Nurfitri Bustamam, SSi, MKes, MPdKed.

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 Introduction
Lens cornea
Aperture of the camera pupil
diameter
Film retina

More sophisticated
Protective casing
Nervous system

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 Learning Objectives
Describe the various parts of the eye and list the
functions of each
Explain how light rays are brought to a focus on
the retina
Explain common defects of the optical system of
the eye
Describe production of nerve impulses in the
eyes & trace the visual pathways to their
destinations in the brain.
Define and explain dark adaptation & visual
acuity
Describe the eye movement
Explain how we are able to distinguish colors &
perceive depth.
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 Anatomy of the Eye

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The tears dilute and wash away the irritating substance.
Watery eyes also occurs when inflammation of the nasal mucosa, such
as occurs with a cold, obstructs the nasolacrimal ducts and blocks
drainage of tears.
Only humans express emotions, both happiness and sadness, by crying
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 Lapisan mata:
Sklera (protektif, putih, tidak dpt dilewati
cahaya) & cornea (di anterior, transparan).
Sklera dilapisi membran mucosa yg jernih
(conjuctiva)
Choroid (jaringan pembuluh darah)
Retina; melapisi 2/3 bag dlm choroid, berupa
jar. saraf yg mengandung fotoreseptor
Lensa kristal; disangga oleh lens ligamen
(zonula) yg terhubung dg badan ciliaris

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 Iris (= rainbow) berada di depan lensa,
terdiri dari melanosit, serat otot sirkular
dan serat otot radial.

The amount of melanin in the iris

determines the eye color. The eyes
appear brown to black when the iris
contains a large amount of melanin,
blue when its melanin concentration is
very low, and green when its melanin
concentration is moderate.

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 Aqueous humor: cairan
jernih, dibuat oleh
corpus cilaris dg cara
difusi dan transpor aktif
mengalir melalui pupil
utk mengisi ruang
anterior bola mata.
Aqueous humor
direabsorpsi oleh Canal
of Schlemm yaitu vena-
vena antara iris dan
cornea.
Vitreous humor: materi
gelatinosa jernih.

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 Aqueous humor dibentuk rata-rata 2-3 l/menit

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 Glaucoma: peningkatan tekanan
intraokuler akibat obstruksi pada Canal of
Schlemm. Hal itu dapat merusak retina.
Tekanan normal bola mata: 10-20 mmHg.
Penyebab glaucoma: infeksi, perdarahan
akumulasi debris di Canal of Schlemm.
Terapi: diberi obat utk mengurangi sekresi
atau meningkatkan absorpsi aqueous
humor atau dioperasi.
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 Rods & cones (fotoreseptor).
Interneuron (inhibisi/eksitasi): sel bipolar, sel horisontal, sel
amacrine, dan keluar mata via sel ganglion yg aksonnya
membentuk serat n. opticus.
Pigmen epitel berperan utk mengabsorpsi cahaya agar tdk
mengalami pemantulan/refleksi kembali shg bayangan tdk
kabur.
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 N. opticus meninggalkan bola mata mll optic
disk (karena tdk ada reseptor maka bagian
ini merupakan bintik buta).
Macula lutea (pigmen kuning) pusatnya
disebut fovea centralis yg tdk mengandung
rods tetapi hanya cones yg sangat padat dan
berperan dalam ketajaman penglihatan
(acuity).
Age-related macular degeneration.
Gerakan bola mata sebenarnya berusaha
menempatkan bayangan tepat di fovea
centralis.
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Oftalmoskopi- melihat permukaan interior di belakang lensa
(fundus) tdd retina, optic disc, macula, fovea, arteriole & vein
in superficial layers of retina
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 Pada fovea, setiap cone
berhub. dg satu sel bipolar
dan langsung ke n. opticus
(penting utk ketajaman
penglihatan).
Di luar fovea byk tdpt rods.
Rods : cones = 120 juta : 6
juta
N opticus tdd 1,2 juta serat
Rasio sel bipolar : sel
ganglion = 105 : 1 (ada
konvergensi)

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 Comparison of Photoreceptors
Characteristic Rods Cone

Photopigment Rhodopsin Blue, green & red sensitive

pigmen (cone pigment)
Acuity Low High

Threshold illumination Low High

Type of vision Black/white Color

Most concentrated Peripheral Central (fovea centralis)

Wave peak sensitivity 505 nm Blue (445 nm), Green (535

nm), Red (570 nm)
Estimated total 120 milion 7 milion
number
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 Kemampuan mata
beradaptasi terhadap cahaya
sangat tinggi (10-7 107 mm
Lambert) krn ada 2
fotoreseptor & ada
pengaturan pupil
Rod vision (scotopic vision)
Transition zone
Cone vision: rhodopsin
terurai
Rod vision: rhodopsin
terbentuk & dirombak
seperlunya
Diperlukan waktu utk
menumpuk rhodopsin yg
terurai saat terang
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 Semakin byk
rhodopsin,
fotoreseptor
semakin sensitif
terhadap cahaya.

