REFRAkSI

jannes fritz tan

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 Bending Light
Prism A triangular piece of glass, plastic, etc with
an Apex & a Base
Light is bent (refracted) toward the base of the
prism
Apex

Apex Apex

Base

Base BAGIAN MATA FK UKI Base

 Refractive Lenses
Refractive lenses are combinations of different
shaped prisms

Convex Lens Concave Lens

Convergent BAGIAN MATA FK UKI Divergent
 Optics Terminology
Parallel Light Rays Assumed to be parallel if they
emanate from a distance source

Divergent Light Rays Appear to be

spreading apart in relationship to their close
proximity to the eye

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Refractive Lens Configurations

Convergent
Lenses

Biconvex Plano-Convex Convex-Meniscus

Divergent
Lenses

Biconcave Plano-Concave Concave-Meniscus

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 Focal Length
The distance from the center of the lens at which
light rays Converge
The power of the lens is measured in Diopters (D)
Higher power lens move the focal point closer to
the lens

Paraxial Rays 1.0 D Lens = Focal length

of 1 meter

Axial Ray
No Refraction
Focal
Point

4.0 D Lens = 0.025 meter

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 External Eye Anatomy

Superior Lachrymal
Tarsal Lid Papillae

Semilunar
Fold
Lateral Caruncle
Canthus
Medial
Canthus
Sclera
(Conjunctiva)
Limbus
Cornea
Iris
Pupil

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 Internal Eye Anatomy
Zonular
Ciliary Fibers Ocular
Muscle Muscles

Superior
Fornix
Macula
(Fovea)
Cornea
Vitreous
Iris Face
Optic
Pupil Vitreous Nerve
Body
Lens
{
Limbus
Inferior
Fornix
Sensory
Retinal
Layer
Anterior Posterior
Chamber BAGIAN MATA FK UKI
Chamber
Corneal Morphology
Corneal Diameter
11 - 13 mm

Central Corneal
Diameter
5 - 7 mm

{500 - 550

900
-
0
70
Intraocular
{

Pressure
13-19 mm Hg

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 Corneal Curvature
Average Cornea
44.00 Diopters

Steep Cornea Flap Cornea

47.00 Diopters 40.00 Diopters

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 Index of Refraction
As light travels through glass, water or tissue, it slows
down
Light is bent as it strikes a material at an oblique
angle
A higher Index yields greater refraction
Index of
Substance Refraction
Air 1.00 (186,000 miles/sec)
Water 1.33 (146,000 miles/sec)
Aqueous 1.336
Cornea 1.37 (136,765 miles/sec)
Lens Cortex 1.38
Lens Nucleus 1.40
PMMA Plastic 1.49 (124,832 miles/sec)
Crown Glass 1.52
Flint Glass 1.65

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Tajam penglihatan dapat diperiksa dengan
menggunakan :
Kartu Snellen
Hitung jari
Senter

AV :
NLP/ No Light Perception
1/~ proyeksi
1/300
1/60
5/60
6/40
6/15
6/6
6/6 E
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Emmetropia
Distance Vision

Parallel (distant images)

light is refracted by the
Cornea & the Lens

Light is focused on the

Fovea & images are clear

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Emmetropia
Near Vision
Divergent (near images)
light rays focus behind
the retina
The lens changes shape
(more convex) to focus
near images on the
retina (accommodation)

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 Presbyopia
Decreasing Accommodation

The aging eye starts to

lose its ability to
accommodate
The lens can not
accommodate enough
to focus near images

Bifocals or reading
glasses are required

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 Myopia
Nearsightedness

The Cornea is too Steep

&/or the eye is too Long
for its refractive
capability

Parallel (distant images)

rays are focused in front
of the fovea

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Correcting Myopia
Contact Lenses or Glasses

A CONCAVE lens diverges

parallel light rays

The focal point moves

back & distant images
are clear

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Correcting Myopia
Laser Refractive Surgery

The cornea is reshaped,

decreasing its convergent
power

Parallel rays of light

focus on the fovea

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 Myopia
Near Vision

The Divergent rays of

objects near the eye are
focused by the cornea
& lens

Nearsighted people,
without their glasses, can
often focus near objects
on the retina with little or
no accommodation
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Hyperopia
Farsightedness

The Cornea is too Flat

&/or the eye is too Short

Light focuses in back

of the Fovea

Both Distant & Near

images are blurred

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 Hyperopia
Latent or Manifest Hyperopes

Young farsighted people

can use accommodation to
focus distant objects

Latent or Manifest Hyperopes

will eventually need distance
& reading glasses as their
accommodative potential
decreases with age

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Correcting Hyperopia
Absolute Hyperopes

Full accommodation does

not have enough power to
focus distant images on the
retina

A Convex lens is required to

converge light rays on the
fovea

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Correcting Hyperopia
Laser Vision Correction

The peripheral cornea is

reshaped with the excimer
laser

A Convex lens is required to

converge light rays on the
fovea

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Hyperopia
Near Vision

Latent or Manifest Hyperopes

usually need glasses to read
because they have used all
their accommodative
potential to correct their
distance vision

