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Refraction
Consists of :
General Optics
The optical system of the eye
Clinical anomalies : refractive errors
Optic
Dioptri (D) : Lens power unit, is an inverse
of focal distance in meters
D = 1/f
1 D lens, parallel light will be directed into
focal spot in 1 meter distance
2 D = 1/f ----> f = ?
If f = 25 cm , ----> D = ?
Parallel rays will be converged to the focus ---> Plus lens (+)
Principles
Rays coming from distance > 5 m
parallel rays
Rays coming from distance < 5m
divergent rays
Spherical lens
Is a lens with the same curvature diameter in
all meridians
Spherical Lens :
Plus sphere : Convex
characteristic : makes larger and nearer images
+2
+2
Biconvex
+4
Plano K
+5
-1
Concave K
-2
-2
Bi Concave
Plano K
-4
+1
-5
Convex K
Cylindrical Lens
Is a kind of lens that have two
meridians that are perpendicular
to each other
The meridian that has no power
is called the axis
The other meridian, has the
power
Spherocylindrical Lens
Is a combination between spherical lens and
cylindrical lens
Example :
C + 1.00 D X 90 0
S + 2.00 D
0.00
+ 2.00
+ 2.00
+ 2.00
0.00
+ 1.00
+ 2.00
+ 1.00
+ 2.00
+ 3.00
Transposition
Methods :
Sphere : Sum with algebra ways SPH + CYL
Cylinder : replace power marks (Neg
Pos),
axis change 90 degrees
Example : S + 2.00 C + 1.00 X 900
S + 3.00
C - 1.00 X 1800
Refraction media :
Cornea
Humour Aqueous
Lens
Vitreous body
n = 1.33
n = 1.33
n = 1,41
n = 1.33
: 60 dioptri
: 40 dioptri
: 20 dioptri
Accommodation Process
Capability of adding the refraction power of the
eye, by increasing the convexity of the lens
normal : rays that come from > 5 m - distance
object regarded as parallel light; the eyes are in
relax position, the images are focused right on
the retina (fovea centralis)
This accommodation
process happens as a
result from the
contraction of M. ciliaris
in the ciliary body
Near Reflex
Refraction Anomalies
Normal : Emetropia
Anomalies : (ametropia)
Myopia
Hypermetropia
Astigmatism
Presbiopia
Emmetropia
Is the condition when the parallel rays focused
exactly on the retina of the eye in relax condition
---> the visual acuity is maximum
Ametropia
Is the condition when the parallel rays are not
focused exactly on the retina of the eye in relax
condition.
The focal point may be behind or in front of the
retina
Myopia
Refractive condition in which, with
accommodation completely relaxed, parallel
rays are brought to a focus in front of the retina.
Myopic eye : refractive state over plus power
Curvature :
The size of the eye ball ---> normal, but there is a increasing of the
cornea/lens curvature
The change of the lens e.g. : intumescens cataract
Clinical findings :
Farsightedness are blurred, nearsightedness are normal
Asthenopia
On high myopia : hemeralopia occurred caused by
periphery retinal degeneration
Floating spots visualization caused by vitreous
degeneration
screw up the eye lids together, in order to get a better
vision
Complication :
Commonly occurred on high myopia
1. Degenarated and liquefied vitreous
2. Retinal detachment
3. Pigmentation changes + Macular bleeding
4. Strabismus
Myopia classification :
< 3.00 D
= low myopia
3.00 - 6.00 D= moderate myopia
> 6.00 D
= high myopia/gravis
Treatment :
Low and moderate myopia : full correction with
weakest spherical lens that give the best visual acuity
Example :
VOD = 5/60
S -2.50 D = 6/7
S -2.75 D = 6/6
S -3.00 D = 6/6
S -3.25 D = 6/7
The glasses are S - 2.75 D
Prognosis :
Simplex/stationer, after puberty will be constant
Progressive myopia, the myopia will be
continuously higher and complication may
occurred
Hypermetropia
Is a refraction anomaly that without accommodation
parallel rays will be focused behind the retina
Divergent rays from near object, will be focused farther
behind the retina
Etiology :
Axial ---> eye ball diameter < N
Deminished convexity of cornea/lens curvature
Decreasing Refractive index
Changed lens position
Clinical manifestation :
H. Manifest ---> is detected without
paralazing accommodation and is represented
by the strongest convex glass needed , the
patient sees most distinctly. It correspons to the
amount of accommodation which he relaxes
when a convex lens is placed before the eye.
