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MYOPIA

Prillia Tri Suryani MD


Ophthalmology Department
Medical Faculty
Airlangga University

10/6/2017
INTRODUCTION
The term myopia was introduced from the
habits :
Short sighted.
Half closing the eyelids, when looking at
distance
Myopia may be caused by :
Largeness of the eyeball.
An increase in the strength
of the refractive power of the media
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DEFINITION

When parallel rays of light come to focus in front of


the sentient layer of the retina when the eye is at
rest.
The eye is relative too large.
The condition is the opposite
of Hypermetropia.
Myopia ~ In close ~ Nearsightness
or Shortsightness

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DEFINITION

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ETIOLOGY
. 1. The great majority of cases, myopia is axial
due to increase in the antero- posterior
diameter of the eye.
2. Curvature myopia may be associated with an
increase in the curvature of the cornea or 1
or both surface of the lens.
3. If the lens dislocated.
4. Index myopia , a change of refractive index
of the aqueous or vitreous.

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CLASIFICATION
BY THE CAUSE :
Axial myopia
Refractive myopia :
Curvatura myopia.
Index myopia.
BY THE CLINICAL APPEARANCE :
1. Simple myopia.
2. Degenerative myopia.
3. Nocturnal myopia.
4. Pseudomyopia.
5. Induced myopia.
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CLASIFICATION

BY THE DEGREE OF CORRECTION :


1. Low myopia : -3.00 D or less.
2. Medium myopia : (-3.25 D) (-6.00 D)
3. High myopia : -6.25 D or more.
BY AGE AT ONSET :
1. Congenital myopia/ Infantile myopia.
2. Youth onset myopia / School myopia.
3. Adult onset myopia.
Early adult onset myopia.
Late adlult onset myopia.
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SYMPTOMS OF MYOPIA
1. The single most important symptom of myopia is
blurred distance vision.
2. Headaches are rarely experienced, although it has
been shown that correction of small myopic error has
been helpful in relieving asthenopic headaches.
3. Tendency for the pateint to squint when he wishes to
see far away.
4. The pinhole effect of the narrowed palpebral fissure
enables him to see more clearly.
5. Nearsighted people usually like to read.

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DEVELOPMENT OF MYOPIA.
Myopia increasing with increasing age.
In US :
Prevalence of myopia 3% (5 -7 years)
8% (8-10years)
14% (11-12 years).
25% (12-17 years).
Ethnic Chinese children highher rate of myopia at all
ages.
Taiwan,Singapore and Japan study :
12 % among 6 years.
84 % among 6 18 years.
In one of the elementary school at Surabaya : 23.4 %
among 7-12 years.(2011)
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DEVELOPMENT OF MYOPIA

Characteristic of myopia depends on onset :


1. Juvenile onset myopia.
7-16 years of age ( growth axial length).
Risk factors :
Esophoria.
Against the rule astigmatism.
Premature birth.
Family history.
Intensive near work.

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DEVELOPMENT OF MYOPIA

2. Adult onset myopia.


Begins at about 20 years of life.
Risk factor : extensive near work.
The propability of myopic progression was related to
the degree of initial refractive error.
At West Point Cadet study found myopia requiring
correcting lens :
46 % in entrance.
54 % after 1 year.
65 % after 2 years.

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DEVELOPMENT OF MYOPIA

20 -40% of patients with low hyperopic or emmetropia


who have extensive near work, requirement become
myopic before 25 years of age.
The etilogic factors are complex, genetic and
environmental factors.
Severe myopia suggest dominant recessive and event
sex-linked inheritance patterns.
Some studies reported :
Near work is not associated with a highher prevalence and
progression of myopia.

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DEVELOPMENT OF MYOPIA

Higher educational achivement has been


strongly associated with a higher prevalence of
myopia.
Poor nutrition has been implicated in the
development of refractive errors.
In Afrika : a chidren suffering malnutrition -
increase prevalence of :
High ametropia.
Astigmatism.
Anisometropia.
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MYOPIA PROGRESSION
Usually myopia is not present at birth.
Although in certain cases it is congenital.
Associated with prematurity.
A simple distance visual acuity test at school in 9 -10
years of age ( 20/50 with the error of (-0.75 -1.00 D )
The myopia tends to increase until the child stop
growing in height.
The term Progressive and Malignant myopia are
clearly defined.