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Astigmatism

The Cornea is Steep in

one axis & Flat in the
other

F1 F2 Multiple focal points in

the eye

Images are blurred &/or

distorted

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 Astigmatism
With-The-Rule Against-The-Rule
Astigmatism Astigmatism
Steep Axis Vertical Steep Axis Horizontal
90 90

45 D 42 D

45 D
42 D 180 180

42.00 / 45.00 X090 42.00 / 45.00 X180

{

Steep K & Axis BAGIAN MATA FK UKI

 Types of Astigmatism
Simple Myopic Simple Hyperopic

1 2 1 2

One focal point in front of retina Mixed One focal point on retina
Second focal point on retina Second focal point behind retina

1 2

One focal point in front of retina

Second focal
BAGIAN point
MATA behind retina
FK UKI
 Types of Astigmatism

Compound Myopic Compound Hyperopic

1 2 1 2

Both focal points in front of retina Both focal points behind retina

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 Astigmatisma:
with the rule - against the rule - irreguler astigmatism
Anisometropia:
perbedaan sferis equivalen
Aniseikonia:
beda ukuran dan bentuk bayangan
Unilateral aphakia:
hiperopik anisometropia koreksi kacamata aniseikonia
25%; KL 7%
Akomodasi :
amplitudo ( perobahan kuat lensa dpt) - range of amplitudo
(jarak titik jauh dari titik dekat)

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 Epidemiologi

Bayi
3.0 dpt hiperopia 1 thn: 1.0 dpt
bayi 6 thn panjang bulbus okuli > 5 mm
Miopia:
5-7 thn 3%; 8-10 thn 8%; 11-12 thn 14%; 12-17 thn 25%
Etnis cina miopia >>
Juvenil onset (7-16 thn) 0,5 dpt/thn 75% stabil 15-16
thn
Adult onset (20 thn) extensive near work
Genetik - lingkungan
Edukasi tinggi prevalens miopia >>
Hiperopia: lower educational, 20% umur 40 an; 60%
umur 60an
Prevensi: tdk ada rekomendasi pasti

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 Refraksi klinis
Refraksi objektif: retinoskop
Refraksi subjektif
sferis
Astigmat dial tehnik - Cross cylinder tehnik
Strongest plus - weakest minus maximum
visual acuity
Balans binokular
Sikloplegik - non
Overrefraksi

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 Koreksi kacamata ametropia
Lensa sferis titik jauh, jarak vertex
Koreksi silinder
Anak koreksi penuh
Dewasa coba penuh
Kacamata anak:
bayangan jatuh pada retina
Balans optimal akkomodasi dan konvergens
Miopia: kongenital / developmental
Sikloplegik refraksi
Koreksi penuh termasuk silinder
Orang tua informasi progresivitas alami
Hiperopia: rendah (-), silinder koreksi; esotropia
koreksi penuh + sikloplegik
Anisometropia: koreksi penuh; ambliopia th/ oklusi

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 Problem akkomodasi
Presbyopia: respons akomodasi
elastisitas lensa << mulai umur 40 thn
Insufisiensi akomodasi asthenopik
Ekses akomodasi: spasmus siliaris sakit
kepala, sakit alis mata, kabur terutama dekat
Lensa multifokal:
Penentuan kuat lensa tambahan:
Refraksi akurat
Amplitudo akomodasi
Pekerjaan (membaca, menjahit, komputer)

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 Kontak lensa
Beda dari kacamata:
Jarak vertex pendek
Perbatasan lensa - kornea: airmata bukan udara
Lapangan pandang: lebih besar
Besar bayangan: minus lebih besar; plus lebih kecil
Anisometopia: lebih kecil
Akomodasi: miopia akomodasi >>; plus
akomodasi <<
Materi: HEMA,MMA,NVP
Jenis:
soft KL, RGP KL, toric soft KL, bifokal KL, keratokonus / kornea
abnormal KL, gas permeable scleral KL
Therapeutic lens:
bullous keratopathy, erosi rekurrens, bells palsy, keratitis
(filamentary, posttrauma chemis), distrofi kornea, post operasi
(KPL), nonhealing epithel defect, lid abnormalities, bleb leak
posttrabeculectomy.
Orthokeratology reshape cornea-hard KL

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 Pemeriksaan pasien KL

Palpebra, pergerakan palpebra, kedipan, film airmata,

neovaskularisasi kornea, allergi
Seleksi: soft-hard soft: adaptasi cepat, kenyamanan
>>
Problem:
Kornea: abrasi, keratitis pungtata, pewarnaan jam 9 & 3, infiltrat
steril, keratokonjungtivitis superior limbik KL, keratitis
dendritik, neovaskularisasi kornea, corneal warpage, ptosis.
Mata merah: pengepasan kurang, hipoxia, deposit , KL rusak,
toksik / alergi larutan KL, dry eye
Transmisi HIV: desinfeksi trial lens:
Hard: hidrogen peroxid, desinfeksi panas (78*-80*/10 min)
RGP: idem kecuali desinfeksi panas
Soft: idem

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 terima kasih

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