Devided into two types :
Facultative : Can be overcome by an effort of
accommodation
Absolute : Can not be overcome
Hypermetrop
Latent Hypermetrop
Hypermetrop manifest
Clinical finding :
Nearsightness are blurred
High hypermetropia at old age : farsightedness
also blurred
Astenophia accommodative (eye strain)
Children : high hypermetropia usually
occurring convergent strabismus (convergent
squint)
Treatment :
If foria/tropia not present, apply strongest
positive spherical lens that give the best visual
acuity
If foria/tropia present, total hypermetrop
correction. If necessary : bifocal eye glasses
astigmatism
Refractive condition of the eye in which there is a
difference in degree of refraction in diferent
meridian, each will focused parallel rays at a
different point. The shape of the images :
Line, oval, circle, never a point
Manifestation :
Regular astigmatism
Difference in the degree of refraction in every
meredian.
Two principles meridian :
Maximmum refraction
Minimum refraction
Right angle
to each other
Irregular astigmatism
Difference in refraction not only in different
meridians, but also in different parts of the same
meridian.
Etiology of astigmatism :
Corneal curvature disturbances ---> 90%
Lens curvature disturbances ---> 10%
Type of Astigmatism :
Ast. M. Simplex
C-2.00 X 90
Ast. H. Simplex
C+2.00 X 45
Ast. M Compositium
S-1.50 C-1.00 X 60
Ast. H Compositium
S+3.00 C+2.00 X 30
0
0
0
0
0
Ast. M. Simplex
Ast. M Compositium
Ast. H. Simplex
Ast. H Compositium
Ast. Mixtus
Presbiopia
Physiological changes because accommodation
capability is lowering at old age
Accommodation
16
10
6
2
10
20
40
50
60
Age
Presbiopia correction :
40 years old
45 years old
50 years old
55 years old
60 years old
S + 1.00 D
S + 1.50 D
S + 2.00 D
S + 2.50 D
S + 3.00 D
Refraction Examination
Technique
Subjective :
Snellen chart/projector, alphabet , inverse E, picture,
Landolt ring
Trial lens
Trial frame
Objective :
Children, incooperative, difficult correction, strabismus :
Ophthlamoscopy
Retinoscopy
Refractometer
Subjective
Check firstly just one eye : OD
Distance : 5 or 6 meters
VOD : ...(basic right eye visus)
a. Trial and error
apply S + 0.50, better visus , add S+ until visus = 6/6
S +0.50, lower visus, change to S -, increase S - until visus
= 6/6
S +/- not working ----> cylindrical
With astigmatism dial, stenoplic slit, cross cylinder
astigmatism dial :
Blurred line ----> C negative lens axis
Nearsightedness/read
Both eyes at one time at required distance : use jaeger
chart
Example :
ODS 6/6
I. AVOD 2/60 S - 3.50 = 6/6
headache, eye strain
AVOS 3/60 S - 3.00 = 6/6
ODS 6/6
II.AVOD 2/60 S - 3.00 = 6/7
w/o headache, eye strain
AVOS 3/60 S - 2.75 = 6/7
read ADD S + 1.50
Give Eye Glasses according to II
Objective
Use cyclopegic
1. Ophthlamoscopy : papilla clearly seen with
which lens
2. Retinoscopy :
Ordinary ---> light source outside
streak -----> light source inside
3. Refactometer
Computerized
Lensmeter principal
Ideally :
Subjective
Objective with cyclopegic
Subjective once more without cyclopegic
Lens meter
Measuring lens power
Measuring focus distance
Eye Glasses
Monofocal
Bifocal
Progressive
M.
E.
H.
H
E.
Antimetropia
Vision in Anisometrop
difference < 2.50 D : still get fusion + single
binocular vision
difference > 2.50 D : fusion difficulties ---->
weak eye suppression ---> amblyopic
alternans vision : left and right alternate
Aniseikonia :
The difference of shape and size of the images
between right and left eye
Contact lens :
Indication :
High anisometropia
irregular astigmatism
Front asymmetry, orbit
Aniridia
Descemetocele
Sports
Cosmetics