D
Near point stereopsis tests - the Vectograph)
Stereo Fly Test (3) o Jarak pemeriksaan
n 16 Inches
Using the Titmus Stereo Test.
o Penerangan :
The patient has been asked to
“touch” the fly’s wings. Trying
n normal - terang
to touch the wings somewhere
in the space above the plane of
o Obyek :
the book is a strong indicatipon
that the patient has stereopsis.
n Gambar Lalat
n Sekumpulan binatang
n Sekelompok lingkaran
196
Identifikasi/ Pemeriksaan Amblyopia
o Tes Filter Density
n Uji penglihatan dg menurunkan
intensitas cahaya,
menggunakan Filter Density
Netral :
l Kodak No.96
l ND 2.00 & ND 0.50
n A test to differentiate between
functional and organic
amblyopia by measuring visual
acuity, with or without a neutral
density filter.
n If acuity is greatly reduced
when looking through the filter,
the amblyopia is organic (e.g.
glaucoma, central retinal
lesions), but
n if the acuity is unaffected or
even slightly improved, the
amblyopia is functional.
Plano Lenses
o Malingering is fabricating or exaggerating the
symptoms of mental or physical disorders for a
variety of "secondary gain" motives, which may
include financial compensation (often tied to
fraud); avoiding school, work or military service;
obtaining drugs; getting lighter criminal sentences;
or simply to attract attention or sympathy.
o Malingering is different from :
n somatization disorder and
n factitious disorder (is a condition in which a person
acts as if they have an illness by deliberately
producing)
o Tests for malingering/ false blindness may also use
the following techniques:
n Put plano lenses into the trial frame and observe any
improvement
n Move the child closer to the chart and then take
visual acuity. No improvement indicates malingering.