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Clinical Optics Basic and Clinical Science Course 2008
2009 Kevin M. Miller Digital Instant Download
Author(s): Kevin M. Miller, MD
ISBN(s): 9781560558767, 1560558768
Edition: Revised
File Details: PDF, 166.22 MB
Year: 2008
Language: english
Clinical Optics
Section3
2008-2009
(Last major revision 2005-2006)
t::I~ AMERICAN ACADEMY

FI
II f E lON(i
~ OF OPHTHALMOLOGY EDUCATION
()
!PRIIII
TheEyeM.D.Association o r H T HAL M I \1 lj I \
r"
The Basic and Clinical Science Course is one component of the Lifelong
Education for the Ophthalmologist (LEO) framework, which assists mem-
bers in planning their continuing medical education. LEO includes an array
of clinical education products that members may select to form individu-
alized, self-directed learning plans for updating their clinical knowledge.
Active members or fellows who use LEO components may accumulate sufficient CME
credits to earn the LEO Award. Contact the Academy's Clinical Education Division for
further information on LEO.
The American Academy of Ophthalmology is accredited by the Accreditation Coun-

cil for Continuing Medical Education to provide continuing medical education for
physicians.
The American Academy of Ophthalmology designates this educational activity for a

maximum of 40 AMA PRA Category 1 CreditsN. Physicians should only claim credit
commensurate with the extent of their participation in the activity.
The Academy provides this material for educational purposes only. It is not intended
to represent the only or best method or procedure in every case, nor to replace a physi-
cian's own judgment or give specific advice for case management. Including all indica-
tions, contraindications, side effects, and alternative agents for each drug or treatment
is beyond the scope of this material. All information and recommendations should be
verified, prior to use, with current information included in the manufacturers' package
inserts or other independent sources, and considered in light of the patient's condition
and history. Reference to certain drugs, instruments, and other products in this course
is made for illustrative purposes only and is not intended to constitute an endorsement
of such. Some material may include information on applications that are not considered
community standard, that reflect indications not included in approved FDA labeling, or
that are approved for use only in restricted research settings. The FDA has stated that
it is the responsibility of the physician to determine the FDA status of each drug or
device he or she wishes to use, and to use them with appropriate, informed patient
consent in compliance with applicable law. The Academy specifically disclaims any
and all liability for injury or other damages of any kind, from negligence or otherwise,
for any and all claims that may arise from the use of any recommendations or other
information contained herein.
Copyright @ 2008
American Academy of Ophthalmology
All rights reserved
Printed in Singapore
Basic and Clinical Science Course
Gregory L. Skuta, MD, Oklahoma City, Oklahoma, Senior Secretary for

Clinical Education
Louis B. Cantor, MD, Indianapolis, Indiana, Secretary for Ophthalmic
Knowledge
Jayne S. Weiss, MD, Detroit, Michigan, BCSC Course Chair
Section 3
Faculty Responsible for This Edition

Kevin M. Miller, MD, Chair, Los Angeles, California
Darren L. Albert, MD, Montreal, Quebec
Penny A. Asbell, MD, New York, New York
Neal H. Atebara, MD, Honolulu, Hawaii
Robert J. Schechter, MD, Los Angeles, California
Ming X. Wang, MD, PhD, Nashville, Tennessee
Christie Morse, MD, Concord, New Hampshire
Practicing Ophthalmologists Advisory Committee for Education
Dr. Miller states that he has an affiliation with Alcon Laboratories and Hoya Holdings and
that he receives financial compensation from STAAR Surgical.
The other authors state that they have no significant financial interest or other relation-
ship with the manufacturer of any commercial product discussed in the chapters that they
contributed to this publication or with the manufacturer of any competing commercial
product.
Recent Past Faculty

Aazy A. Aaby, MD
Mathias Fellenz, MD, FRCS(C)
Perry Rosenthal, MD
Constance E. West, MD
In addition, the Academy gratefully acknowledges the contributions of numerous past

faculty and advisory committee members who have played an important role in the devel-
opment of previous editions of the Basic and Clinical Science Course.
American Academy of Ophthalmology Staff
Richard A. 2orab, Vice President, Ophthalmic Knowledge
Hal Straus, Director, Publications Department
Carol L. Dandrea, Publications Manager
Christine Arturo, Acquisitions Manager
Nicole DuCharme, Production Manager
Stephanie Tanaka, Medical Editor
Steven Huebner, Administrative Coordinator
t::I~ AMERICAN ACADEMY

'-:.) OF OPHTHALMOLOGY
Tht Eyt M.D.Association
655 Beach Street

Box 7424
San Francisco, CA 94120-7424
Contents
General Introduction . . . . . . . . . . . . . . . . . . . . . . . . . XI
Objectives . . . .1
1 Physical Optics . . . . . . .3
WaveTheory. . . . . . . . . . . 3
Photon (Particle) Aspects of Light. .7
Interference and Coherence . . . .7
Applications of Interference and Coherence. . 8
Polarization . . . . . . . . . 10
Applications of Polarization 10
Diffraction. II
Scattering . . . . . . . . . 12
Reflection . . . . . . . . . 13
Transmission and Absorption 14
Illumination. . . . . . . . 14
Laser Fundamentals. . . . . 17
Properties of Laser Light. 17
Elements of a Laser . . . 19
Laser Sources. . . . . . 22
Laser-Tissue Interaction. 23
2 Geometrical Optics. . 25
Pinhole Imaging . . . . . . 25
Imaging with Lenses and Mirrors. 28
Object Characteristics. 30
Image Characteristics . 30
Magnification. . 30
Image Location . 34
Depth of Focus . 35
Image Quality . 36
Brightness and Irradiance 39
Light Propagation. . . . . . 39
Optical Media and Refractive Index 39
Law of Rectilinear Propagation . . 41
Optical Interfaces. . . . . . . . 41
Specular Reflection: Law of Reflection . 42
Specular Transmission: Law of Refraction 44
Normal Incidence . . . . 46
Total Internal Reflection. . . . . . . . 47
Dispersion. . . . . . . . . . . . . . 49
Reflection and Refraction at Curved Surfaces . 51
v
vi . Contents
Fermat's Principle. . . . . . . . . . . . . . . . 51
Stigmatic Imaging Using a Single Refracting Surface. 53
First-Order Optics . . . . 55
Ignoring Image Quality . . 56
Paraxial Approximation . . 56
Small-Angle Approximation 58
The Lens Maker's Equation. 60
Ophthalmic Lenses. . . . . . 62
Vergence and Reduced Vergence 62
Transverse Magnification for a Single Spherical Refracting Surface. 65
Thin-Lens Approximation . 66
Lens Combinations . . . . 67
Virtual Images and Objects. 67
Focal Points and Planes . . 69
Paraxial Raytracing Through Convex Spherical Lenses. 71
Concave Lenses. . . . . . . . . . . . . . . . . . 72
Paraxial Raytracing Through Concave Spherical Lenses 74
Objects and Images at Infinity . . . . 74
Principal Planes and Points. . . . . . 75
Modeling an Unknown Optical System. 76
Thick Lenses. . . . 78
Focal Lengths. . . . . . . . . . . . 79
Gaussian Reduction. . . . . . . . . 80
Knapp's Law, the Badal Principle, and the Lensmeter . 80
Afocal Systems . . 81
Ophthalmic Prisms. . 84
Plane Parallel Plate 84
Angle of Deviation 84
Prism Diopter . . 85
Displacement of Images by Prisms. 86
Prismatic Effect ofLenses (Prentice's Rule) 87
Vector Addition of Prisms 88
Prism Aberrations. 89
Fresnel Prisms . 89
Mirrors . . . . . . . 90
Reflecting Power . 90
Reversal of Image Space 90
Central Ray for Mirrors 91
Vergence Calculations . 92
Optical Aberrations. . . 93
Regular Astigmatism . 93
Transposition. . . . . 98
Combining Spherocylindrical Lenses 99
Combining Cylinders at Oblique Axes . 100
Spherical Aberration. . . 101
Chromatic Aberration. . . . . 102
3 Optics of the Human Eye. 105

The Human Eye as an Optical System . 105
Contents . vii
Schematic Eyes. . . . . . . . . . . . . . 105

Important Axes of the Eye. . . . . . . . . 108
Pupil Size and Its Effect on Visual Resolution. 109
Visual Acuity. . . . . . . . . . . . . . . III
Contrast Sensitivity and the Contrast Sensitivity Function 112
Refractive States of the Eyes . . . 115
Epidemiology of Refractive Errors 119
Developmental Myopia . . . . 120
Developmental Hyperopia. . . 122
Prevention of Refractive Errors. 122
Treatment of Refractive Errors 123
4 Clinical Refraction . . 125

Objective Refraction: Retinoscopy 125
Positioning and Alignment. 126
Fixation and Fogging 126
The Retinal Reflex. . 126
The Correcting Lens. 128
Finding Neutrality. . 129
Retinoscopy of Regular Astigmatism. 129
Aberrations of the Retinoscopic Reflex. 133
Summary of Retinoscopy. . . 133
Subjective Refraction Techniques . 134
Astigmatic Dial Technique. . 134
Cross-Cylinder Technique . . 136
Summary of Cross-Cylinder Refraction 139
Refining the Sphere . . . . . . . . . 139
Binocular Balance. . . . . . . . . . 140
Cycloplegic and Noncycloplegic (Manifest) Refraction. 141
Overrefraction. . . . . . . . . . . . . . . . . . 142
Spectacle Correction of Ametropias. . . . . . . . . 143
Spherical Correcting Lenses and the Far Point Concept. 143
Vertex Distance. . . . . . . . . . . . . . . . . . 143
Cylindrical Correcting Lenses and the Far Point Concept. 145
Prescribing for Children. 145
Myopia . . . 146
Hyperopia . . . . . 146
Anisometropia . . . 147
Clinical Accommodative Problems 147
Presbyopia. . . . . . . . . 147
Accommodative Insufficiency. 147
Accommodative Excess . . . 148
Accommodative Convergence/Accommodation Ratio 148
Effect of Spectacle and Contact Lens Correction on
Accommodation and Convergence . 149
Prescribing Multifocal Lenses . . . . . . 150
Determining the Power of a Bifocal Add 150
Types of Bifocal Lenses. . . . . . . . 152
viii . Contents
Trifocal Lenses . . . . . . . . . . 152

Progressive Addition Lenses . . . 152
Prentice's Rule and Bifocal Design. . 155
Occupation and Bifocal Segment 163
Prescribing Special Lenses . . 164
Aphakic Lenses. . . . . 164
Absorptive Lenses. . . . 165
Special Lens Materials . . 168
Therapeutic Use of Prisms . 169
Monocular Diplopia. . 170
5 Contact Lenses. 173

Introduction. . . . 173
Contact Lens Glossary. 174
Clinically Important Features of Contact Lens Optics 177
Field of Vision . 177
Image Size. . . . . . 177
Accommodation . . . 179
Convergence Demands . 180
Tear Lens . . . . . . . 180
Correcting Astigmatism . 181
Correcting Presbyopia . . 182
Contact Lens Materials and Manufacturing. . 183
Materials. . . . . . . . . . . . . . . 183
Manufacturing . . . . . . . . . . . 185
Patient Examination and Contact Lens Selection 186
Patient Examination. . 186
Contact Lens Selection. 186
Contact Lens Fitting . . . 189
Soft Contact Lenses. . . 189
RGP Contact Lenses. . 191
Toric Soft Contact Lenses . 195
Bifocal Contact Lenses. . . 198
Keratoconus and the Abnormal Cornea . 199
Gas- Permeable Scleral Contact Lenses . .200
Therapeutic Lens Usage. . . . . . . . . .202
Orthokeratology and Corneal Reshaping. . .203
Custom Contact Lenses and Wavefront Technology . .205
Contact Lens Care and Solutions . . . . . . . . . .206
Contact Lens-Related Problems and Complications. .207
Cornea . . . . . . . . . . . . . . . .207
The Red Eye . . . . . . . . . . . . .209
HIV Transmission in Contact Lens Care . 211
Federal Law and Contact Lenses . 211
6 Intraocular Lenses . . 213

TypesoflOLs . . . . . . . . 213
Anterior Chamber Lenses . 214
Posterior Chamber Lenses . 215
Contents . ix
Optical Considerations for IOLs . 215

Image Magnification. .216
IOL Power Selection. . . . . 216
Piggyback IOLs. . . . . . . 221
IOL Power After Corneal Refractive Surgery . 221
Lens- Related Visual Disturbances. . 222
Nonspherical Optics .224
IOL Standards . . . . . . . . 225
Multifocal IOLs. . . . . . . . 225
Types of Multifocal IOLs . .226
Clinical Results of Multifocal IOLs. . 228
Accommodating IOLs. . . . . . . 229
7 Optical Considerations in Refractive Surgery. 231

Corneal Shape . 231
Angle Kappa. . . . . . 235
Pupil Size . . . . . . . 235
Irregular Astigmatism. .236
Wavefront Analysis .237
Causes of Irregular Astigmatism. .241
Conclusion . . . . . . . . .242
8 Vision Rehabilitation. 243

Epidemiology of Vision Impairment. .244
Important Definitions in Low Vision .244
Legal Blindness. .245
Low Vision. . . . . . . . . . .245
Visual Function. . . . . . . . .245
Classification of Functional Visual Deficits. .246
Cloudy Media . . . . .246
Central Field Deficit. . .246
Peripheral Field Deficit .248
Patient Assessment . . . . . 248
Functional History . . . 248
Measuring Visual Function. .249
Helping Patients Function Better . 254
Refraction . . . . . . . . .254
Distance Spectacles . . . . .254
Optical Aids Providing Magnification .254
Nonoptical Aids. . . . .260
Contrast Enhancement . . . 263
Lighting and Glare Control. .264
Instruction and Training. . .264
Counseling and Support Groups .264
Visual Rehabilitation Professionals and Services. .264
Levels of Vision Rehabilitation Services .265
Pediatric Low Vision Issues .266
Infants. . . . . . .266
Preschool Children . . .266
x . Contents
School-Age Children .266

