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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
Base
Apex
Base
Apex
Base
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Refractive Lenses
Refractive lenses are combinations of different
shaped prisms
Convex Lens
Convergent
Concave Lens
Divergent
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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
Biconvex Plano-Convex Convex-Meniscus
Convergent
Lenses
Biconcave
Plano-Concave Concave-Meniscus
Divergent
Lenses
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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
Focal
Point
Paraxial Rays
Axial Ray
No Refraction
1.0 D Lens = Focal length
of 1 meter
4.0 D Lens = 0.025 meter
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External Eye Anatomy
Medial
Canthus
Lateral
Canthus
Lachrymal
Papillae
Cornea
Limbus
Sclera
(Conjunctiva)
Pupil
Iris
Caruncle
Semilunar
Fold
Superior
Tarsal Lid
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I nternal Eye Anatomy
Superior
Fornix
Inferior
Fornix
Ciliary
Muscle
Vitreous
Body
Cornea
Optic
Nerve
Macula
(Fovea)
Vitreous
Face
Pupil
Iris
Lens
Limbus
Anterior
Chamber
Posterior
Chamber
Zonular
Fibers
Ocular
Muscles
Sensory
Retinal
Layer
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Corneal Morphology
{
Intraocular
Pressure
13-19 mm Hg
500 - 550
Corneal Diameter
11 - 13 mm
Central Corneal
Diameter
5 - 7 mm
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Corneal Curvature
Average Cornea
44.00 Diopters
Steep Cornea
47.00 Diopters
Flap Cornea
40.00 Diopters
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I ndex 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
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
Substance
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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 lens can not
accommodate enough
to focus near images
The aging eye starts to
lose its ability to
accommodate
Bifocals or reading
glasses are required
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Myopia
Nearsightedness

Parallel (distant images)
rays are focused in front
of the fovea
The Cornea is too Steep
&/or the eye is too Long
for its refractive
capability
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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
Nearsighted people,
without their glasses, can
often focus near objects
on the retina with little or
no accommodation
The Divergent rays of
objects near the eye are
focused by the cornea
& lens
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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
Multiple focal points in
the eye
Images are blurred &/or
distorted
F1
F2
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Astigmatism
90
180
45 D
42 D
42.00 / 45.00 X090
With-The-Rule
Astigmatism
Steep Axis Vertical
90
180
42 D
45 D
42.00 / 45.00 X180
Against-The-Rule
Astigmatism
Steep Axis Horizontal
Steep K & Axis
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Types of Astigmatism
Simple Myopic
1 2
One focal point in front of retina
Second focal point on retina
Simple Hyperopic
One focal point on retina
Second focal point behind retina
Mixed
One focal point in front of retina
Second focal point behind retina
1 2
1 2
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Types of Astigmatism
1 2
Compound Myopic
Both focal points in front of retina
Compound Hyperopic
Both focal points behind retina
1 2
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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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