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LAMBEJRT: RETIN08G0PY IX ESTIMATIXG ASTIGMATISM. 243 peropia, because the rays do not cross and he sees the erect image on the fundus ; also will this be the case in myopia of less than 1 D., because, although the rays are convergent, he intercepts them cipralex 20 mg tabletten before they meet to form the aerial im- age, and still sees the erect image on the fundus. In mj'opia of 1 D. or more the rays from the patient's eye cross before reaching the observer, precio de cipralex 15 mg and at the point of meeting form an aerial inverted image of the illuminated area of the fundus ; consequently this image referred to the eye appears to move in the opposite direction to which the mirror is rotated. The intensity of the illumination having given some idea as to cipralex 15 mg biverkningar the degree of error, and the direction of motion the kind, the amount cipralex 20 mg tablet can be estimated by ordinary trial glasses in the following manner : The patient being seated in a dark room with the lamp immediately above and a little behind cipralex 20 mg fiyat the head, the observer sits directly in front, at a distance of one metre and twenty centimetres, his eyes being about on a level with the patient's. Looking through the small hole in the center of the mirror cual generico cipralex and reflecting the cipralex 10mg weight loss light on to the patient's eye, the latter directing his gaze to the observer's forehead, there will appear in the area of the pupil the light reflected from the fundus surrounded by the shadow. By now rotating the mirror on its various a.\es the light and shadow will move across the pupillary area at right angles to the axis on which the mirror is rotated and cipralex⬠10/- 20 mg filmtabletten indi- cate the refraction of that meridian. Let us suppose that the motion is with the mirror ; con- vex glasses are then placed in front 10 20 mg cipralex of 15 mg cipralex the patient's eye, gradually increasing in strength until the motion of light is just reversed (i. e., against the mirror). Myopia of 1 D. must then exist to produce this effect, and, taking this into consideration, by deducting 1 D. from convex glass used, we have the correction. If the motion is reversed in one meridian (i. e., cipralex 20 mg 56 tablet going against the mirror) by a spherical glass, but remains un- changed (i. can take 30 mg cipralex e., with mirror) in the opposite meridian, astig- matism is present. The amount is then estimated in one of two ways : by either continuing to increase the strength of spherical glass until the one is found which just reverses the motion in the previously unconnected meridian ; the dif- ference in strength between this glass and the one first found to reverse motion in one meridian will represent the degree of astigmatism. The better method is, I think, to use cylinders. Hav- ing first found the spherical which just changes motion in meridian of lesser error, leaving this in frame, place a cyl- inder in front with its axis at right angles to meridian in which motion of shadow is still with mirror, increasing strength of cylinder until motion is just reversed and is the same in all meridians. The cylinder will then represent the degree of astigmatism and the correcting glass be found by deducting 1 D. from spherical and then combining this with cylinder. Another advantage in using the cylinders instead of correcting each meridian separately with spherical glasses is that the axis of cylinder can be changed and its proper position determined should the astigmatism not be in generika f𴱘r cipralex the principal meridians. In the same manner as described above, myopia and myopic astigmatism can cipralex price india be estimated, using concave glasses instead of convex, increasing the strength of the glasses in front of the patient's eye until we have produced a condi- tion of 1 D. of my., when the shadow will still move slightly against the mirror ; with the next stronger glass the motion being with the mirror ; allowing as before, when dealing with hy. for this 1 D. of my. necessarily existing to produce the effect, we get the correcting glass, only in my. the 1 D. must be added, not subtracted. A concave mirror may be used instead of a plane getting off cipralex 10mg one remembering that the effect is exactly opposite in the same condition of refraction. I prefer the plane mirror because it gives a better illumination at a greater distance, and the farther off one is from the patient the more probable is a perfect relaxation of accommodation. Again, should the patient look at the mirror, as he is very likely to do — in fact, some authorities so direct — the object seen will be at a still greater distance being the image of the lamp projected as far behind the mirror as the lamp is in front. The distance from the patient must always be taken into consideration, as on this depends the allowance to be made for myopia existing in order to have the far point of the patient a little in front of the observer, and thus produce the effect of just reversino- the motion of the shadow. The chief coming off 10mg cipralex objection to the practice of retinoscopy and the reason I think why it is not more generally used, is the tedious process of changing glasses in front of the patient's eye, the strength of which must be increased or diminished by consecutive numbers, in order to obtain accurate results. To obviate this difficulty I have devised an apparatus which Mr. ileyrowitz has constructed, and I find it very useful, greatly facilitating the process of examination. It consists essentially of two discs, about a foot in di- ameter, and in these discs convex and concave spherical lenses are so arranged that by adjusting one of the discs for a cer- tain range of glasses, the strength of glass in front of eye- piece is increased or cipralex farmaco generico diminished 0-:25 D. by turnino- the cipralex 15 mg hinta other disc either to the right or left. The cylinders are arranged in consecutive numbers from 0-25 D. up, in slides which fit into a clip cipralex 10 mg insomnia on the front of the eye-piece that re- volves, so that the cylinder can be placed in any axis, the same being indicated as on trial frames ; the strength of the cylinder can then be increased or diminished by pushing slides through clips. The lenses are all the same size, as in ordinary trial cases, which I think is an advantage over other instruments of the kind.

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