Teenagers . . . . . .267
9 Telescopes and Optical Instruments 269

Direct Ophthalmoscope. . . . . . . .269
Indirect Ophthalmoscope . . . . . . .272
Optics of Fundus Image Formation .272
Aerial Image . . . . .272
Conjugacy of Pupils. . .272
Fundus Illumination. . .275
Binocular Observation. .275
Fundus Camera . . . . . .275
Slit-Lamp Biomicroscope . .279
Astronomical Telescope .280
Inverting Prism. . .280
Galilean Telescope. . .280
Objective Lens . . . . 281
Illumination System. . 281
Binocular Viewing System .284
Slit-Lamp Fundus Lenses . . .285
Goldmann Applanation Tonometer . .289
Pachymeter . . . . . . 293
Specular Microscope . .294
Operating Microscope. .296
Keratometer. . . . . .298
Corneal Topographer . . 302
Manual Lensmeter . . .304
Measuring the Bifocal Add . .306
Automatic Lensmeter. . . . .307
Diagnostic Ultrasonography . .308
Automated Refraction. . . 312
Macular Function Testing . . 315
Laser Interferometer. . . 315
Potential Acuity Meter. . 316
Glare Testing. . . . . . . 317
Wavefront Aberrometers. . . 318
Wavefront Analysis . . . 318
Hartmann-Shack Aberrometry .320
Tscherning Aberrometry. . . .320
Retinal Raytracing Technique. .320
Optical Coherence Tomography . . 322
Appendix: Common Guidelines for Prescribing Cylinders . 325

Basic Texts. . . . . . . . . 341
Related Academy Materials . 343
Credit Reporting Form .345
Study Questions .349
Answers. .359
Index. . . . . .369
General Introduction
The Basic and Clinical Science Course (BCSC) is designed to meet the needs of residents
and practitioners for a comprehensive yet concise curriculum of the field of ophthalmol-
ogy. The BCSC has developed from its original brief outline format, which relied heavily
on outside readings, to a more convenient and educationally useful self-contained text.
The Academy updates and revises the course annually, with the goals of integrating the
basic science and clinical practice of ophthalmology and of keeping ophthalmologists cur-
rent with new developments in the various subspecialties.
The BCSC incorporates the effort and expertise of more than 80 ophthalmologists,
organized into 13 Section faculties, working with Academy editorial staff. In addition, the
course continues to benefit from many lasting contributions made by the faculties of pre-
vious editions. Members of the Academy's Practicing Ophthalmologists Advisory Com-
mittee for Education serve on each faculty and, as a group, review every volume before
and after major revisions.
Organization of the Course

The Basic and Clinical Science Course comprises 13 volumes, incorporating fundamental
ophthalmic knowledge, subspecialty areas, and special topics:
I Update on General Medicine
2 Fundamentals and Principles of Ophthalmology
3 Clinical Optics
4 Ophthalmic Pathology and Intraocular Tumors
5 Neuro-Ophthalmology
6 Pediatric Ophthalmology and Strabismus
7 Orbit, Eyelids, and Lacrimal System
8 External Disease and Cornea
9 Intraocular Inflammation and Uveitis
10 Glaucoma
II Lens and Cataract
12 Retina and Vitreous
13 Refractive Surgery
In addition, a comprehensive Master Index allows the reader to easily locate subjects
throughout the entire series.
References
Readers who wish to explore specific topics in greater detail may consult the references
cited within each chapter and listed in the Basic Texts section at the back of the book.
These references are intended to be selective rather than exhaustive, chosen by the BCSC
faculty as being important, current, and readily available to residents and practitioners.
xi
xii . General Introduction
Related Academy educational materials are also listed in the appropriate sections.
They include books, online and audiovisual materials, self-assessment programs, clinical
modules, and interactive programs.
Study Ouestions and CME Credit

Each volume of the BCSC is designed as an independent study activity for ophthalmology
residents and practitioners. The learning objectives for this volume are given on page 1.
The text, illustrations, and references provide the information necessary to achieve the ob-
jectives; the study questions allow readers to test their understanding of the material and
their mastery of the objectives. Physicians who wish to claim CME credit for this educa-
tional activity may do so by mail, by fax, or online. The necessary forms and instructions
are given at the end of the book.
Conclusion
The Basic and Clinical Science Course has expanded greatly over the years, with the ad-
dition of much new text and numerous illustrations. Recent editions have sought to place
a greater emphasis on clinical applicability while maintaining a solid foundation in basic
science. As with any educational program, it reflects the experience of its authors. As
its faculties change and as medicine progresses, new viewpoints are always emerging on
controversial subjects and techniques. Not all alternate approaches can be included in
this series; as with any educational endeavor, the learner should seek additional sources,
including such carefully balanced opinions as the Academy's Preferred Practice Patterns.
The BCSC faculty and staff are continuously striving to improve the educational use-
fulness of the course; you, the reader, can contribute to this ongoing process. If you have
any suggestions or questions about the series, please do not hesitate to contact the faculty
or the editors.
The authors, editors, and reviewers hope that your study of the BCSC will be oflasting
value and that each Section will serve as a practical resource for quality patient care.
Objectives
Upon completion of BCSC Section 3, Clinical Optics, the reader
should be able to
· compare and contrast physical and geometrical optics

. discuss the clinical and technical relevance of such optical
phenomena as interference, coherence, polarization,
diffraction, and scattering
. review the basic properties of laser light and how they affect
laser-tissue interaction
· outline the principles of light propagation and image formation

and work through some of the fundamental equations that
describe or measure such properties as refraction, reflection,
magnification, and vergence
. explain how these principles can be applied diagnostically and
therapeutically
· describe the clinical application of Snell's law and the lens

maker's equation
. identify optical models of the human eye and describe how to
apply them
. define the various types of visual perception and function,
including visual acuity, brightness sensitivity, color perception,
and contrast sensitivity
. summarize the steps for performing streak retinoscopy
. summarize the steps for performing a manifest refraction using
a phoropter or trial lenses
. describe the use of the Jackson cross cylinder
. describe the indications for prescribing bifocals and common
difficulties encountered in their use
. review the materials and fitting parameters of both soft and
rigid contact lenses
. explain the optical principles underlying various modalities
of refractive correction: spectacles, contact lenses, intraocular
lenses, and refractive surgery
. discern the differences among these types of refractive
correction and describe how to apply them most appropriately
to the individual patient
. discuss the basic methods of calculating intraocular lens
powers and the advantages and disadvantages of the different
methods
. describe the conceptual basis of multifocal lOLs and how
the correction of presbyopia differs between these lOLs and
spectacles
. recognize the visual needs of low vision patients and how to
address these needs through optical and nonoptical devices
and/or appropriate referral
. describe the operating principles of various optical instruments
in order to use them more effectively
CHAPTER 1
Physical Optics
What is light? This question has been the subject of vigorous debate for centuries. One school
of thought supported the wave theory, originally stated by Christian Huygens and amplified
by Young and Maxwell. Opposed to this school were those who championed the corpuscular
theory, originated by Newton and supported by Planck. Ultimately, however, both theories
are necessary to account for all the phenomena associated with light. The science of quan-
tum mechanics, which evolved from Planck's quantum theory, successfully addresses the
dual nature of light by comprehending both the particle and the wave aspects of light.
The description of optical phenomena is currently divided into the areas of physical
optics, geometrical optics, and quantum optics. Physical optics describes those phenom-
ena that are most readily understood in terms oflight's wave properties. Geometrical optics
conceives of light as rays and deals with the imaging properties of lenses and mirrors.
Quantum optics is concerned with the interaction of light and matter and considers light
as having both wave and particle (photon) characteristics.
In brief, light behaves like a wave as it passes through air, a vacuum, or transparent
materials. Light exhibits some characteristics of particles (photons) when it is being gener-
ated or absorbed. The ray model is a simplified method for describing the propagation of
light. Although it ignores the effects of diffraction and other physical optics phenomena,
it provides a powerful method for calculations involving lenses and images.
Because our primary interest is in propagation of light through media, including
transparent ocular tissues, we concentrate on the wave and ray descriptions of light, with
only occasional references to its photon characteristics.
Wave Theory
Water waves provide a good analogy for understanding light waves. When a wave travels
along the water's surface, particles at the surface move up and down as the wave passes but
they do not move along with the wave. In the case of light, no material substance moves as
the light wave propagates. Rather, at each point the electric field increases, decreases, and
reverses direction as the wave passes (Fig 1-1). The electric field is always perpendicular
to the direction of propagation.
Two principal characteristics of a wave, as illustrated in Figure 1-1, are its wavelength
(I.) and amplitude (A). Wavelength is determined by the distance between crests of the
wave. Amplitude is the maximum value attained by the electric field as the wave propa-
gates. It determines the intensity of the wave. The third characteristic of a wave, not shown
3
4 . Clinical Optics
+
A
~
Direction of propagation
Figure ,-, Instantaneous" snapshot" of a light wave. 1 represents the light at a particular in-
stant; 2 represents the wave a short time later, after it has moved a fraction of 1 wavelength to
the right. The wavelength, )., is the distance between crests of the wave. The electric field, E,
at a particular point, is represented by the solid line for wave 1 and by the dashed line for wave
2. The amplitude of the wave, A, is the maximum value of the electric field. The frequency is
the number of wave crests that pass a fixed point per second and is dependent on the speed
of the wave. (Redrawn by C. H. Wooley.!
in Figure 1-1, is the frequency, which is the number of wave crests that pass a fixed point
per second. Finally, multiple waves may be described as "in phase;' which doubles the in-
tensity; "out of phase;' where they cancel each other; or at some level in between, resulting
in an intermediate level of intensity (Fig 1-2).
In addition to an electric field, a light wave has a magnetic field that increases and
decreases with the electric field. As indicated in Figure 1-3, the magnetic field (H) is per-
pendicular both to the direction of propagation of the light and to the electric field. The
magnetic field is less important than the electric field and is often omitted in descriptions
of a light wave.
Figure 1-4 illustrates the electromagnetic wave spectrum, including the very small
portion occupied by visible light. In common usage, the term light refers to the visible
portion of the electromagnetic wave spectrum, but it can be applied to radiation in the
infrared and near-ultraviolet portions of the spectrum as well. Although the visible light
region is normally defined as 400-700 nanometers (nm), the boundaries are not precise,
and under certain conditions the eye's sensitivity extends well into the infrared and ultra-
violet regions. For example, in aphakia, without the UV absorption of the natural lens, the
retina is able to detect wavelengths well below 400 nm. X-rays also produce a response in
the retina, but these waves are not focused by the optical components of the eye.
The speed of light in a vacuum (c) is one of the fundamental constants of nature, al-
most exactly 3 x 108 m/see. The wavelength of a light wave is related to its frequency (v)
by the equation
When light travels through any transparent medium (m) other than a vacuum, its
velocity (v) is reduced. The index of refraction (n) of the medium is defined as the ratio
CHAPTER 1: Physical Optics. 5
A
Figure '-2 When light waves are
fully "in phase" with one another,
their superposition results in a dou-
bling of the light intensity (AI. When
they are fully" out of phase," they
cancel each other out, and the re-
sulting light intensity is zero (81.
When they are in between these 2
extremes, the resulting light inten-
sity is at an intermediate level (C).
8
(Illustrator C. H. Wooley.)
Figure '-3 A magnetic field always accompanies the electric field in any electromagnetic
wave. The magnetic field, represented by H, is always perpendicular to the electric field. (Re-
drawn by Jonathan Clark.)
6 . Clinical Optics
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Figure 1-4 The electromagnetic spectrum. (Reproduced with permission from Steinert RF. Pufiafito CA. The
Nd:YAG Laser in Ophthalmology: Principles and Clinical Applications of Photodisruption. Philadelphia: Saunders; 1985.
Redrawn by C. H. Wooley.)
of the speed of light in a vacuum to the speed of light in the given material and is written
as
Lens materials have unique indices of refraction. The index of refraction of typical
CR-39 plastic lenses is 1.50, whereas the "high-index lenses" have an index of refraction
of 1.66. The higher the index of refraction, the thinner, and, therefore, more attractive,
the lens. This is important for patients with higher refractive errors who prefer "thin
lenses:'
The frequency of a wave does not change on traveling through a transparent medium,
but the wavelength Um) becomes shorter, as governed by the relationship
Photon (Particle) Aspects of Light

When light interacts with matter, individual quanta of energy (photons) are emitted or
absorbed. The amount of energy (E) per photon is equal to Planck's constant multiplied
by the frequency and is written as
E=h\'
where \' is the frequency of the light wave and h is Planck's constant: 6.626 x 10-.14Jlsee.
Because the frequency of blue light is greater than that of red light (see Fig 1-4), a photon
of blue light has greater energy than a photon of red light.
The diagnostic use of fluorescein demonstrates a practical application of this princi-
ple. For example, a photon of blue light is absorbed by an individual fluorescein molecule.
When the molecule reemits light (fluoresces), the emitted photon has a lower energy,
lying in the yellow-green portion of the spectrum. The remaining energy is converted into
heat or chemical energy. As a general rule, light emitted through fluorescence has a longer
wavelength than the excitation light.
The particle-wave duality extends to other fundamental concepts as well. The elec-
tron, for example, behaves like a wave with a wavelength much shorter than that of light.
Because diffraction effects are much reduced at shorter wavelengths (see Diffraction,
later), extremely high resolution can be obtained with the electron microscope.
Interference and Coherence

Interference occurs when 2 light waves originating from the same source are brought to-
gether. Interference occurs most readily when the light is monochromatic; that is, it lies
within a narrow band of wavelengths. But interference can also be obtained with white
light under optimum conditions.
In Figure 1-5, the curved lines represent the crests of the waves at a particular instant.
Where the crests coincide (for example, at A), a maximum of intensity is produced be-
cause the energy of the electromagnetic fields is added together (constructive interference).
Where the crest of 1 wave coincides with the trough of the other wave (B), the 2 electro-
magnetic fields cancel each other, and intensity is minimized (destructive interference). If
the 2 waves are exactly equal in amplitude, the destructive interference will be complete,
and the light intensity will be zero. Thus, in Figure 1-5, the screen displays a series of light
and dark bands corresponding to areas of constructive and destructive interference.
The term coherence describes the ability of 2 light beams, or different parts of the
same beam, to produce interference. Spatial, or lateral, coherence defines the ability
of 2 separated portions of the same wave (P and Q in Fig 1-5) to produce interference.
8 . Clinical Optics
Screen
(side) Screen
_
@Maximum~
@ Minimum ~
Figure '-5 Interference. A represents constructive interference; B indicates destructive inter-

ference. (Redrawn bV Jonathan Clark.)
Temporal, or longitudinal, coherence is the ability of 1 wave of a beam to interfere with a

different wave within the same beam (P and R). A large, white light source has a coher-
ence close to zero. However, if the light is passed through a narrow slit, as in Figure 1-5,
the spatial coherence between P and Q improves, approaching unity as the slit approaches
zero width. Temporal coherence is improved by using a filter to select a narrow band
of wavelengths, thereby making it highly monochromatic. Laser light is highly coherent.
Most gas lasers approach perfect temporal coherence, meaning that a portion of the beam
can be made to interfere with a much later portion of the beam.
Applications of Interference and Coherence