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MYOPIA PROGRESSION

Myopia increases rapidly by as much as 4.00 D/year,


associated with :
Vitreous opacity.
Fluidity of the vitreous.
Chorioretinal changes.
The rate of increase of myopia generaly tappers of at
about 20 years of age or may continue 15 years of age.

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TREATMENT OF MYOPIA
The optical correction for Myopia is :
Spectacles.
Contact lenses.
Refractive surgery.
Principal correction with concave or minus lens to
diverge the rays of light so that they will focus on the
retina .

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VISUAL HYGIENE
1. Resting from reading or working in close distance
every 30 mins. During the rest, you should take a walk
around the room and looking far though the window.
2. Have a comfortable upright sitting during reading.
3. Using enough light during reading.
4. A good reading distance is an arm length to elbow.
5. Sitting from 6 feet distance during wacthing TV.
6. Limit the amount of time spent for watching TV
or playing game/gadget.

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PRESCRIBING IN CHILDREN
1. THE INFANT (the first 12 - ,18 months).
Total spatial world is at near.
Not correcting.
Under correcting as much as 4.00 D of Myopia..
Visual aquity must be monitored for amblyopia.
2. TOODLERS AND OLDER CHILDREN.
The child begins to walk and move around.
-3.00 D of Myopia as a threshold for correction.
If without correction, monitored visual aquity, refractive error
and emetropization every 3 -4 mothns.

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PRESCRIBING IN CHILDREN

3. PRESCHOOL AGE ( 3 4 years).


Accurate myopic prescribing is necessary.
Myopia of 2.00 D or greater require correction.
Monitured every 6 months.
4. SCHOOL AGE ( about 5 years ).
Up to 1.50 D of myopia may not be impottant to
correct.
Monitored every 6 months.
Full correction of myopia if :
Esotropia.
Exotropia.
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PSEUDOMYOPIA
Pseudomyopia is a rare disorder that is usually due to
spasm of the cilirry muscle / spasm of accomodation.

Parallel rays of light to converge to focus in front of the


retina.
Caused by :
Exessive acomodative effort in uncorrected hyperopia
or it may be a hysterical phenomenon.

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PSEUDOMYOPIA

Diagnosis is confirmed upon relaxation of the spasm


by the instilation of a cycloplegic drug.
Refraction without the use of cycloplegic drug.
Prescription on concave lens only neccesitate greater
accomodative effort.

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DEGENERATIVE MYOPIA
(MALIGNANT MYOPIA / PROGRESSIVE MYOPIA)

The diagnosis is based upon the changes that are


observed in the retina and choroid upon
ophthalmoscopic examination.
Much less common than simple myopia.
Higher incidense in female, in certain races and ethnic
groups, eg Chinese, Arabs.
Two types have been described : congenital and
developmental.

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DEGENERATIVE MYOPIA

The main characteristic of degenerative myopia as


follow :
1. Changes at the optic disk
Myopic crescent
2. Changes at the choroid and retina.
Forster Fuchs black spot
3. Changes in the sclera.
Streching sclera to form Staphyloma.
4. Changes in the vitreous.
Fibril degeneration and Posterior vitreous detachment

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DEGENERATIVE MYOPIA

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DEGENERATIVE MYOPIA

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COMPLICATION OF MYOPIA

1. Retinal detachment.
2. Strabismus.
Exotropia.
Esotropia.
3. Amblyopia.

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ASTIGMATISM
Prillia Tri Suryani MD
Ophthalmology Department
Medical Faculty Airlangga University

10/6/2017
INTRODUCTION
Astigmatism is distorted vision caused by
a variation in refractive power along
different meridians of the eye.
Astigmatism :
Regular astigmatism.
Irregular astigmatism
Regular astigmatism :
With the rule.
Against the rule.
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DEFINITION

When parallel rays of light enter the eye


without accomodation and do not come to
a single point focus or near the retina.
The refracting power is not uniform in all
meridians.
.

