You are on page 1of 39

REFRACTIVE ERRORS

Z A L D I

FAKULTAS KEDOKTERAN
UNIVERSITAS ISLAM SUMATERA UTARA
MEDAN
2014

REFRACTIVE ERRORS

ZALD I

11/3/2014

Dengan menyebut nama Allah


Yang Maha Pengasih Maha Penyayang.

REFRACTIVE ERRORS

ZALD I

11/3/2014

I. TUJUAN INSTRUKSIONAL UMUM


3

Setelah Proses Belajar Mengajar mahasiswa


mampu menegakkan diagnosa kelainan refraksi
dan dapat memberikan koreksi terbaik bagi pasien
dengan melakukan pemeriksaan sederhana yang
akan dipelajari selama masa perkuliahan secara
baik dan benar .

REFRACTIVE ERRORS

ZALD I

11/3/2014

II. TUJUAN INSTRUKSIONAL KHUSUS


4

Setelah Proses Belajar Mengajar mahasiswa


mampu menegakkan diagnosa dan memberikan
koreksi kacamata yang sesuai bagi pasien miopia ,
hipermetropia , astigmatisma dan presbiopia
dengan baik dan benar sesuai dengan
kompetensinya

REFRACTIVE ERRORS

ZALD I

11/3/2014

VISUAL EXAMINATION
5

REFRACTIVE ERRORS

ZALD I

11/3/2014

VISUAL ACUITY
6

SNELLEN CHART = 6/6 6/60


FINGER COUNTING ( FC ) = 5/60 0,5/60
HAND MOVEMENT ( HM ) = 1/300
LIGHT PERCEPTION ( LP ) = 1/
NO LIGHT PERCEPTION ( NLP ) = 0

REFRACTIVE ERRORS

ZALD I

11/3/2014

MAGNITUDE OF VISUAL
IMPAIRMENT
7

(Visual Acuity <6/18)


153 Million

161 Million

Uncorrected
Refractive Errors

Eye Diseases

= 314 Million
People severely visually impaired
REFRACTIVE ERRORS

ZALD I

11/3/2014

In addition, recent studies indicate that there are:


8

517million uncorrected presbyopes

REFRACTIVE ERRORS

ZALD I

11/3/2014

EMMETROPIA
9

REFRACTIVE ERRORS

ZALD I

11/3/2014

REFRACTIVE ERRORS
10

=
=
=

REFRACTIVE DISORDERS
ANOMALI REFRAKSI
KELAINAN REFRAKSI

REFRACTIVE ERRORS

ZALD I

11/3/2014

CLASSIFICATION
11

REFRACTIVE ERRORS :
A. FAR VISION
1. MYOPIA
2. HYPERMETROPIA
3. ASTIGMATISM ( 5 )

B. NEAR VISION : PRESBYOPIA

REFRACTIVE ERRORS

ZALD I

11/3/2014

FOCUS NODE IN MACULA


12

REFRACTIVE ERRORS

ZALD I

11/3/2014

THE ROLE OF OPTICAL DEFOCUS


Positive Treatment
Lens

Optically Imposed Myopia


To compensate, the eye must
become more hyperopic.

Negative Treatment
Lens

Optically Imposed
Hyperopia
To compensate, the eye must
become more myopic.

13

REFRACTIVE ERRORS

ZALD I

11/3/2014

EMMETROPIA
14

Is the condition when the


parallel rays focused
exactly on the macula of
the eye in relax condition
---> the visual acuity is
maximum

REFRACTIVE ERRORS

ZALD I

11/3/2014

REFRACTIVE ERRORS

11/3/2014

ZALD I

15

MYOPIA
16

Refractive

condition
in which, with
accommodation
completely relaxed,
parallel rays are
brought to a focus in
front of the macula.
Myopic
eye
:
refractive state over
plus power
REFRACTIVE ERRORS

ZALD I

11/3/2014

ETIOLOGY
17

Axial : The antero-posterior axis of the eye ball > normal

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

Increasing of the refraction index

in this case, the refraction power of the cornea, lens and the lens position
are normal. The eye usually looks like proptosis

could occur on Diabetic patient

Changes of the lens location

changes of the lens position to the anterior after glaucoma surgery

lens subluxation

REFRACTIVE ERRORS

ZALD I

11/3/2014

SIGNS & SYMPTOMS


18

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

On high myopia -> proptosis simulation, deep Anterior Chamber

REFRACTIVE ERRORS

ZALD I

11/3/2014

COMPLICATIONS
19

Commonly

occurred on high myopia


1. Degenarated and liquefied vitreous
2. Retinal detachment
3. Pigmentation changes + Macular bleeding
4. Strabismus
5. Amblyopia

REFRACTIVE ERRORS

ZALD I

11/3/2014

CLASSIFICATION
20

Myopia classification :
<

3.00 D
= low myopia
3.00 - 6.00 D = moderate myopia
> 6.00 D
= high myopia/gravis

REFRACTIVE ERRORS

ZALD I

11/3/2014

MANAGEMENT
21

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 ???

