Professional Documents
Culture Documents
Refraction: Dr. Saskia N Mokoginta, SPM
Refraction: Dr. Saskia N Mokoginta, SPM
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 (+)
or will be diverged as if it comes from the focus ----> Minus Lens (-)
Principles
Spherical lens
A convex lens may be regarded as a series of prisms bases toward the middle of the lens A concave lens may be regarded as a series of prisms apex toward the middle of the lens
Spherical Lens :
+2
+2
+4
+5
-1
Biconvex
Plano K
Concave K
Minus
sphere : Concave
-2
-2
-4
+1
-5
Bi Concave
Plano K
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 :
+ 2.00
S + 2.00 D
0.00
C + 1.00 D X 90
0
+ 2.00 0.00
+ 2.00
+ 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 90 0
S + 3.00 C - 1.00 X 180
0
Refraction media :
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
For object at less than 5 meters distance, the rays do not come parallel but divergent. If the eyes are still in relax position, the images will be focused behind the retina. So the object will be seen blurred. These images must be moved forward so it will be focused on the retina by increasing the convexity of the lens. This process is called accommodation process.
This accommodation process happens as a result from the contraction of M. ciliaris in the ciliary body
Near Reflex
Refraction Anomalies
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
in this case, the refraction power of the cornea, lens and the lens position are normal. The eye usually looks like proptosis The size of the eye ball ---> normal, but there is a increasing of the cornea/lens curvature
Curvature :
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
Funduscopy : Tigroid fundus ---> thin retina and the choroid, myopic crescent arround the papilla area, sthaphyloma posterior
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
On high myopia, usually full correction are not given due to headache that may occurred. If necessary, reading glasses can be given ---> bifocal glasses
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 :
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 :
Treatment :
If foria/tropia not present, apply strongest positive spherical lens that give the best visual
acuity
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
Maximmum refraction
Minimum refraction
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
Ast. H. Simplex Ast. M Compositium Ast. Mixtus
C-2.00 X 90
C+2.00 X 45
0 0 0 0 0
S-1.50 C-1.00 X 60
Ast. M. Simplex
Ast. H. Simplex
Ast. M Compositium
Ast. H Compositium
Ast. Mixtus
Presbiopia
Accommodation
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
Subjective :
Snellen chart/projector, alphabet , inverse E, picture, Landolt ring Trial lens Trial frame Children, incooperative, difficult correction, strabismus :
Objective :
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 :
S + sp. Lens --> blurred vision, step by step distracting --> best sp.
Nearsightedness/read
Example
:
ODS 6/6 headache, eye strain
ODS 6/6 w/o headache, eye strain
I. AVOD 2/60 S - 3.50 = 6/6 AVOS 3/60 S - 3.00 = 6/6 II.AVOD 2/60 S - 3.00 = 6/7 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
the flashlight light onto both eyes, the light is coming from in front of the patient, The patient look at the observer forehead or the light ----> measure the distance of light spot between OD and OS ----> as near pupil distance Far distance :
add
2 mm ---> for pupil distance less than 60 mm. Add 3 mm ---> for pupil distance more than 60 mm
Eye Glasses
Monofocal Bifocal Progressive
Anisometropia :
Condition wherein the refractions of the two eyes are an equal variation : Myopia M
M. H. H. M.
Antimetropia
E. E. H. H
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
cannot applied for anisometropia more than 2.50 Dioptri anisometropia causing aniseikonia
Contact lens :
Indication :
High anisometropia irregular astigmatism Front asymmetry, orbit Aniridia Descemetocele Sports Cosmetics