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DEFINITION

The amount of astigmatism is equal to the


difference in refracting power of the two
principal meridians.
The steepest and flattest meridian of an
eye with astigmatism are called Principal
meridian.

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DEFINITION

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PREVALENCE

2.523 American children ages 5 17


years, > 28 %had astigmatism of > 1.0 D.
Asian 33,6%, Whites 26.4%, Africa 20.0%.
Myopic astigmatism 31.7%.
Hyperopic astigmatism 15.7%.
UK eyeglass wearers 4.7% had
astigmatism one eye and 24.1% in both
eyes.
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ETIOLOGY
Astigmatism may be an error of curvature, of centring, or
of refractive index.
Curvature astigmatism :
Cornea.
Congenital.
Vertical > Horizontal curve.
At birth the cornea is normally almost spherical,
astigmatism is present in 68% of children 4 years and
95% at 7 years.
Tend to increase/disappear or reverse horizontal >
vertical.
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TYPE OF ASTIGMATISM
1. REGULAR ASTIGMATISM.
The two principal meridian are of right angel.
The meridians of greatest and least curvature.
Correcting by Cylinder lens.
A .Astigmatism with the rule ( Direct
astigmatism).
V curve > H curve.
Correction by Cyl (-) axis 1800 or Cyl (+) axis 900
B. Astigmatism against the rule ( Indirect
astigmatism ).
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H curve > V curve.
Correction by Cyl (-)axis 900 or Cyl (+) axis 1800
TYPE OF ASTIGMATISM

2. IRREGULAR ASTIGMATISM.
Irregularities in the curvature of the meridians.
Caused :
Corneal irregularity.
Corneal cicatrix /Keratoconus.
Not lend it self adequate correction by
spectacles.

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TYPE OF ASTIGMATISM.

REGULAR ASTIGMATISM
Simple astigmatism.
Compound astigmatism.
Mixed astigmatism.

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TYPE OF ASTIGMATISM.

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SYMPTOMS OF ASTIGMATISM
Blurred or distorted vision at all distances.
Photophobia
Headaches especially after reading.
Squinting
Eye strain.
Constanly clossing eye.
In High astigmatism :
Tilting of the head ( obliq astigmatism ).
Turning of the head ( high astigmatism)
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DIAGNOSIS OF ASTIGMATISM

1. Patient history.
2. Refraction.
Subyective.
Trial & error.
Obyective.
Retinoscopy.
Fogging technique.
Autorefractometer.
Jackson Cross Cylinder.
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MANAGEMENT OF ASTIGMATISM

1. Spectacle.
2. Contact lens.
3. Refractive surgery.

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MANAGEMENT OF ASTIGMATISM

SPECTACLE.
1. Regular astigmat :
Correction : Cyl (-) /(+).
Combined Sphere (-) /(+)
2. Irregular astigmatism :
Mild : Hard contact lens.
Severe : Keratoplasty.

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MANAGEMENT OF ASTIGMATISM

Cylinder spectacle lenses produce


monocular and binocular distortion.
Primary cause is Meridional aniseikonia
(Unequal magnification of retinal images in
the various meridians.)

Corrected by ISEIKONIC SPECTACLE.

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MANAGEMENT OF ASTIGMATISM

Guidelines for prescribing astigmatic


spectacle corrections :
For children : full astigmatic correction at the
correct axis.
For adults : try full correction, walking around
and adaptation.
To reduce distortion :
Use minus cylinder.
Minimize vertex distance.
Reduce the cylinder power.
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MANAGEMENT OF ASTIGMATISM

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MANAGEMENT OF ASTIGMATISM

CONTACT LENS.
If Cyl < 1.00 D : Sphere SCL.
If Cyl ( 1.00 3.00 ) D : Toric SCL/ RGP- CL.
If Cyl > 3.00 D : RGP CL.

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MANAGEMENT OF ASTIGMATISM

REFRACTIVE SURGERY.
LASIK
To decrease the curvature by relaxing incision
in the axis.

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