Interference resulting from the high degree of coherence in laser light can lead to seri-
ous problems in some laser applications. However, interference effects can also be put to
practical use, as in laser interferometry,a technique for evaluating retinal function in the
presence of a cataractous lens. A laser beam is split into 2 beams, which then pass through
different parts of the pupil. Where the beams again overlap on the retina, interference
fringes are formed, even if the beams have been diffused by the cataract.
One of the most important applications of interference is in antireflectionfilms
(Fig 1-6) and interference filters (Fig 1-7). If the 2 reflected beams in Figure 1-6 are equal
in amplitude but exactly half a wavelength out of phase, the resulting destructive interfer-
ence will cause the beams to cancel each other and thereby prevent reflection for a given
wavelength. Modern low-reflection coatings consist of several thin layers of transparent
materials designed to give a reflection of only a few tenths of a percent over the visible
spectrum. Films are typically prepared by evaporation of the material in a vacuum cham-
ber and deposition on the glass surface.
The interference filter (see Fig 1-7) is designed so that successive rays transmitted
through the filter are exactly in phase and therefore interfere constructively. This con-
dition applies exactly for only 1 wavelength, and therefore the filter transmits only that
wavelength and a narrow band of wavelengths on either side. Other wavelengths are re-
Glass substrate
/
Figure 1-6 Destructive interference by an antireflection film. (Redrawn by C H. Wooley.)
Sumo!
+
rvv .
transmitted waves
+
Reflected waves
}
(
{ (
+
+
etc.
Figure 1-7 The interference filter transmits only that wavelength for which the internally re-
flected waves are in phase with one another. (Redrawn by C H. Wooley.)
fleeted by the interference filter. The reflecting layers can be thin films of metal such as
silver or aluminum. More frequently they consist of multiple thin layers of transparent
materials, with the thickness of each layer chosen to give the desired reflectance.
Thin layers can also be designed so that the transmission (or reflection) has the char-
acteristic properties of a sharp cutoff filter. For example, a so-called cold mirror has a
multilayer coating designed to reflect the visible (cold) light and transmit the infrared
wavelengths. The excitation filter used in fluorescein angiography transmits short wave-
lengths, below about 500 nm, that cause fluorescein to fluoresce. The barrier filter lIsed in
the fundus camera transmits only the long wavelengths, above about 500 nm. Therefore,
the fluorescent emission is received by the film, but all excitation light is excluded.
10 . Clinical Optics
Polarization
In general, the human eye is not sensitive to polarization of light. Nevertheless, polariza-
tion has a number of applications in visual science and ophthalmology, as we shall see.
A good analogy for polarization is light waves moving through a picket fence. The
fence lets only waves of a certain direction through, blocking the rest of the waves. Plane-
polarized, or linearly polarized, light consists of waves that all have their electric fields in
the same plane.
In a different analogy, we could turn one end of a rope in a circular motion. The wave
would then travel along the rope as a circular oscillation. Similarly, in circularly polarized
light, the electric field at any point rotates rapidly. In elliptically polarized light, the electric
field both rotates and changes amplitude rapidly as the wave passes.
Unpolarized light consists of a random mixture of various plane-polarized beams.
Partial polarization, as the name implies, produces a mixture of unpolarized light and
polarized light (plane, circular, or elliptical).
One way to produce plane-polarized light is to pass a beam of unpolarized light
through a polarizing filter (eg, sheet plastic). This is analogous to passing a vibrating rope
through a picket fence so that only the vertical vibration is transmitted. Certain crystals,
particularly calcite, can be used to polarize light. As will be seen later, reflection can also
cause complete or partial polarization. Even the sky acts as a partial polarizer by means of
the scattering properties of air molecules.
Applications of Polarization
One exception to the eye's lack of sensitivity to polarization is the Haidinger brush phe-
nomenon. This can be demonstrated clinically by rotating a polarizer continuously in
front of a uniform blue field. A normal subject will see a rotating structure that looks like
a double-ended brush or a propeller. This phenomenon is useful in localizing the fovea
during sensory testing and in evaluating the status of the nerve fiber layer of Henle at the
macula.
Polarizing sunglasses are sometimes useful in reducing the glare from reflected sun-
light. In boating, for example, sunlight reflected from the water surface is partially polar-
ized. Because the predominant polarization is horizontal (see Fig 1-9 later in the chapter),
the sunglasses are constructed to pass only the vertical polarization. Similarly, in driving,
the light reflected from the road surface and from the painted or glass surfaces of other
automobiles is also partially polarized, usually horizontally.
Certain materials such as glass or plastic, when stressed, will change the state of polar-
ized light. A heat-treated ophthalmic lens, for example, will exhibit a distinctive pattern
when placed between crossed polarizing sheets. People who wear polarizing sunglasses
may be especially aware of stress patterns in glass doors and auto rear windows.
Polarized light is used in some ophthalmic instruments to eliminate the strong reflex
from the cornea. The viewer looks through a polarizer that is placed 90° to the polariza-
tion of the light incident on the examined eye. The polarizer eliminates the light that is
specularly reflected from the cornea, while partially transmitting the light diffusely re-
flected from the retina.
CHAPTER 1: Physical Optics.
"
Polarizing projection charts are especially useful because they can be made to test
1 eye at a time while the patient is viewing binocularly through a pair of special polar-
izing glasses. For example, alternate letters on a Snellen chart can be polarized at 90° to
each other and therefore are seen by each eye separately. Other charts provide sensitive
tests for binocular functions or abnormalities such as stereopsis, fixation disparity, and
aniseikonia.
Diffraction
Diffraction is the ability of light to bend around edges. All waves are subject to diffraction
when they encounter an obstruction, an aperture, or another irregularity in the medium.
Diffraction changes the direction of the wave; in the case of light, this corresponds to a
bending of the light ray. The shorter the wavelength, the less the change of direction.
Diffraction is seldom seen alone; rather, it is usually combined with other effects, such
as interference or refraction. One example in which diffraction dominates is in the light
streaks seen through windshields that have been repeatedly rubbed by windshield wipers.
Each fine scratch diffracts the light into directions perpendicular to the scratch-that is,
into a plane of rays normal to the diffracting groove. Another example is the pattern seen
when viewing a distant light through fine-woven curtain material. Again, the diffraction
is in a direction perpendicular to the diffracting material-in this case, the threads. With
cross-woven material, a 2-dimensional array of bright spots is seen. Here, diffraction is
mixed with interference, producing discrete spots of light rather than continuous streaks.
Diffraction sets a limit on visual acuity when the pupil size is less than about 2.5 mm
(for the person with emmetropia). The image formed on the retina from a distant small
source takes the form of concentric light and dark rings surrounding a bright central disk,
the Airy disk (Fig 1-8). The diameter, d, of the central disk increases as the pupil size de-
creases according to the equation
d = 2.44fi. / a
where: ;, = wavelength
a = diameter of the aperture (pupil)
f = focal length of the optical system (the eye)
This equation illustrates another property of diffraction: that longer wavelengths
(red) diffract more than shorter wavelengths (blue) and therefore form a larger-diameter
Airy disk. The best resolution obtainable from an optical instrument is limited by dif-
fraction. The minimum resolvable distance is approximately equal to the radius of the
Airy disk. Because of this, telescopes generally increase in resolution as the aperture of
the objective lens is increased. However, ground-based astronomical telescopes larger
than 10 inches in diameter are limited in resolution by atmospheric turbulence, the same
phenomenon that gives rise to the familiar twinkling of stars. A space telescope operating
in the relative vacuum high above the earth's atmosphere is unaffected by atmospheric
conditions.
Figure 1-8 Diffraction pattern produced by a small circular aperture. The central bright spot is
called an Airy disk. (From Campbell CJ. Physiological Optics. Hagerstown. MD: Harper & Row; 1974:20.1
An Airy disk is seldom seen directly, even when the viewer looks at a small source
through a small pupil, usually because of aspherical irregularities in the cornea and the
crystalline lens. In this way, diffraction combines with other aberrations to increase
the blur circle size on the retina. (Blur circles are discussed in Chapter 2, under Image
Quality.)
Because diffraction sets a limit on an optical system's resolution, there is a degree of
precision in the fabrication of optical components beyond which any improvement in the
image is negligible. This limit is given by the Rayleigh criterion: If the wavefront produced
by the optical system is within one-quarter wavelength of being perfect, further improve-
ment will not result in significantly better resolution. This tolerance has a practical appli-
cation in setting standards for the fabrication of optical components.
Scattering
Scattering of light occurs at irregularities in the light path, such as particles or inclusions
in an otherwise homogeneous medium. Scattering caused by very small particles, such
as the molecules in the atmosphere, is called Rayleigh scattering. Although Rayleigh scat-
tering is generally very weak, it varies according to wavelength, with greater scattering
at shorter wavelengths. The sky appears blue because blue light from the sun is scattered
more than sunlight of longer wavelengths. Larger particles, such as dust in the air, scatter
light more intensely and with less dependence on wavelength.
Scattering of light in ocular tissues can result from various pathological conditions.
Corneal haze is caused by excess water in the stroma, which disrupts the very regular,
close-packed collagen structure of the stroma. In an early cataract, large molecules in the
lens structure cause scattering. Anterior chamber flare is caused by protein in the aqueous
humor.
CHAPTER 1: Physical Optics . 13
Such scattering material interferes with vision in 2 ways. The primary effect is that
of glare, starbursts, and halos. For example, when light from a source such as the sun or
an oncoming headlight reaches the eye, a fraction of the light scattered within the ocu-
lar media falls on the retina. That which falls in the foveal area reduces the contrast and
tends to obscure detail in the image of interest. The second effect, particularly important
when the scattering is intense, is a reduction in the light available to form the image on
the retina.
Reflection
The laws of reflection as they affect light rays and the formation of images are discussed in
Chapter 2, Geometrical Optics).
The magnitude of the reflection at an interface between 2 media depends primarily
on the difference in index of refraction between the first and second media. An air-glass
interface reflects approximately 4% (at normal incidence). The air-cornea interface re-
flects about 2%, whereas the cornea-aqueous interface reflects only about 0.02%.
Reflection from an interface also depends strongly on the angle of incidence. As illus-
trated in Figure 1-9, polarization becomes important for oblique incidence. At 1 particular
angle (known as the Brewster angle) for every interface, only 1 polarization is reflected.
The fact that 1 polarization is reflected more strongly than the other enables polarizing
sunglasses to block reflected light, as explained in the earlier discussion of polarization
and in the following paragraph.
1.0
A
0.8
fl
C
Q)
'(3
it:Q)
0.6
/ II
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2Q)
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~CU V /
~VII
~a:
t ......V
0.2
o
- ~v
VV
V
o 10 20 30 40 50 60 70 80 90
()
Angle of Incidence,
Figure '-9 Reflection by a glass surface in air as a function of angle of incidence, O. The
symbol-L indicates the polarization perpendicular to the plane of incidence; II denotes the po-
larization parallel to the plane of incidence. At grazing incidence, 90°, the reflection coefficient
approaches 100%. In this example, the glass has an index of refraction of 1.51; the Brewster
angle for this index is 56.5°. At the Brewster angle, 0B, the reflection of the parallel component
is essentially zero. (From Oitchburn RW Light. 2nd ed. London: Blackie and Son; 1952: Fig 14.3. Redrawn bV C. H.
Woolev.)
Total reflection occurs when light from a medium with a high index of refraction
encounters a medium with a lower index at oblique incidence (see Total Internal Reflec-
tion in Chapter 2). The basis for transmission of light in fiberoptics is total reflection at
the internal surface of the fiber. The fiber usually consists of a high-index core glass sur-
rounded by a lower-index cladding glass. Total reflection occurs at the interface between
the 2 glasses. This interface must remain free of dirt, contamination, and contact with any
other material that might degrade the total reflection.
Reflection from metals such as silver or aluminum can be as high as 85% to 95%. As
with other materials, the reflectivity increases with the angle of incidence. Mirrors used
in ophthalmic instruments usually consist of an aluminum layer that has been vaCUUffi-
evaporated on a glass substrate and then overcoated with a protective thin film of trans-
parent material such as silicon monoxide to prevent oxidation and scratching of the
aluminum surface.
Semitransparent mirrors, sometimes used as I-way mirrors, often consist of a metallic
layer thin enough to transmit a fraction of the incident light. They are not 100% efficient
in that a substantial fraction of the light is also absorbed. In critical applications, partially
reflecting mirrors can be made of other materials so that only a negligible fraction is lost
to absorption.
Metallic reflection partially polarizes the reflected light. As with other materials, the
perpendicular component is more strongly reflected than the parallel component. How-
ever, with metals there is no angle at which only 1 polarization is reflected; therefore, the
polarization of the reflected light is never complete.
Transmission and Absorption

Transmission is the passing of radiant energy through a medium or space. It is measured
in terms of transmittance, the percentage of energy that can pass through a particular me-
dium. For absorbing materials, the transmittance is often a function of wavelength.
Absorption is usually expressed as an optical density (OD). An optical density of 1
means a transmittance of 10%. Other values are 2 (0.01) = 1%; and 3 (0.001) = 0.1%.
In general, the expression for optical density is OD = log liT, where T is the transmit-
tance. See also Chapter 4, Clinical Refraction, for a discussion of absorptive lenses.
Duke-Elder S. Abrams D. eds. System of Ophthalmology. Vol V, Ophthalmic Optics alld Refrac-
tioll. SI Louis: Mosby; 1970:30-36.
Illumination
The quantitative measurement of light is carried out in 2 different ways. Radiometry mea-
sures light in terms of power, the basic unit being the watt. For example, the irradiance on
a surface is the number of watts per square meter incident on that surface.
Photometry measures light in units based on the response of the eye. The basic unit
is the candela, a more precisely defined replacement for the old unit, the candle. A point
source with output of 1 candela emits a total of 4rc (ie, 12.6) lumens. The illuminance on a
~
CHAPTER 1: Physical Optics . 15
surface is the number oflumens per square meter incident on that surface. The luminance
of a surface is the amount of light reflected or emitted by the surface.
If a source has a known output in watts, can we determine its output in lumens? Yes,
provided we know the spectral properties of the lamp-that is, power at each wavelength.
The output at each wavelength is multiplied by the sensitivity of the eye to that wave-
length, and the results are summed to obtain the total response of the eye to light from
that source. For example, if the source is monochromatic, with a wavelength at the peak
of the eye's photopic sensitivity (555 nm), the conversion factor is 685 lumens per watt. At
other wavelengths the factor is less, falling to approximately zero at 400 and 700 nm (Figs
1-10 and 1-11).
The apostilb is defined as the luminance of a perfectly diffusing surface that is emit-
ting or reflecting 1 lumen per square meter. It is encountered in perimetry, where the
luminance of the background and of the targets is often specified in apostilbs.
Brightness is a subjective term referring to the sensation produced by a given illumi-
nance on the retina. The commonly used radiometric and photometric terms are sum-
marized in Table 1-1.
The clinician should be familiar with levels of illumination frequently recom-
mended by illumination engineers (Table 1-2). It should be noted that the recommended
Fixed
brightness
Figure 1-10 Schematic arrangement
for measuring the spectral sensitivity
of the eye. The subject is light-adapted.
For I. a certain amount of power (W)
x'
will be needed to match the standard
brightness. A curve can then be con-
[Variable A structed of Wx versus I.x (see Fig 1-11).
(Redrawn by C. H. Wooley)
t
~ower source]
Figure 1-11 The amount of power (W) at each

wavelength (I.) needed to match a standard bright-
ness in the arrangement of Figure 1-10. This curve
is inverted with respect to the familiar photopic lu-
minosity curve. The greatest energy efficiency is
roughly in the middle of the visible spectrum, at a
wavelength of 555 nm. (Redrawnby C. H. Wooley.)
4=
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Table 1-2 Recommended Illumination Levels

