• Fogging Method

    THE FOGGING METHOD

    The cornerstone for the work of an ophthalmologist and optometrist is in-depth knowledge and understanding of the accommodation event. Revealing latent hyperopia as well as pseudomyopia will always be the yardstick for the quality of work of these professionals.

    A prerequisite for being successful is mastering the fogging method, which is the aim of my books Tetralogia and Panacea. The fogging method has been known and also used through the ages, but in such an ineffective form.

    I have developed this method further into a ”polyphasic fogging method”, which will not let the examiner down. If one trick will not work, e.g. the relaxation will not progress, we must resort to another, as there are innumerable variations. Each one of the different methods is accurately described, and no detail is unnecessary. This is something you have to just believe and accept, if you wish to achieve mastery. Experience will then bring so much illumination to the matter, that over the years the examination will become less cumbersome.

    Those interested in my method can read all about it in my works. I will only mention a few central issues:
    One must understand that with fogging, one aims at voluntary, knowing prevention of the phase of adjustment, thus also preventing the exact focussing which provokes the spasm of accommodation. In this, 1-2-3 dioptres will be no help, and the fogging needs to be strong enough to, for a start, make the distinguishing of even the biggest details impossible. There is no upper limit for the dioptres! One should also all the time ensure that the patients blinks as little as possible, as blinking also maintains accommodation tension. You often see the stream of tears starting just at the end of the blinking, and this is when the relaxation of accommodation takes place. I here refer to a patient description in Feedback for visits to me.

    The examination is always started binocularly, with both eyes fogged and the patient not being allowed even to glance at the vision acuity test chart in beforehand. At the end you can test the acuity separately for both eyes, which the patient usually always is interested in, with whatsoever glasses, but this will not be the basis for any prescription for glasses.

    We must remember that continuing merely with fogging may result in the opposite effect; stretching or relaxing of a smooth muscle as such provokes a contractions (Guyton. Textbook of Medical Physiology, 1964, s.256.W.B. Saunders Company. Philadelphia and London) This is why the “unsuspecting, virgin” answers at the beginning are important in the fogging method.

    Confirmation test or flipper test

    One of the most efficient ways of getting results with fogging is the confirmation test, the name of the instrument below.

    flipper

    I have several of these as ± 0,25, ± 0.5, ± 0,75, ± 2,0(which enables fogging of 4 dioptres instantly),
    and also custom made flipper cylinders ±0.5 as a direct and on the other side ±0.25 as an indirect cylinder.

    flipper-2

    As much as I have advised my colleagues to purchase them, only few have done it.

    In general when prescribing glasses, we should not strive for excessive acuity (which the whole world of optic business is toting in the advertising), as this is precisely what will destroy the whole treatment. The patient usually finds relief for hisailments not in focussing his vision but in alleviating the accommodation strain. This is almost another dogma. Vision acuity of 1.0 is therapeutically adequate. The best is the enemy of the good, even in this case.

    The fogging method is also known by another name: CYCLODAMIA.

    This is a non-cycloplegic (binocular) method of refraction employing a fogging technique for relaxing accommodation, especially one based on an excessive amount of convex sphere and not drugs inhibiting accommodation. This is how we can determine acuity reduction gradients, from which the refractive error can be estimated by extrapolation. In other words, this is the conventional fogging method under a different name.