Contact Lens
Laser ( LASIK , PRK )
Clear Lens Extraction
Phakic IOL

REFRACTIVE ERRORS

ZALD I

11/3/2014

HYPERMETROPIA
22

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

REFRACTIVE ERRORS

ZALD I

11/3/2014

ETIOLOGY
23

Axial

---> eye ball diameter < N

Deminished
Decreasing
Changed

REFRACTIVE ERRORS

convexity of cornea/lens curvature


Refractive index

lens position

ZALD I

11/3/2014

CLINICAL MANIFESTASION
24

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

REFRACTIVE ERRORS

ZALD I

11/3/2014

CLINICAL MANIFESTATION
25

Total

Hipermetrop : detected after the accommodation

has been paralyzed with cylcopegic agents

Latent

Hypermetrop : is the diference of the total

hypermetrop with the manifest hypermetrop

REFRACTIVE ERRORS

ZALD I

11/3/2014

CLINICAL MANIFESTATION
Hypermetropia

Latent Hypermetropia

Manifest Hypermetropia

26

REFRACTIVE ERRORS

ZALD I

11/3/2014

CLINICAL FINDING
27

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 :
REFRACTIVE ERRORS

Glasses !!!!!
ZALD I

11/3/2014

ASTIGMATISM
28

Refractive condition of
the eye in which there is
a difference in degree of
refraction in different
meridian,
each
will
focused parallel rays at
a different point.
The shape of the
images :

Line, oval, circle, never


a point

REFRACTIVE ERRORS

ZALD I

11/3/2014

ETIOLOGY
29

Etiology of Astigmatism :
Corneal
Lens

curvature disturbances ---> 90%

curvature disturbances ---> 10%

0
REFRACTIVE ERRORS

ZALD I

11/3/2014

CLINICAL FINDING
30

Nearsightness or farsightedness are blurred

Astenophia (eye strain)

Headache

REFRACTIVE ERRORS

ZALD I

11/3/2014

TYPE OF ASTIGMATISM
31

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

Ast.

Mixtus

S+2.00 C-5.00 X 180

REFRACTIVE ERRORS

ZALD I

11/3/2014

CLINICAL MANIFESTATIONS
32

Ast. M. Simplex

Ast. M Compositium

Ast. H. Simplex

Ast. H Compositium

Ast. Mixtus

REFRACTIVE ERRORS

ZALD I

11/3/2014

MANAGEMENT
33

Glasses
Contact Lens
LASIK
Refractive Surgery ( Keratotomi Radial )

REFRACTIVE ERRORS

ZALD I

11/3/2014

PRESBYOPIA
34

Physiological changes because accommodation


capability is lowering at old age

Accommodation
16

10
6

2
10

20

40

50

60 Age

PRESBYOPIA CORRECTION
35

Presbiopia additions :
40

years old
45 years old
50 years old
55 years old
60 years old

REFRACTIVE ERRORS

S + 1.00 D
S + 1.50 D
S + 2.00 D
S + 2.50 D
S + 3.00 D

ZALD I

11/3/2014

GLASSES PRESCRIPTION
36

FAR CORRECTION PLUS ADDITION


EXAMPLE ; MALE , 50 YEARS
RE : S -1,50 D
AND LE : S +1,00 D
ADDITION : S +2,00 D
R/ RE : S -1,50 AND LE : S +1,00 D
NEAR CORRECTION : RE : S +0,50 D
AND LE : S +3,00 d
REFRACTIVE ERRORS

ZALD I

11/3/2014

REFERENCES
37

American Academy of Ophthalmology, Clinical


Refraction , 2011-2012
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p) Limited
Publisher, 2007.
Vaughan & Asbury's :
General Ophthalmology
17th Edition , Mc Graw- Hills Companies , May 2007

REFRACTIVE ERRORS

ZALD I

11/3/2014

38

REFRACTIVE ERRORS

ZALD I

11/3/2014

Segala puji bagi Allah, Tuhan semesta alam.

39

REFRACTIVE ERRORS

ZALD I

11/3/2014