Office. kitchen 150 footcandles
Reading 70 footcandles
Refracting lane:
Wall chart 25-50 footcandles
Projector 10 footcandles
Operating table 2500 footcandles
footcandles are a measure of the luminous power impinging on a surface, not that which
is reflected into the eye. An ideallOO-watt lamp bulb provides about 600 footcandles of
illumination 3 feet away and ISO footcandles 6 feet away.
Michaels DO. Visual Optics and Refraction:A ClinicalApproach.St Louis: Mosby; 19H5:
14-16.
Laser Fundamentals
Laser is an acronym for light amplification by stimulated emission of radiation-a phrase
that highlights the key events in producing laser light. In the most simplified sequence,
an energy source excites the atoms in the active medium (a gas, solid, or liquid) to emit a
particular wavelength of light. The light thus produced is amplified by an optical feedback
system that reflects the beam back and forth through the active medium to increase its
coherence, until the light is emitted as a laser beam. This process is described in greater
detail in the following sections.
Properties of laser Light

Lasers are only one of many sources of light energy. The unique properties of laser light,
however, make it particularly suitable for many medical applications. These properties are
monochromaticity, directionality, coherence, polarization, and intensity.
Monochromaticity
Lasers emit light at only I wavelength or sometimes at a combination of several wave-
lengths that can be separated easily. Thus a "pure;' or monochromatic, beam is obtained.
Although the wavelength spread is not infinitesimally small, a gas laser emission line can
be as narrow as 0.0 I nm, compared with the 300-nm span of wavelengths found in white
light. At best, a filter might reduce the transmission of white light to a color range (band
width) of 5 nm at the expense of most of the white light's energy. For medical purposes,
the color of light can be used to enhance absorption or transmission by a target tissue with
a certain absorption spectrum. The wavelength specificity of a laser greatly exceeds the
absorption specificity of pigments in tissues. In addition, monochromatic light is not af-
fected by chromatic aberration in lens systems. Thus, monochromatic light can be focused
to a smaller spot than can white light.
Oirectionality
The second property of laser-emitted light is directionality. Lasers emit a narrow beam
that spreads very slowly. As explained later in this chapter, lasers amplify only those pho-
tons that travel along a very narrow path between 2 mirrors. This process serves as a very
efficient mechanism for collimating light. In a typical laser, the beam increases by about
I mm in diameter for every meter traveled. Directionality makes it easy to collect all of the
light energy in a simple lens system and focus this light to a small spot.
Coherence
Coherence, meaning that all the propagated energy from the source is in phase, is the term
most often associated with lasers (see Fig 1-5 and the earlier discussion, Interference and
Coherence). Laser light projected onto a rough surface produces a characteristic sparkling
quality known as laser speckle. This phenomenon occurs because the irregular reflection
of highly coherent light creates irregular interference patterns, or speckle. Coherence of
laser light is utilized to create the interference fringes of the laser interferometer. In thera-
peutic ophthalmic lasers, coherence, like directionality, is important because it improves
focusing characteristics.
Polarization
Many lasers emit linearly polarized light. Polarization is incorporated in the laser sys-
tem to allow maximum transmission through the laser medium without loss caused by
reflection. The specific polarization of the light beam is not currently used in medical
applications.
Intensity
In most medical applications, the most important property of lasers is intensity. Intensity
is the power in a beam of a given angular size, and the physical correlate of the perception
of "brightness" is the intensity per unit area. In medical laser applications, the 4 important
radiometric terms are energy 0), power (W), radiant energy density (J/cm2), and irradi-
ance (W/cm2) (Table 1-3). The laser output is quantitated in either joules or watts. Recall
Table '.3 Radiometric Terminology for Medical lasers

Term Unit
Radiant energy joule*
Radiant power watt
Radiant energy density joules/cm2
Irradiance watts/cm2
Radiant intensity watts/srt
Radiance (brightness) watts/sr cm2
* 1 joule = 1 watt x 1 sec.

tSteradian is the unit of solid angle. There are 411steradians in a sphere.
From Steinert RF, Puliafito CA. The Nd:YAG Laser in Ophthalmology: Principles and Clinical Applications
of Photodisruption. Philadelphia: Saunders; 1985.
that energy is work, and power is the rate at which work is done. One joule = I watt x
1 second, or 1 W = 1 J/sec. The tissue effect is then determined by the focal point spot
size, which determines energy density and irradiance (or, less properly stated, "power
density"). In ophthalmic lasers, spot size is conventionally given as the diameter. Thus, a
50-).lm spot size has an area of IT(25 x 10-4)2cm2, or about 2 x 10-5cm2.
In an ophthalmic laser with a continuous beam of light, such as argon and krypton,
the control panel meter gives the power in watts; in a pulsed laser, such as the Nd:YAG,
the meter reading gives the energy per pulse in joules. This specification is convenient
because the continuous laser beam has a constant power, but the energy varies according
to the shutter setting (for example, 100 m W for 0.2 second delivers 20 m]). In the case of
pulsed lasers, the beam is intermittent, varying in strength over the course of the pulse,
and thus has both average and peak power. A single discrete pulse, however, carries a de-
terminate amount of energy that can be readily measured. Knowledge of any two of the
variables of energy, power, and time allows ready calculation of the third variable.
In sum, directionality, coherence, polarization, and, to some degree, monochroma-
ticity enhance the most important characteristic of lasers, which is light intensity. The
sun has a power of 1026watts but emits energy in all directions at a great distance from
the earth. Thus, a simple 1-m W helium neon laser has 100 times the radiance of the sun.
Their intense radiance, combined with monochromaticity that can target selected tissues
and avoid others on the basis of spectral absorption, makes lasers a unique tool in medi-
cine. This is particularly true in ophthalmology, as the eye is designed to allow light trans-
mission to most of its structures. Figure 1-12 summarizes the major properties of laser
light in comparison with a conventional light source.
Elements of a Laser
All ophthalmic lasers currently in use require 3 basic elements: (1) an active medium to
emit coherent radiation; (2) energy input, known as pumping; and (3) optical feedback, to
reflect and amplify the appropriate wavelengths.
In 1917, Albert Einstein explained the mathematical relationships of3 atomic tran-
sition processes: absorption, spontaneous emission, and stimulated emission. According
to the fundamental principles of quantum physics, certain atomic energy transitions are
highly probable, or "allowed:' Light energy can readily induce such an allowed transition,
causing the energy of the atom to move from its ground state (Eo) to an excited state (E1).
The atom absorbs a quantum of energy at a predictable frequency appropriate to cause
the specific transition. If the source of illumination is white light, a discrete frequency
(line spectrum) will be subtracted from the illuminating beam. Each atomic element has a
characteristic line spectrum. This process is known as absorption (Fig 1-13A).
Because the lowest energy state is the most stable, the excited atom soon emits a quan-
tum of energy at the same frequency in order to return to the ground state. This process
can occur without external stimulation (spontaneous emission; Fig 1-13B) or as a result of
stimulation by a photon of light at the same frequency (stimulated emission; Fig 1-13C).
Spontaneous emission occurs randomly in time, whereas stimulated emission is in phase
,
,
,
,
\
\
\
I
I
I
I
I
I
I
I
I
I
I
I
I
A I
)
c
) )
001111111111111111111111)
Figure 1-12 Comparison of properties of incandescent and laser light sources. A, The incan-
descent bulb emits incoherent. rapidly divergent light with a broad mixture of wavelengths
(solid and broken waves). B. A narrow-band pass filter absorbs all but a narrow portion of the
spectrum (solid waves) but. in doing so, absorbs much of the light energy. C. Directionality
and coherence are improved by the addition of a pinhole aperture, but still more energy is lost;
a lens system collects some of the light and brings it to a focus. D. A laser emits monochro-
matic, directional, coherent light that is readily collected by a lens system and brought to a
much smaller focal area. Compared with the incandescent source, the power and irradiance of
the laser system are many orders of magnitude greater. (Reproduced with permission from Steinert RF.
Puliafito CA. The Nd:YAG Laser in Ophthalmology: Principles and Clinical Applications of Photodisruption. Philadelphia:
Saunders; 1985. Redrawn bV Jonathan Clark.)
CHAPTER': Physical Optics. 21
Before After
Stimulated
.
A
absorption
.
Spontaneous
. E, hv
8
emission
Eo .
2hv
Stimulated
h-v . E,
~emission
C Eo
Figure 1-13 Schematic representation of an electron moving between the lowest energy
(ground) state (Eo)and an allowed excited state (E,) in conjunction with absorption of a quan-
tum of light energy (i1E = E, - Eo = hI'). A, Stimulated absorption. B, Spontaneous emission.
C, Stimulated emission. (Reproduced with permission from Steinert RF, Puliafito CA. The Nd:YAG Laser in Oph-
thalmology: Principles and Clinical Applications of Photodisruption. Philadelphia: Saunders; 1985. Redrawn by C. H.
Wooley.!
with the stimulating wave. Therefore, stimulated emission is coherent. After absorption,
the majority of energy release is through spontaneous emission occurring incoherently
in all directions, and only a small fraction of the energy is normally released as coher-
ent stimulated emission. The laser environment, however, amplifies only the stimulated
emission.
As indicated in Figure I-l3C, stimulated emission occurs when an incident photon
of the proper frequency interacts with an atom in the upper energy state. The result is
the emission of a photon of the same wavelength and the return of the atom to its lower
energy state. The emitted photon also has the same phase and direction of propagation as
the incident photon.
The active medium is an atomic or molecular environment that supports stimulated
emission. The active medium allows a large number of atoms to be energized above the
ground state so that stimulated emission can occur. The particular atomic energy tran-
sition determines the wavelength of the emission (E = hv = he! ),). Lasers are usually
named for the active medium. The medium can be a gas (argon, krypton, carbon diox-
ide, argon-fluoride excimer, or helium with neon), a liquid (dye), a solid (an active ele-
ment supported by a crystal, such as neodymium supported by yttrium-aluminum-garnet
[Nd:YAG] and erbium supported by yttrium-lanthanum-fluoride [Er:YLF)), or a semi-
conductor (diode).
The second requirement for a laser is a means for imparting energy to the active
medium so that a majority of the atoms are in an energy state higher than the ground
state. This condition is known as a population inversion because it is the inverse of the
usual condition in which the majority of atoms are in the ground energy state. The energy
input that makes possible population inversion is known as pumping. Gas lasers are usu-
ally pumped by electrical discharge between electrodes in the gas. Dye lasers are often
pumped by other lasers. Solid crystals are usually pumped by incoherent light such as the
xenon arc flash lamp.
Once population inversion in an active medium has been achieved, optical feedback
is required to promote stimulated emission and suppress spontaneous emission. The laser
cavity acts as an optical resonator. Mirrors are placed at each end of a beam path to reflect
light back and forth through the active medium, in which pumping maintains a popula-
tion inversion (Fig 1-14). Each time the light wave resonates through the active medium,
the total coherent light energy is increased through stimulated emission. Spontaneous
emission, which occurs randomly in all directions, rarely strikes a mirror and therefore is
not amplified.
The last element in this schematic laser design is a mechanism for releasing some of
the oscillating laser light from the cavity. This is achieved by making one of the mirrors
fully reflective and the other mirror only partially reflective. A portion of the light waves
striking the second mirror is emitted from the cavity as the laser beam. The reflectivity of
the mirror is selected to satisfy the requirements for efficient amplification in a particular
system. For example, if a laser has a 98% reflective mirror, the light waves are coherently
amplified by stimulated emission during an average of 50 round-trips through the active
medium before they are emitted as the laser beam.
Laser Sources
Solid-state laser sources commonly used in medical applications are ruby and Nd:YAG.
Refractive surgery uses excimer lasers (ablative procedures) and, less commonly, infra-
red holmium- YLF (IntraLase) and holmium:YAG lasers (laser thermal keratoplasty
[LTK]). Argon, krypton, carbon dioxide, and argon-fluoride excimer are the most im-
Laser output
~
f
Active medium
100% R < 100% R
Mirror Mirror
Figure'-'4 Elementary laser schematic illustrating the active medium within the optical reso-
nance cavity formed by the mirrors and the pump, which creates a population inversion in the
active medium. One mirror is fully reflective (100% R), whereas the other is partiallytranspar-
ent «100% R). As drawn, the mirror is 66% reflective, and the average light wave makes
3 round-trips through the active medium before being emitted. (Reproduced withpermissionfrom
Steinert RF. Puliafito CA. The Nd:YAG Laser in Ophthalmology: Principles and Clinical Applications of Photodisruption.
Philadelphia: Saunders: 1985. Redrawn bV Jonathan Clark.)
portant gas laser sources used in medicine. The dye laser is the only liquid laser used in
ophthalmology.
In 1975, it was shown that rare gas atoms in metastable excited states could react with
halogens to form diatomic rare gas halides in a bound excited dimer (excimer) state. Decay
of these excimer molecules to a weakly bound or unbound ground state is accompanied
by emission of a photon with ultraviolet frequency. Excimer lasers efficiently produce
high-power ultraviolet irradiation. A number of different excimer molecules can be cre-
ated, and each is associated with a specific transition and emission wavelength: argon
fluoride, or ArF (193 nm); krypton fluoride, or KrF (249 nm); and xenon fluoride, or XeF
(351 nm).
Semiconductor diode lasers are solid-state lasers that are extremely compact and
highly efficient. These laser sources are commonly used in communications applications
and in digital information and audio systems. Increased power output of semiconductor
diode lasers now makes them feasible for retinal photocoagulation and for some glaucoma
applications.
laser-Tissue Interaction
Although Einstein had developed the basic theory of laser emission more than 40 years
earlier, it was not until 1960 that Theodore Maiman built the first successful laser with a
ruby crystal medium.
Even before the invention of lasers, light energy had been employed therapeutically
to heat and permanently alter target tissue. This early phototherapy had its origins in ob-
servations of solar retinitis and was used in the treatment of numerous retinal disorders
and glaucoma. A laser could now achieve similar effects in a more controlled manner. The
term photocoagulation refers to the selective absorption of light energy and conversion of
that energy to heat, with a subsequent thermally induced structural change in the target.
These processes and their therapeutic results depend on laser wavelength and laser pulse
duration. A variety of photocoagulating lasers are currently in clinical use: argon, krypton,
dye, holmium, and the solid-state gallium arsenide lasers.
A second category of laser-tissue interaction uses high-peak-power pulsed lasers
to ionize the target and rupture the surrounding tissue. In clinical practice, this process
(known as photodisruption) uses laser light as a pair of virtual microsurgical scissors,
reaching through the ocular media to open tissues such as lens capsule, iris, inflamma-
tory membranes, and vitreous strands without damaging surrounding ocular structures.
Currently, the Nd:YAG and Er:YAG lasers are the principal photodisruptive lasers used in
clinical ophthalmology.
A third category of laser-tissue interaction, called photoablation. arose from the
insight that high-powered ultraviolet laser pulses can precisely etch the cornea in the
same manner that they etch synthetic polymers. The high energy of a single photon of
193-nm ultraviolet light exceeds the covalent bond strength of corneal protein. The high
absorption of these laser pulses precisely removes a submicron layer of cornea without
opacifying adjacent tissue, owing to the relative absence of thermal injury. A decade of
laboratory and clinical investigation has brought excimer laser photoablation to clinical
use in refractive surgery and corneal therapeutics. (Seealso BCSC Section 13,Refractive
Surgery.)
Figure 1-15 shows some typical laser wavelengths.
Campbell C). Physiological Optics. Hagerstown, MD: Harper & Row; 1974.
Rubin ML, Walls GL. FUlldamentals of Visual Science. Springfield, IL: Charles C Thomas; 1969.
20.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0 Erbium-YAG
Hydrogen-fluoride
2.0
E Holmium-YLF
..:!:
.c
C,
cQ)
Qj
>
ca Erbium-YLF
3:
1.0
Nd:YAG
Gallium arsenide (diode)
Alexandrite (tunable)
Ruby-red
Krypton-red
0.6328 He Ne-red/orange
0.532 2x Nd:YAG-green
0.5
0.514 Argon-green
0.488 Argon-blue
0.4
0.355 3x Nd:YAG
0.351 XeF
0.3
0.266 4x Nd:YAG
0.247 KrF
0.2
0.193 ArF
0.1
Figure 1-15 Typical laser wavelengths. (Adapted from Steinert RF. Puliafito CA. The Nd:YAG Laser in Oph-
thalmology: Principles and Clinical Applications of Photodisruption. Philadelphia: Saunders; 1985. Redrawn by Jonathan
Clark.)
CHAPTER 2
Geometrical Optics
Geometrical optics deals primarily with imaging: how to produce images using light and
how to manipulate image features such as size, brightness, and location. As its name im-
plies, geometrical optics can be understood largely in terms of geometrical principles. In
contrast, physical optics emphasizes the wave nature of light, and quantum optics (not
covered in this text) emphasizes the particle nature of light and the interaction of light and
matter. Geometrical optics models light as rays, which emanate from object points and
focus to image points.
Pinhole Imaging
The simplest imaging device is a pinhole aperture. Here's a simple experiment. Make a
pinhole near the center of a large sheet of aluminum foil, light a candle, and extinguish all
other illumination in the room. Hold a sheet of plain white or, better, waxed paper about
2 feet from the candle, and place the pinhole midway between the paper and the candle.
Observe an inverted image of the candle flame on the paper (Fig 2-1).
The image is faint, but the object's features are faithfully duplicated. Moreover, the
characteristics of the image are readily manipulated. For instance, moving the pinhole
closer to the candle while keeping the paper stationary yields a larger image.
~ II
1 1
Figure Pinhole imaging. (Illustration developed bV Edmond H. Thall, MO, and Kevin M. Miller, MO, and
2-'
rendered bV C. H. Woolev)
25
The object may be treated as a collection of points. Geometrical optics regards every
object point as a point source of light. A point source (ie, a point in the mathematical
sense) is infinitesimally small and radiates light equally in all directions. Although point
sources do not exist, some objects may be treated as point sources for practical purposes.
For example, stars other than our own sun, by virtue of their enormous distances from the
earth, behave as point sources. The point source is mainly a conceptual tool: it is usually
easier to understand an optical system by concentrating on the light radiating from only
a few object points.
For every object point there is a unique, corresponding image point. Thus, a I-to-l
correspondence exists between object points and image points. In optics, the term conju-
gate refers to the correspondence between object and image points. An object point and
its corresponding image point constitute a pair of conjugate points (Clinical Example 2-1).
An image point is said to be conjugate to its corresponding object point and vice versa. It
is common practice to use a letter to identify a specific point in the object and the same
letter with a prime to indicate the conjugate image point (eg, A and A').
A ray is a geometrical construct that indicates the route (or routes) light follows as
it travels from an object point to the conjugate image point. Rays represent only a path;
they do not indicate the amount (ie, intensity) or wavelengths of the light traveling along
the path. An arrowhead on the ray indicates the direction light travels; however, too many
arrowheads can clutter illustrations. To minimize this problem, light is conventionally
depicted as traveling from left to right unless indicated otherwise.
A pencil oflight is a small bundle of rays that travel in the same direction. The smaller
a pencil (the narrower the pinhole or aperture forming it), the more it behaves like a single
ray of light.
Pinhole imaging has been known for millennia, but pinhole images are usually too
faint to be useful. Only in rare situations is pinhole imaging practical. For instance, a solar
eclipse can be safely observed by using a pinhole to image the sun on a piece of paper. Of
course, one should not look through the pinhole to directly view the sun!
CLINICAL EXAMPLE 2-1

The concept of conjugate points can be illustrated by retinoscopy. When
performing retinoscopy, the examiner observes the light reflex emanat-
ing from the subject's pupil. The examiner's retina is conjugate to the
subject's pupil (Fig 2-2A). At the point of neutrality in the refraction,
the subject's retina is conjugate with the peephole of the retinoscope
(Fig 2-2B). After being adjusted for the working distance, the subject's
retina is conjugate with optical infinity (Fig 2-2C). (Retinoscopy is cov-
ered in detail in Chapter 4, Clinical Refraction.)
Another example of conjugacy is demonstrated by direct ophthalmos-
copy. After being compensated for the refractive errors of the eyes of the
examiner and subject by dialing an appropriate working lens into the oph-
thalmoscope, the 2 retinas are conjugate (Fig 2-3). Because light entering
the subject's eye is intense and distracting, and little light illuminates the
inside of the examiner's eye, the subject cannot see the examiner's retina.
CHAPTER 2: Geometrical Optics. 27
Peephole of
Correcting lens retinoscope
A Subject's eye Examiner's eye
Working distance
subtracted
c
Figure 2-2 A, In retinoscopy, the examiner's eye is conjugate with the subject's pupil. B, At
the point of neutrality, the subject's retina is conjugate with the peephole of the retinoscope.
C, After the working distance has been subtracted, the subject's retina is conjugate with opti-
cal infinity. (Illustration developed by Kevin M. Miller, MO, and rendered by C. H. Wooley.)
Now what happens if we punch several pinholes in aluminum foil, separated by a few
inches, and repeat the pinhole-imaging experiment? Several complete images of the flame
appear simultaneously (Fig 2-4), Each object point is a point source radiating light in all
directions, Some light from each object point traverses every pinhole and produces an
image, Note that only a small amount of light from each object point is necessary to yield
a complete image. The pinhole restricts the brightness, not the size, of the image.
Working lens
Subject's eye Aperture Examiner's eye
Figure 2-3 In direct ophthalmoscopy, the retina of the examiner is conjugate with the retina of
the subject. IlIIustration developed by Kevin M. Miller, MO, and rendered by C. H. Wooley.)
,
11 ---J I
I
Figure 2-4 Multiple pinholes produce distinct. complete images. IlIIustration developed by Edmond H.
Thall, MO, and Kevin M. Miller. MO, and rendered by C. H. Wooley.)
Imaging with Lenses and Mirrors

Repeat the pinhole-imaging demonstration, but replace the pinhole with a +6 D spherical
trial lens, and note the improvement in the image. Vary the distances among the candle,
lens, and paper, and observe the variety of different image characteristics that can be ob-
tained from the same lens (Fig 2-5). Different lenses provide an even broader range of
images.
Compared with the pinhole, the lens allows much more light from each object point
to traverse the lens and ultimately contribute to the image. Generally, lenses produce bet-
ter images than pinholes. However, lenses do have some disadvantages. Place a lens at
a fixed distance from the candle and note that the image appears in only 1 location. In
pinhole imaging, an image appears at any location behind the aperture. Changing the
distance between an object and a lens causes the distance between the image and the lens
to change, but the image still forms in only 1 location.
CHAPTER 2: Geometrical Optics . 29
Mirrors produce images in much the same way as lenses (Fig 2-6). The comments
made in this section regarding lenses also apply to mirrors.
Most optical systems are rotation ally symmetric about their long axis. This axis of
symmetry is the optical axis (see Figs 2-5 and 2-6). Although the human eye is not truly
rotationally symmetric, it is nearly symmetric, and theoretical models of the eye often
+6 D
A
Object
Optical
axis
Image
Figure 2-5 Basic imaging with a lens. The lens collects light from an object point and redirects
the light to a small spot in the image. (Illustration developed by Kevin M Miller, MO. and rendered by C. H.
Wooley.)
Image
Center of
Optical
curvature
axis
Figure 2-6 Basic imaging with a mirror. In this example, an upright magnified, and virtual
image is produced because the object is located inside the focal point, F (Illustration developed by
Kevin M Miller, Mo, and rendered by C. H. Wooley.)
approximate the eye as a rotationally symmetric system. (See the discussion of schematic
eyes in Chapter 3, Optics of the Human Eye.)
Object Characteristics
Objects may be characterized by their location with respect to the imaging system and by
whether they are luminous. Objects that can be felt or touched, that are located in front of
an imaging system, are known as real objects. Objects that cannot be felt or touched, that
are located behind an imaging system, are known as virtual objects. These concepts will be
developed more fully later.
If an object point produces its own light, such as the candle flame in the previous il-
lustrations, it is called luminous. If it does not produce its own light, it can only be imaged
if it is reflective and illuminated.
Image Characteristics
Images can be described by characteristics such as magnification, location, depth of focus,
quality, and brightness. Some of these features will be discussed briefly.
Magnification
The most important characteristic of an image is its magnification. Magnification can be
classified as transverse, axial, or angular.
The ratio of image height to corresponding object height is known as transverse mag-
nification (Fig 2-7):
Transverse magnification = image height/object height
t
a
t
Object 4 cm
height
Figure 2-7 Transverse magnification is the ratio of image height to object height. Object height
and image height may be measured from any pair of off-axis conjugate points. In this illustra-
tion, an object point. 0, on the wick, and its conjugate, I, are used to measure object and image
height. (Illustration developed by Edmond H. Thall. MD. and Kevin M Miller. MO, and rendered by C. H. Wooley.)
CHAPTER 2: Geometrical Optics. 31
To calculate transverse magnification, any off-axis object point and its conjugate
image point may be used. Object and image heights are measured perpendicularly from
the optical axis. By convention, object or image height is considered positive when the
point is above the optical axis and negative when the point is below the axis.
In general usage, magnification means enlargement; however, in optics the term mag-
nification refers to making images larger or smaller than the object. An image is a scale
model of the object, and magnification is the scale factor. Inverted images are indicated
by a minus sign, whereas images with the same orientation as the object (upright images)
have a positive magnification. For instance, in Figure 2-7 the object height is +4 cm and
the image height is -2 cm; thus, the transverse magnification is -0.5, meaning that the
image is inverted and half as large as the object. A magnification of +3 means the image is
upright and 3 times larger than the object.
Transverse magnification applies to linear dimensions. For example, a 4 cm x 6 cm
object imaged with a magnification of 2 produces an 8 cm x 12 cm image. Both width and
length double, yielding a fourfold increase in image area.
The word power is sometimes used synonymously with transverse magnification. This
usage is unfortunate because "power" has several different meanings, and confusion often
arises. Other uses of the word include refracting power, resolving power, prism power,
angular magnification, and light-gathering power. Generally, the multiplication sign, x,
is used to indicate magnification. The transverse magnification of microscope objectives,
for example, is sometimes expressed by this convention.
Most optical systems have a pair of nodal points (Fig 2-8). Occasionally, the nodal
points overlap, appearing as a single point, but technically they remain a pair of overlap-
ping nodal points. The nodal points are always on the optical axis and have an important
property. From any object point, a unique ray passes through the anterior nodal point.
This ray emerges from the optical system along the line connecting the posterior nodal
point to the conjugate image point (Fig 2-9). These rays form 2 angles with the optical
Optical system
Object
Figure 2-8 The anterior and posterior nodal points (N and N', respectively) of an optical sys-
tem. Any ray from an object point to the anterior nodal point will emerge along the line joining
the posterior nodal point and the image point. The angles formed by these rays with the optical
axis are identical. (Illustration developed by Kevin M Miller,MO, andrenderedby C.H. Woolev)
Exploring the Variety of Random
Documents with Different Content
just passed was caused by the large number of Congregationalists in
the state.
Even when two events are repeatedly associated so far as time is
concerned we should not regard the repetition as proof of the causal
relation but only as an indication that a causal relation probably
exists. We should not arrive at any definite conclusion until the
existence of the causal relation has been finally established.
(2). Mistaking an effect for a cause.
The fallacy of mistaking an effect for a cause consists in pointing

to one effect as the cause of another effect when in reality both
effects are the result of one cause. For example, a recent writer
attributes the anarchistic tendency of the masses of Russia to the
arrogance of the soldiery in that country. This reasoning is criticised
on the ground that both the anarchistic tendencies of the masses
and the arrogance of the soldiery are effects of the same cause, viz.
—the despotic government of Russia.
(3). Mistaking a subsequent cause for a real cause.
This fallacy arises when an effect is observed and in the search for
the cause we accept something which in reality happened after the
effect was observed. A striking example of this fallacy occurred in a
recent municipal election. The increased cost of city government was
charged to the present mayor. His opponents pointed to him as the
cause of this increase in the city’s expenses. The mayor’s friends
revealed the fallacy by showing that the expense had really been
incurred under the former mayor. The acts of the present mayor
could not have been the cause of the increased expense because
that expense had been incurred before he went into office.
Therefore those who made the unjust charge had committed the
fallacy of mistaking a subsequent cause for the real cause.
(4). Mistaking an insufficient cause for a sufficient cause.
This fallacy differs from those previously discussed in that there

exists some causal relation between the effect and the alleged
cause. The error consists of a failure to recognize the insufficiency of
the cause to produce the effect without the help of some other
cause.
In a discussion of the proposition, “Resolved, that department
stores have proved a benefit to municipal communities,” one speaker
argued that such stores were the cause of the low price at which
small necessities such as hardware and dry-goods novelties could be
purchased by the consumer. The next speaker exposed the fallacy of
this argument by admitting that department stores had been a factor
in lowering the cost of such commodities, but that this could not
have been done except for the assistance of another and more
powerful cause, viz.,—the invention of machinery by which such
articles could be manufactured in enormous quantities.
2. Fallacies of the argument from cause to effect.
Fallacies of the argument from cause to effect may be exposed by

showing
1. That the observed cause is insufficient to produce the alleged
effect.
2. That past experience shows that the alleged effect does not
always follow the observed cause.
3. That an independent force has intervened to prevent the
observed cause from operating.
4. That the conclusion established by the argument is overthrown
by positive evidence.
It must be kept in mind that the argument from cause to effect is
subject to errors similar to those discussed in connection with
fallacies of the argument from effect to cause. In his desire to
predict the course of future events man is led to ignore the complex
nature of human affairs. A certain individual believes that if he puts
all his money into a business and then gives all his attention to its
management that that is a sufficient cause for success.
Nevertheless, so much depends upon the nature of the man and of
the business that it is extremely difficult to foretell the effect. The
principle underlying this situation is common to practically every
argument from cause to effect. Unless the fallacy is obvious it
requires a broad and penetrating intellect to fathom it.
3. Fallacies of the argument from effect to effect.
The fallacies of the argument from effect to effect are discovered

by resolving it into the argument from effect to cause and from
cause to effect, of which it is composed, and examining the validity
of each of these processes.
IV. Fallacies of the argument from analogy.
The chapter on Argument from Analogy treated of the

requirements for validity to which such an argument must conform.
We may expose the fallacy of an argument from analogy by showing
—
1. That the two factors in the analogy are not alike in all the
particulars affecting the conclusion.
2. That the alleged facts upon which the analogy is based are not
true.
3. That the conclusion established by analogy is disproved by
positive evidence.
No test of an analogy is absolute. Its very nature makes it more
susceptible to fallacy than are the other forms of argument. At its
best it creates only a high degree of probability. As already stated,
its chief use is to give clearness and force to persuasive writing and
speaking. In the search for fallacies, here as well as elsewhere, the
best guarantee of success is an unprejudiced mind equipped with a
thorough working knowledge of all the argumentative processes of
reasoning and of the numerous fallacies to which they are subject.
EXERCISES IN FALLACY
I. Point out clearly the kind of fallacies, if any, involved in the following
arguments.
1. The only people excluded from the privilege of voting are children,
idiots, foreigners, convicts, and women. How much longer will the
civilized nations of the earth permit their women to be classed with the
incompetent and the criminal classes of society?
2. Political parties are a necessity to free institutions. The United States is
the oldest democracy on earth and in it political parties have always
ruled.
3. The election of a Republican president in 1896 was followed by a period
of prosperity unrivalled in our history. Who can doubt that had a
Democratic president been elected it would have worked the beginning
of a sure decline of our industrial supremacy?
4. The rapid increase in wages for the past twenty years shows the
superior advantage gained by the organization of the working men.
5. Is not the Spanish-American war proof of the fact that the government
can meet its expenditures in time of great national emergencies without
resorting to the income tax?
6. England, France, and Germany are the great powers of Europe. Both
England and Germany have signified their willingness to sign this treaty.
We are therefore certain that the great powers of Europe will become
parties to this treaty provided we give them the opportunity.
7. Soon after the great flood the city of Galveston was grappling with
serious municipal problems. By adopting the commission form of city
government all these difficulties were solved. Therefore all American
cities, oppressed by governmental difficulties, may secure prompt relief
by adopting this plan of municipal administration.
8. (1) Some Italians are good musicians.
(2) This man is an Italian.
(3) Therefore this man is a good musician.
9. (1) All college students are interested in athletics.
(2) Ira Simpson is not a college student.
(3) Therefore Ira Simpson is not interested in athletics.
10. My opponent must remember that the finger of suspicion has pointed
to him as the one who willfully misrepresented that great mine disaster.
Does he dare to assert that he is now telling the truth?
11. The capitalistic class has always oppressed the working man. It has
ground into the dust the man who toils for his living. It has enjoyed its
ill-gotten wealth by living in luxury while the laboring man has earned
his bread by the sweat of his brow. Now, my fellow workmen, shall we
cast our vote for one of the most vicious members of this class?
12. Never in its history has the town of Grogan stooped to borrow money
for public improvements. No one will dare maintain that this time
honored custom, founded upon reason and common sense, should now
be broken.
13. Brown County is overwhelmingly Republican in politics; it is therefore
quite probable that your cousin who lives in that county is a Republican.
14. The very foundation of this great republic is the idea of democracy.
Why, then, should not every right minded citizen recognize his duty to
support the Democratic party in the coming election?
15. This climate is very healthful, for if it were not healthful the people who
live here would not be free from disease.
16. There must be a substantial reason back of the opinion that the tariff
should be lowered, for the prevalence of this opinion throughout the
country shows that it has a sound foundation.
17. The inhuman method of killing murderers by electrocution should be
abolished.
18. It is evident that the recommendations of the Simplified Spelling Board
should be adopted because one of the members of that board is the
most eminent authority on the English Language in this country.
19. The price of wheat is bound to increase rapidly within the next few
months because the recent flood of the Arkansas River has destroyed
many hundred acres of this crop.
20. James was quite sure that something disagreeable would occur
because only last night he saw the new moon over his left shoulder.
21. Since this tax has worked well in England there can be no doubt of its
practicability if it is adopted in the United States.
II. Each student should write out and bring to the class at least one fallacy
which he has found in the conversation of his fellow-students.
III. Whenever possible use diagrams to show the fallacies in the specimens
under I.
CHAPTER VI
REFUTATION
In discussing the Practice of Argumentation and Debate we have

considered the importance of refutation in both the main argument
and in rebuttal. We have seen that refutation must be introduced
into the main arguments whenever the prominence of opposing
arguments makes it necessary. We have seen that rebuttal consists
largely of refutation. In fact, rebuttal and refutation are used by
some writers as synonymous terms. However, in the chapter on
rebuttal a distinction was made by which that term was used to
indicate the practical work of defending an argument and attacking
an opponent. In this chapter on Refutation we shall consider the
theory of the various methods employed in attacking an opponent’s
argument.
Refutation is entirely destructive as distinguished from
constructive argument. While the work of rebuttal includes both a
defense of one’s own argument and an attack upon that of an
opponent, refutation consists of weakening or destroying the
arguments of the opposition. From the destructive nature of
refutation it is plain that it must be adapted to the argument against
which it is directed. This involves keen powers of analysis and
adaptation, an exact knowledge of the theory and practice of
argumentation, and a thorough insight into both sides of the
proposition under discussion. The first essential in refutation is that
the writer or speaker make perfectly plain the exact argument that
he is refuting. He must then show just how the refutation which he
is making bears upon that argument. Finally he must show plainly
that his refutation has weakened or destroyed the argument against
which it was directed. These three steps in refutation must be
indicated plainly.
In refutation it is proper to establish a contrary proposition or to
refer to the fact that such a contrary proposition has been
established. The actual destructive work may be accomplished in any
legitimate manner. Of the methods employed in refutation the
following are the most important.
I. Revealing a fallacy.
The chapter on fallacies has pointed out the argumentative

defects of reasoning most frequently encountered. The student must
not assume that these errors will always occur in the exact form in
which they have been treated in any text-book. They are sure to
appear in many and varied guises. To identify and expose them
requires the keenest qualities of mind. Each student should pride
himself on his ability to detect a fallacy quickly and should look back
with humiliation upon any occurrence when he has allowed a
fallacious argument to pass by unchallenged.
Familiarity with the valid forms of logical reasoning and with the
errors to which they are subject are prerequisites to success. It is
not sufficient that the student have a vague feeling that there is
something wrong with an argument; he must be able to locate the
defect exactly and to point it out to others in such a way that they
will see it. Vagueness and ambiguity are the very substance of
fallacies. Sometimes the student must use his knowledge of
constructive logic to build up a parallel argument in the way it ought
to stand and show more plainly by means of contrast the defects of
the unsound argument. In such cases it often happens that the
evidence points in an opposite direction from that which is needed to
support a valid argument. All of these devices should be utilized in
making plain the existence of fallacies.
II. Reductio ad absurdum.

This method of refutation adopts for the time being the argument
of an opponent and then by carrying out that argument to its logical
conclusion shows that it is absurd. For example, Beecher answered
those who favored the South, during the late Civil War, because they
were “the weaker party,” by reducing their argument to an absurdity.
He said,
“Nothing could be more generous than your doctrine that you
stand for the ‘weaker’ party in a controversy, when that weak party
stands for its own legitimate rights against imperious pride and
power. But who ever sympathized with a weak thief, because three
constables had got hold of him? And yet the one thief in three
policemen’s hands is the weaker party. I suppose you would
sympathize with him.”
The following quotation from Laycock and Scales’ Argumentation
and Debate still further illustrates this method of refutation.
“This method is effective because of its simplicity and directness.
It also has in it an element of ridicule that is persuasive against an
opponent. William Ellery Channing, in a reply to Henry Clay on the
slavery question, used this method as follows:—
“‘But this property, we are told, is not to be questioned on account
of its long duration. “Two hundred years have sanctioned and
sanctified negro slaves as property.” Nothing but respect for the
speaker could repress criticism on this unhappy phraseology. We will
trust it escaped him without thought. But to confine ourselves to the
argument from duration; how obvious the reply! Is injustice changed
into justice by the practice of ages? Is my victim made a righteous
prey because I have bowed him to the earth till he cannot rise? For
more than two hundred years heretics were burned, and not by
mobs, not by lynch law, but by the decrees of councils, at the
instigation of theologians, and with the sanction of the laws and
religions of nations; and was this a reason for keeping up the fires,
that they had burned two hundred years? In the eastern world,
successive despots, not for two hundred years, but for twice two
thousand, have claimed the right of life and death over millions, and
with no law but their own will, have beheaded, bowstrung, starved,
tortured unhappy men without number who have incurred their
wrath; and does the lapse of so many centuries sanctify murder and
ferocious power?’
“Again:—‘But the great argument remains. It is said that this
property must not be questioned, because it is established by law.
“That is property which the law declares to be property.” Thus
human law is made supreme, decisive, in a question of morals. Thus
the idea of an eternal, immutable justice is set at naught. Thus the
great rule of human life is made to be the ordinance of interested
men. But there is a higher tribunal, a throne of equal justice,
immovable by the conspiracy of all human legislatures. “That is
property which the law declares to be property.” Then the laws have
only to declare you, or me, or Mr. Clay, to be property, and we
become chattels and are bound to bear the yoke! Does not even
man’s moral nature repel this doctrine too intuitively to leave time or
need for argument?’”
III. The dilemma.
The dilemma is one of the most conclusive forms of refutation. It

consists in forcing upon an opponent a choice between two possible
solutions to the question under discussion, and then showing that
both conclusions are unsound. These two conclusions are called the
“horns of the dilemma.” It matters not which of the “horns” an
opponent selects; the result is disastrous. For example, Lincoln used
the dilemma against those who charged that the Republicans stirred
up insurrection among the slaves and pointed to John Brown and his
men as a specific example showing the truth of that charge. Lincoln
said, “John Brown was no Republican; and you have failed to
implicate a single Republican in his Harper’s Ferry enterprise. If any
member of our party is guilty in that matter, you know it or you do
not know it. If you do know it, you are inexcusable for not
designating the man and proving the fact. If you do not know it, you
are inexcusable for asserting it, and especially for persisting in the
assertion after you have tried and failed to make the proof. You need
not be told that persisting in a charge which one does not know to
be true, is simply malicious slander.” In effect Lincoln said, “You
know it or you do not know it. If you know it you are inexcusable. If
you do not know it you are inexcusable. Whichever horn of the
dilemma you accept, your conduct is inexcusable.”
In order to be conclusive a dilemma must meet two requirements.
First, there must be only two possibilities in the case; the alternative
must include these exactly. Second, both members of the
alternative, or “horns” of the dilemma must be untenable. To ignore
or fail to comply with either of these requirements is fatal to this
method of refutation. Lincoln, in the following quotation, shows that
Douglas has violated the first of these requirements. He refuses to
accept either of the horns of the dilemma which Douglas has sought
to force upon him, by pointing out a third possibility. On this third
possibility, overlooked by Douglas, he can stand with safety. He says:
—
“Judge Douglas finds the Republicans insisting that the Declaration
of Independence includes all men, black as well as white, and
forthwith he boldly denies that it includes negroes at all, and
proceeds to argue gravely that all who contend it does, do so only
because they went to vote, to eat and sleep, and marry with
negroes. He will have it that they cannot be consistent else. Now I
protest against this counterfeit logic which concludes that because I
do not want a black woman for a slave I must necessarily want her
for a wife. I need not have her for either. I can just leave her alone.”
IV. Residues.
The method of residues consists in stating all the possible

conclusions regarding the controverted subject and then destroying
all of these except one which is then regarded as the true
conclusion. For example, there are three possibilities, A, B, and C. A
and B are false. Therefore the presumption is that C is true. It will
be seen that this process is destructive and hence belongs with
refutation. This method of refutation must be used with great care.
It is absolutely essential that every possibility be included in the
process. If one possibility is overlooked the refutation is worthless.
This is true because no one can tell whether the known possibility is
the true one or whether the possibility which has been omitted is the
true one. In such a case no conclusion is reached. Even when it is
apparent that the entire field has been covered, and that every
possibility has been stated the residuary part should be supported by
direct positive proof. This will offset the suspicion, which is otherwise
ever present in the minds of those who are listening to or reading
the argument, that perhaps one possibility has been overlooked.
Foster in his Argumentation and Debate quotes two excellent
examples of this method of refutation. The first of these is taken
from Burke’s Speech on Conciliation. After showing that a fierce
spirit of liberty has developed in the American colonies Burke asks
what is to be done with that spirit. Answering his own question he
says:—
“‘As far as I am capable of discerning there are but three ways of
proceeding relative to this stubborn spirit which prevails in your
colonies, and disturbs your government. These are—to change that
spirit, as inconvenient, by removing the cause; to prosecute it as
criminal; or to cope with it as necessary. I would not be guilty of an
imperfect enumeration; I can think of but these three. Another has
indeed been started,—that of giving up the colonies; but it met so
slight a reception that I do not think myself obliged to dwell a great
while upon it. It is nothing but a little sally of anger, like the
frowardness of peevish children, who when they cannot get all they
would have, are resolved to take nothing.’
“Burke then proceeds to show that the first and second of these
plans are impracticable, and concludes with the following
characteristic, logical summary:—
“‘If, then, the removal of the causes of this spirit of American
liberty be for the greater part, or rather entirely, impracticable; if the
ideas of criminal process be inapplicable—or if applicable, are in the
highest degree inexpedient—what way yet remains? No way is open
but the third and last—to comply with the American spirit as
necessary; or, if you please, to submit to it as a necessary evil.’
“Huxley, in his first lecture on Evolution, presented three
hypotheses regarding the origin of the universe:—
“‘So far as I know, there are only three hypotheses which ever
have been entertained, or which well can be entertained, respecting
the past history of Nature. I will, in the first place, state the
hypotheses, and then I will consider what evidence bearing upon
them is in our possession, and by what light of criticism that
evidence is to be interpreted.
“‘Upon the first hypothesis, the assumption is that phenomena of
Nature similar to those exhibited by the present world have always
existed; in other words, that the universe has existed from all
eternity in what may be broadly termed its present condition.
“‘The second hypothesis is, that the present state of things has
had only a limited duration; and that at some period in the past, a
condition of the world, essentially similar to that which we now
know, came into existence, without any precedent condition from
which it could have naturally proceeded. The assumption that
successive states of Nature have arisen, each without any relation of
natural causation to an antecedent state, is a mere modification of
this second hypothesis.
“‘The third hypothesis also assumes that the present state of
things has had but a limited duration; but it supposes that this state
has been evolved by a natural process from an antecedent state,
and that from another, and so on; and on this hypothesis, the
attempt to assign any limit to the series of past changes is usually
given up.’
“Huxley thus destroyed the first two hypotheses and left the third
—since called the Theory of Evolution—standing alone. Following
this indirect, destructive method of proof, Huxley offered direct,
constructive proof of the probable soundness of the Theory of
Evolution. Such positive proof should always be offered in
corroboration of negative proof, for the method of residues is, at
best, only an indirect argument. The chances of overlooking a
possibility, or of failing completely to destroy those dealt with, are so
great that the result of the indirect method should be reinforced by
direct argument.”
V. Inconsistencies.
When a witness testifies in a court of law he injures his own

credibility as soon as one part of his story contradicts another part.
His entire account of the events about which he has been called to
give testimony must be consistent. Any inconsistency may prove
fatal to the acceptance of his testimony. In like manner any
inconsistency in an argument may prove fatal to its acceptance. The
exposure of such inconsistencies in an opponent’s argument is one
of the most important methods of refutation. In most cases the
difficulty of the task is greatly increased by the form in which such
inconsistencies usually occur. Seldom are they apparent. In most
cases the error is revealed only after the argument has been
carefully analyzed and the inconsistent parts stripped of their
covering of confusing language.
The following quotation taken from the argument of Lincoln in one
of the Lincoln-Douglas debates shows the application of this method.
Douglas had maintained that slavery could be lawfully excluded from
a territory in spite of the Dred Scott decision. In refuting this
argument by exposing the inconsistency which it contained, Lincoln
said:—
“The Dred Scott Decision expressly gives every citizen of the
United States a right to carry his slaves into the United States
Territories. Now, there was some inconsistency in saying that the
decision was right, and saying, too, that the people of the Territory
could lawfully drive slavery out again. When all the trash, the words,
the collateral matter, was cleared away from it,—all the chaff was
fanned out of it,—it was a bare absurdity: no less than that a thing
may be lawfully driven away from a place where it has a lawful right
to be. Clear it of all the verbiage, and that is the naked truth for his
proposition—that a thing may be lawfully driven from the place
where it has a lawful right to stay.”
VI. Adopting an opponent’s evidence.
This method of refutation consists in taking evidence which an

opponent has introduced in favor of his own argument and showing
that in reality it supports the opposite contention. This method of
refutation is so effective that it should never be neglected when an
opportunity to use it is presented. The opportunity may arise from
the failure of an opponent to grasp the full bearing of the evidence
which he offers, or it may arise from an unexpected turn in the
discussion. Evidence may be introduced in the beginning of a
discussion to support a particular contention by which it favors the
writer or speaker who introduces it. Later this same evidence may
be interpreted as supporting a contention entirely adverse to the
writer or speaker who introduced it. An excellent example of this
method of refutation is found in Bouton’s Lincoln and Douglas
Debates in Lincoln’s Cooper Institute Speech, where he turns the
warning of Washington against those who had been quoting it
against him.
“Some of you delight to flaunt in our faces the warning against
sectional parties given by Washington in his Farewell Address. Less
than eight years before Washington gave that warning, he had, as
President of the United States, approved and signed an act of
Congress enforcing the prohibition of slavery in the Northwest
Territory, which act embodied the policy of the Government upon
that subject up to and at the very moment he penned that warning;
and about one year after he penned it, he wrote Lafayette that he
considered that prohibition a wise measure, expressing in the same
connection his hope that we should at some time have a
confederacy of free states.
“Bearing this in mind, and seeing that sectionalism has since risen
upon this same subject, is that warning a weapon in your hands
against us, or in our hands against you? Could Washington himself
speak, would he cast the blame of that sectionalism upon us who
sustain his policy, or upon you who repudiate it? We respect the
warning of Washington, and we commend it to you, together with
his example pointing to the right application of it.”
We have now considered the important methods of refutation.
Their successful use depends upon the conscientious effort of the
student. Just as a boy cannot hope to learn to swim by sitting on the
bank of a stream and reading a book containing directions on how to
swim, so can no student hope to become successful in refutation by
a study of the methods explained and illustrated in this chapter. He
must master the theory of refutation, but it does not become an
effective instrument in his hands until he has applied it in actual
practice. Moreover, just as the boy can better profit by the
instructions regarding swimming after he has actually tried to swim,
so can the debater better profit by the theory of refutation after he
has engaged in some real debates.
EXERCISES IN REFUTATION
I. Point out the different methods of refutation employed in the arguments in

Appendix A; Appendix B; Appendix C.
II. Refute the following statements and name the method of refutation
employed in each case.
1. High school courses should be wholly prescribed. No electives should be
offered.
2. So far as political rights are concerned all citizens should have equal
privileges. Therefore women should have the right to vote.
3. The term of office of the President of the United States should be
extended to eight years because we should not run the risk of losing the
services of an efficient president at the end of four years.
4. Our government should annex Cuba because we must gain possession
of all territory adjacent to, or not separated by foreign possessions
from, the United States.
5. There is no ground for anticipating an immediate war with Japan since
she has been compelled to come to our terms in the recent disputes.
III. What methods of refutation are employed by Burke in his Speech on
Conciliation? By Webster in his Reply to Hayne?
IV. In the next class debate point out and name all the methods of refutation
employed by your opponents and yourself.
APPENDICES
APPENDIX A: The Lincoln-Douglas Debate at Alton 273

APPENDIX B: Brief of the Lincoln-Douglas Debate at Alton 317
APPENDIX C: Lincoln’s Cooper Institute Speech 324
APPENDIX D: Memorandum of Agreement for High School Debating League
under the Direction of a College or University 342
APPENDIX E: Debating Agreement for a League composed of Five Institutions 346
APPENDIX F: Memorandum of Agreement for a Triangular Debating League 352
APPENDIX G: Propositions 355
APPENDIX A
The Lincoln-Douglas Debate at Alton
[October 15, 1858]
SENATOR DOUGLAS’S SPEECH
Ladies and Gentlemen: It is now nearly four months since the

canvass between Mr. Lincoln and myself commenced. On the 16th of
June the Republican Convention assembled at Springfield and
nominated Mr. Lincoln as their candidate for the United States
Senate, and he, on that occasion, delivered a speech in which he
laid down what he understood to be the Republican creed and the
platform on which he proposed to stand during the contest. The
principal points in that speech of Mr. Lincoln’s were: First, that this
government could not endure permanently divided into Free and
Slave States, as our fathers made it; that they must all become free
or all become slave; all become one thing, or all become the other,—
otherwise this Union could not continue to exist. I give you his
opinions almost in the identical language he used. His second
proposition was a crusade against the Supreme Court of the United
States because of the Dred Scott decision, urging as an especial
reason for his opposition to that decision that it deprived the
negroes of the rights and benefits of that clause in the Constitution
of the United States which guarantees to the citizens of each State
all the rights, privileges, and immunities of the citizens of the several
States. On the 10th of July I returned home, and delivered a speech
to the people of Chicago, in which I announced it to be my purpose
to appeal to the people of Illinois to sustain the course I had
pursued in Congress. In that speech I joined issue with Mr. Lincoln
on the points which he had presented. Thus there was an issue clear
and distinct made up between us on these two propositions laid
down in the speech of Mr. Lincoln at Springfield, and controverted by
me in my reply to him at Chicago. On the next day, the 11th of July,
Mr. Lincoln replied to me at Chicago, explaining at some length and
reaffirming the positions which he had taken in his Springfield
speech. In that Chicago speech he even went further than he had
before, and uttered sentiments in regard to the negro being on an
equality with the white man. He adopted in support of this position
the argument which Lovejoy and Codding and other Abolition
lecturers had made familiar in the northern and central portions of
the State; to wit, that the Declaration of Independence having
declared all men free and equal, by divine law, also that negro
equality was an inalienable right, of which they could not be
deprived. He insisted, in that speech, that the Declaration of
Independence included the negro in the clause asserting that all
men were created equal, and went so far as to say that if one man
was allowed to take the position that it did not include the negro,
others might take the position that it did not include other men. He
said that all these distinctions between this man and that man, this
race and the other race, must be discarded, and we must all stand
by the Declaration of Independence, declaring that all men were
created equal.
The issue thus being made up between Mr. Lincoln and myself on
three points, we went before the people of the State. During the
following seven weeks, between the Chicago speeches and our first
meeting at Ottawa, he and I addressed large assemblages of the
people in many of the central counties. In my speeches I confined
myself closely to those three positions which he had taken,
controverting his proposition that this Union could not exist as our
fathers made it, divided into Free and Slave States, controverting his
proposition of a crusade against the Supreme Court because of the
Dred Scott decision, and controverting his proposition that the
Declaration of Independence included and meant the negroes as
well as the white men, when it declared all men to be created equal.
I supposed at that time that these propositions constituted a distinct
issue between us, and that the opposite positions we had taken
upon them we would be willing to be held to in every part of the
State. I never intended to waver one hair’s breadth from that issue
either in the north or the south or wherever I should address the
people of Illinois. I hold that when the time arrives that I cannot
proclaim my political creed in the same terms, not only in the
northern, but in the southern part of Illinois, not only in the
Northern, but the Southern States, and wherever the American flag
waves over American soil, that then there must be something wrong
in that creed; so long as we live under a common Constitution, so
long as we live in a confederacy of sovereign and equal States,
joined together as one for certain purposes, that any political creed
is radically wrong which cannot be proclaimed in every State and
every section of that Union, alike. I took up Mr. Lincoln’s three
propositions in my several speeches, analyzed them, and pointed out
what I believed to be the radical errors contained in them. First, in
regard to his doctrine that this government was in violation of the
law of God, which says that a house divided against itself cannot
stand, I repudiated it as a slander upon the immortal framers of our
Constitution. I then said, I have often repeated, and now again
assert, that in my opinion our government can endure forever,
divided into Free and Slave States as our fathers made it,—each
State having the right to prohibit, abolish, or sustain slavery, just as
it pleases. This government was made upon the great basis of the
sovereignty of the States, the right of each State to regulate its own
domestic institutions to suit itself; and that right was conferred with
the understanding and expectation that inasmuch as each locality
had separate interests, each locality must have different and distinct
local and domestic institutions, corresponding to its wants and
interests. Our fathers knew when they made the government that
the laws and institutions which were well adapted to the Green
Mountains of Vermont were unsuited to the rice plantations of South
Carolina. They knew then, as well as we know now, that the laws
and institutions which would be well adapted to the beautiful prairies
of Illinois would not be suited to the mining regions of California.
They knew that in a Republic as broad as this, having such a variety
of soil, climate, and interest, there must necessarily be a
corresponding variety of local laws,—the policy and institutions of
each State adapted to its condition and wants. For this reason this
Union was established on the right of each State to do as it pleased
on the question of slavery, and every other question; and the various
States were not allowed to complain of, much less interfere with, the
policy of their neighbors.
Suppose the doctrine advocated by Mr. Lincoln and the
Abolitionists of this day had prevailed when the Constitution was
made, what would have been the result? Imagine for a moment that
Mr. Lincoln had been a member of the Convention that framed the
Constitution of the United States, and that when its members were
about to sign that wonderful document, he had arisen in that
Convention as he did at Springfield this summer, and, addressing
himself to the President, had said, “A house divided against itself
cannot stand; this government, divided into Free and Slave States
cannot endure, they must all be free or all be slave; they must all be
one thing, or all the other,—otherwise, it is a violation of the law of
God, and cannot continue to exist;”—suppose Mr. Lincoln had
convinced that body of sages that that doctrine was sound, what
would have been the result? Remember that the Union was then
composed of thirteen States, twelve of which were slaveholding, and
one free. Do you think that the one Free State would have outvoted
the twelve slaveholding States, and thus have secured the abolition
of slavery? On the other hand, would not the twelve slaveholding
States have outvoted the one free State, and thus have fastened
slavery, by a constitutional provision, on every foot of the American
Republic forever? You see that if this Abolition doctrine of Mr. Lincoln
had prevailed when the government was made, it would have
established slavery as a permanent institution in all the States,
whether they wanted it or not; and the question for us to determine
in Illinois now, as one of the Free States, is whether or not we are
willing, having become the majority section, to enforce a doctrine on
the minority which we would have resisted with our heart’s blood
had it been attempted on us when we were in a minority. How has
the South lost her power as the majority section in this Union, and
how have the Free States gained it, except under the operation of
that principle which declares the right of the people of each State
and each Territory to form and regulate their domestic institutions in
their own way? It was under that principle that slavery was
abolished in New Hampshire, Rhode Island, Connecticut, New York,
New Jersey, and Pennsylvania; it was under that principle that one-
half of the slaveholding States became free; it was under that
principle that the number of Free States increased until, from being
one out of twelve States, we have grown to be the majority of States
of the whole Union, with the power to control the House of
Representatives and Senate, and the power, consequently, to elect a
President by Northern votes, without the aid of a Southern State.
Having obtained this power under the operation of that great
principle, are you now prepared to abandon the principle and declare
that merely because we have the power you will wage a war against
the Southern States and their institutions until you force them to
abolish slavery everywhere?
After having pressed these arguments home on Mr. Lincoln for
seven weeks, publishing a number of my speeches, we met at
Ottawa in joint discussion, and he then began to crawfish a little,
and let himself down. I there propounded certain questions to him.
Amongst others, I asked him whether he would vote for the
admission of any more Slave States, in the event the people wanted
them. He would not answer. I then told him that if he did not answer
the question there, I would renew it at Freeport, and would then trot
him down into Egypt, and again put it to him. Well, at Freeport,
knowing that the next joint discussion took place in Egypt, and being
in dread of it, he did answer my question in regard to no more Slave
States in a mode which he hoped would be satisfactory to me, and
accomplish the object he had in view. I will show you what his
answer was. After saying that he was not pledged to the Republican
doctrine of “no more Slave States,” he declared:
“I state to you freely, frankly, that I should be exceedingly sorry to
ever be put in the position of having to pass upon that question. I
should be exceedingly glad to know that there never would be
another Slave State admitted into this Union.”
Here permit me to remark, that I do not think the people will ever
force him into a position against his will. He went on to say:
“But I must add, in regard to this, that if slavery shall be kept out
of the Territory during the Territorial existence of any one given
Territory, and then the people should, having a fair chance and a
clear field, when they come to adopt a constitution, if they should do
the extraordinary thing of adopting a slave constitution uninfluenced
by the actual presence of the institution among them, I see no
alternative, if we own the country, but we must admit it into the
Union.”
That answer Mr. Lincoln supposed would satisfy the old line Whigs,
composed of Kentuckians and Virginians, down in the southern part
of the State. Now, what does it amount to? I desired to know
whether he would vote to allow Kansas to come into the Union with
slavery or not, as her people desired. He would not answer, but in a
roundabout way said that if slavery should be kept out of a Territory
during the whole of its Territorial existence, and then the people,
when they adopted a State Constitution, asked admission as a Slave
State, he supposed he would have to let the State come in. The case
I put to him was an entirely different one. I desired to know whether
he would vote to admit a State if Congress had not prohibited
slavery in it during its Territorial existence, as Congress never
pretended to do under Clay’s Compromise measures of 1850. He
would not answer, and I have not yet been able to get an answer
from him. I have asked him whether he would vote to admit
Nebraska, if her people asked to come in as a State with a
constitution recognizing slavery, and he refused to answer. I have
put the question to him with reference to New Mexico, and he has
not uttered a word in answer. I have enumerated the Territories, one
after another, putting the same question to him with reference to
each, and he has not said, and will not say, whether, if elected to
Congress, he will vote to admit any Territory now in existence with
such a constitution as her people may adopt. He invents a case
which does not exist, and cannot exist under this government, and
answers it; but he will not answer the question I put to him in
connection with any of the Territories now in existence. The contract
we entered into with Texas when she entered the Union obliges us
to allow four States to be formed out of the old State, and admitted
with or without slavery, as the respective inhabitants of each may
determine. I have asked Mr. Lincoln three times in our joint
discussions whether he would vote to redeem that pledge, and he
has never yet answered. He is as silent as the grave on the subject.
He would rather answer as to a state of the case which will never
arise than commit himself by telling what he would do in a case
which would come up for his action soon after his election to
Congress. Why can he not say whether he is willing to allow the
people of each State to have slavery or not as they please, and to
come into the Union, when they have the requisite population, as a
Slave or a Free State as they decide? I have no trouble in answering
the question. I have said everywhere, and now repeat it to you, that
if the people of Kansas want a Slave State they have a right, under
the Constitution of the United States, to form such a State, and I will
let them come into the Union with slavery or without, as they
determine. If the people of any other Territory desire slavery, let
them have it. If they do not want it, let them prohibit it. It is their
business, not mine. It is none of our business in Illinois whether
Kansas is a Free State or a Slave State. It is none of your business in
Missouri whether Kansas shall adopt slavery or reject it. It is the
business of her people, and none of yours. The people of Kansas
have as much right to decide that question for themselves as you
have in Missouri to decide it for yourselves, or we in Illinois to decide
it for ourselves.
And here I may repeat what I have said in every speech I have
made in Illinois, that I fought the Lecompton Constitution to its
death, not because of the slavery clause in it, but because it was not
the act and deed of the people of Kansas. I said then in Congress,
and I say now, that if the people of Kansas want a Slave State, they
have a right to have it. If they wanted the Lecompton Constitution,
they had a right to have it. I was opposed to that constitution
because I did not believe that it was the act and deed of the people,
but, on the contrary, the act of a small, pitiful minority acting in the
name of the majority. When at last it was determined to send that
constitution back to the people, and, accordingly, in August last, the
question of admission under it was submitted to a popular vote, the
citizens rejected it by nearly ten to one, thus showing conclusively
that I was right when I said that the Lecompton Constitution was
not the act and deed of the people of Kansas, and did not embody
their will.
I hold that there is no power on earth, under our system of
government, which has the right to force a constitution upon an
unwilling people. Suppose that there had been a majority of ten to
one in favor of slavery in Kansas, and suppose there had been an
Abolition President and an Abolition Administration, and by some
means the Abolitionists succeeded in forcing an Abolition
Constitution upon those slaveholding people, would the people of
the South have submitted to that act for an instant? Well, if you of
the South would not have submitted to it a day, how can you, as fair,
honorable, and honest men, insist on putting a slave constitution on
a people who desire a Free State? Your safety and ours depend upon
both of us acting in good faith, and living up to that great principle
which asserts the right of every people to form and regulate their
domestic institutions to suit themselves, subject only to the
Constitution of the United States.
Most of the men who denounced my course on the Lecompton
question objected to it, not because I was not right, but because
they thought it expedient at that time, for the sake of keeping the
party together, to do wrong. I never knew the Democratic party to
violate any one of its principles, out of policy or expediency, that it
did not pay the debt with sorrow. There is no safety or success for
our party unless we always do right, and trust the consequences to
God and the people. I chose not to depart from principle for the
sake of expediency on the Lecompton question, and I never intend
to do it on that or any other question.
But I am told that I would have been all right if I had only voted
for the English bill after the Lecompton was killed. You know a
general pardon was granted to all political offenders on the
Lecompton question, provided they would only vote for the English
bill. I did not accept the benefits of that pardon for the reason that I
had been right in the course I had pursued, and hence did not
require any forgiveness. Let us see how the result has been worked
out. English brought in his bill referring the Lecompton Constitution
back to the people, with the provision that if it was rejected, Kansas
should be kept out of the Union until she had the full ratio of
population required for member of Congress,—thus in effect
declaring that if the people of Kansas would only consent to come
into the Union under the Lecompton Constitution, and have a Slave
State when they did not want it, they should be admitted with a
population of 35,000; but that if they were so obstinate as to insist
upon having just such a constitution as they thought best, and to
desire admission as a free State, then they should be kept out until
they had 93,420 inhabitants. I then said, and I now repeat to you,
that whenever Kansas has people enough for a Slave State she has
people enough for a Free State. I was, and am willing to adopt the
rule that no State shall ever come into the Union until she has the
full ratio of population for a member of Congress, provided that rule
is made uniform. I made that proposition in the Senate last winter,
but a majority of the Senators would not agree to it; and I then said
to them, If you will not adopt the general rule, I will not consent to
make an exception of Kansas.
I hold that it is a violation of the fundamental principles of this
government to throw the weight of Federal power into the scale,
either in favor of the Free or the Slave States. Equality among all the
States of this Union is a fundamental principle in our political system.
We have no more right to throw the weight of the Federal
Government into the scale in favor of the slaveholding than the Free
States, and last of all should our friends in the South consent for a
moment that Congress should withhold its powers either way when
they know that there is a majority against them in both Houses of
Congress.
Fellow-citizens, how have the supporters of the English bill stood
up to their pledges not to admit Kansas until she obtained a
population of 93,420 in the event she rejected the Lecompton
Constitution? How? The newspapers inform us that English himself,
whilst conducting his canvass for re-election, and in order to secure
it, pledged himself to his constituents that if returned he would
disregard his own bill and vote to admit Kansas into the Union with
such population as she might have when she made application. We
are informed that every Democratic candidate for Congress in all the
States where elections have recently been held was pledged against
the English bill, with perhaps one or two exceptions. Now, if I had
only done as these anti-Lecompton men who voted for the English
bill in Congress, pledging themselves to refuse to admit Kansas if
she refused to become a Slave State until she had a population of
93,420 and then returned to their people, forfeited their pledge, and
made a new pledge to admit Kansas at any time she applied,
without regard to population, I would have had no trouble. You saw
the whole power and patronage of the Federal Government wielded
in Indiana, Ohio, and Pennsylvania to re-elect anti-Lecompton men
to Congress who voted against Lecompton, then voted for the
English bill, and then denounced the English bill, and pledged
themselves to their people to disregard it. My sin consists in not
having given a pledge, and then in not having afterward forfeited it.
For that reason, in this State, every postmaster, every route agent,
every collector of the ports, and every Federal officeholder forfeits
his head the moment he expresses a preference for the Democratic
candidates against Lincoln and his Abolition associates. A Democratic
Administration which we helped to bring into power deems it
consistent with its fidelity to principle and its regard to duty to wield
its power in this State in behalf of the Republican Abolition
candidates in every county and every Congressional District against
the Democratic party. All I have to say in reference to the matter is,
that if that Administration have not regard enough for principle, if
they are not sufficiently attached to the creed of the Democratic
party, to bury forever their personal hostilities in order to succeed in
carrying out our glorious principles, I have. I have no personal
difficulty with Mr. Buchanan or his Cabinet. He chose to make certain
recommendations to Congress, as he had a right to do, on the
Lecompton question. I could not vote in favor of them. I had as
much right to judge for myself how I should vote as he had how he
should recommend. He undertook to say to me, “If you do not vote
as I tell you, I will take off the heads of your friends.” I replied to
him, “You did not elect me. I represent Illinois, and I am
accountable to Illinois, as my constituency, and to God; but not to
the President or to any other power on earth.”
And now this warfare is made on me because I would not
surrender my convictions of duty, because I would not abandon my
constituency, and receive the orders of the executive authorities as
to how I should vote in the Senate of the United States. I hold that
an attempt to control the Senate on the part of the Executive is
subversive of the principles of our Constitution. The Executive
department is independent of the Senate, and the Senate is
independent of the President. In matters of legislation the President
has a veto on the action of the Senate, and in appointments and
treaties the Senate has a veto on the President. He has no more
right to tell me how I shall vote on his appointments than I have to
tell him whether he shall veto or approve a bill that the Senate has
passed. Whenever you recognize the right of the Executive to say to
a Senator, “Do this, or I will take off the heads of your friends,” you
convert this government from a republic into a despotism. Whenever
you recognize the right of a President to say to a member of
Congress, “Vote as I tell you, or I will bring a power to bear against
you at home which will crush you,” you destroy the independence of
the representative and convert him into a tool of Executive power. I
resisted this invasion of the constitutional rights of a Senator, and I
intend to resist it as long as I have a voice to speak or a vote to
give. Yet Mr. Buchanan cannot provoke me to abandon one iota of
Democratic principles out of revenge or hostility to his course. I
stand by the platform of the Democratic party, and by its
organization, and support its nominees. If there are any who choose
to bolt, the fact only shows that they are not as good Democrats as
I am.
My friends, there never was a time when it was as important for
the Democratic party, for all national men, to rally and stand
together, as it is to-day. We find all sectional men giving up past
differences and continuing the one question of slavery; and when we
find sectional men thus uniting we should unite to resist them and
their treasonable designs. Such was the case in 1850, when Clay left
the quiet and peace of his home, and again entered upon public life
to quell agitation and restore peace to a distracted Union. Then we
Democrats, with Cass at our head, welcomed Henry Clay, whom the
whole nation regarded as having been preserved by God for the
times. He became our leader in that great fight, and we rallied
around him the same as the Whigs rallied around old Hickory in
1832 to put down nullification. Thus you see that whilst Whigs and
Democrats fought fearlessly in old times about banks, the tariff,
distribution, the specie circular, and the sub-treasury, all united as a
band of brothers when the peace, harmony, or integrity of the Union
was imperiled. It was so in 1850, when Abolitionism had even so far
divided this country, North and South, as to endanger the peace of
the Union; Whigs and Democrats united in establishing the
Compromise Measures of that year, and restoring tranquillity and
good feeling.
These measures passed on the joint action of the two parties.
They rested on the great principle that the people of each State and
each Territory should be left perfectly free to form and regulate their
domestic institutions to suit themselves. You Whigs and we
Democrats justified them in that principle. In 1854, when it became
necessary to organize the Territories of Kansas and Nebraska, I
brought forward the bill on the same principle. In the Kansas-
Nebraska bill you find it declared to be the true intent and meaning
of the Act not to legislate slavery into any State or Territory, nor to

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2008 2009 Basic and Clinical Science Course Section 2

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t::I~ AMERICAN ACADEMY

The American Academy of Ophthalmology is accredited by the Accreditation Coun-

The American Academy of Ophthalmology designates this educational activity for a

Gregory L. Skuta, MD, Oklahoma City, Oklahoma, Senior Secretary for

Faculty Responsible for This Edition

Recent Past Faculty

In addition, the Academy gratefully acknowledges the contributions of numerous past

t::I~ AMERICAN ACADEMY

655 Beach Street

3 Optics of the Human Eye. 105

Schematic Eyes. . . . . . . . . . . . . . 105

4 Clinical Refraction . . 125

Trifocal Lenses . . . . . . . . . . 152

5 Contact Lenses. 173

6 Intraocular Lenses . . 213

Optical Considerations for IOLs . 215

7 Optical Considerations in Refractive Surgery. 231

8 Vision Rehabilitation. 243

School-Age Children .266

9 Telescopes and Optical Instruments 269

Appendix: Common Guidelines for Prescribing Cylinders . 325

Organization of the Course

Study Ouestions and CME Credit

· compare and contrast physical and geometrical optics

· outline the principles of light propagation and image formation

· describe the clinical application of Snell's law and the lens

Frequency Wavelength Optical Visible

10'. Cosmic rays

Photon (Particle) Aspects of Light

Interference and Coherence

Figure '-5 Interference. A represents constructive interference; B indicates destructive inter-

Temporal, or longitudinal, coherence is the ability of 1 wave of a beam to interfere with a

Applications of Interference and Coherence

Figure 1-6 Destructive interference by an antireflection film. (Redrawn by C H. Wooley.)

Transmission and Absorption

Figure 1-11 The amount of power (W) at each

Table 1-2 Recommended Illumination Levels

Properties of laser Light

Table '.3 Radiometric Terminology for Medical lasers

* 1 joule = 1 watt x 1 sec.

CLINICAL EXAMPLE 2-1

A Subject's eye Examiner's eye

Subject's eye Aperture Examiner's eye

Imaging with Lenses and Mirrors

(2). Mistaking an effect for a cause.

The fallacy of mistaking an effect for a cause consists in pointing

(3). Mistaking a subsequent cause for a real cause.

(4). Mistaking an insufficient cause for a sufficient cause.

This fallacy differs from those previously discussed in that there