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 Buta senja (Nyctalopia)

Pada defisiensi vit. A, pembentukan rhodopsin

lambat. Mengapa disebut buta senja?
Bagaimana perubahan intensitas cahaya pada
senja hari?
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 Adaptasi Gelap & Adaptasi Terang
Adaptasi Gelap
Perub. terang ke gelap: retina
buta, perlahan
mampu/terbiasa melihat dlm
gelap. Penurunan ambang
visual adaptasi gelap yg
lamanya 20-30 menit.
Terdapat 2 komponen
adaptasi gelap:
Adaptasi gelap cones: cepat,
sdkt/kecil, hanya di daerah fovea
& sekitarnya.
Adaptasi gelap rods: lambat, lbh
besar, lbh lama, utk daerah
perifer retina.
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 Kacamata merah akan memperpendek masa
adaptasi gelap karena gelombang sinar merah
hanya sedikit merangsang rods, tetapi cones
tetap mampu berfungsi seperti biasa (studio
foto/kamar gelap, radiologist, pilot terbang
malam)
Masa adaptasi gelap adalah masa pembentukan
rhodopsin (jika kena sinar rusak). Diperlukan
jumlah rhodopsin cukup utk mampu melihat
dalam gelap.
Dari gelap ke terang: silau, cahaya terlalu
terang, tetapi lama kelamaan terbiasa dalam
terang, adaptasi cahaya (light adaptation)
lamanya 5 menit.

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 Phototransduction in rods & cones
Structural changes in the
Incident light
retinene of photopigment

Metarhodopsin II

Activation of transducin Semakin kuat cahaya

semakin besar respons
Activation of photodiesterase hiperpolarisasi
Neurotransmiter yg
Decreased intracelular cGMP dihasilkan fotoreseptor
bersifat inhibisi
Closure of Na+ channels

Hyperpolarization

Decreased released of Response in bipolar cells

synaptic transmitter & other neural elements
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 An object can absorb certain wavelengths of visible
light and reflect others; the object will appear the
color of the wavelength that is reflected.
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 Melihat Warna

Teori YOUNG HELMHOLTZ:

manusia mempunyai 3 cones
Sensasi warna ditentukan
oleh frekuensi relatif & impuls
dari tiap jenis kerucut.
Ke-3 sel kerucut dapat
terangsang dg intensitas yg
berbeda atau hanya 1 jenis
kerucut yg terangsang
sehingga dapat melihat
berbagai kombinasi warna.
MEJIKUHIBINIU (ROY G BIV)

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 Colorblindness (buta warna)
Test: Ishihara charts
Buta warna: tdk dpt membedakan
warna tertentu.
Anomaly: thd warna tertentu lemah, tdk
cerah
Anopia: buta warna, protanopia (buta
warna merah), deuteranopia (buta
warna hijau), trianaopia (buta warna
biru).
Trichromat (punya 3 cones), dichromat
(2 cones), monochromat (hanya punya
1 macam cones)

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 Garden by the Bay, Singapore

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 Prinsip Optik & Pembentukan Bayangan di Retina

Berkas sinar yg melewati pusat lensa tdk

dibiaskan/refraksi
Besarnya bayangan ditentukan oleh sudut visual
(visual angle)
Bayangan di retina terbalik (terbiasa sejak lahir)

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 Inverted Glasess Experiment
George Malcolm Stratton (1865 1957) was a
psychologist who pioneered the study of perception
in vision by wearing special glasses which inverted
images up and down and left and right.

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 Titik fokus lensa bergantung radius. Kekuatan
refraksi = 1/jarak fokus dalam meter (Dioptri)
Jarak fokus = 0,5 m kekuatan refraksi = 1/0,5 =
2 Dioptri

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 M. ciliaris relaksasi jika
melihat jauh ( > 6 meter)
Jika melihat dekat terjadi
refleks akomodasi/near
response (lensa mata
mencembung karena
kontraksi m. ciliaris, pupil
konstriksi, & konvergensi
mata).
Pada umur 40-45 th daya
akomodasi mulai
menurun (presbyopia)
karena lensa mata mulai
mengeras & melemahnya
m. ciliaris akibat proses
menua.
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 Akomodasi
Refleks
Stimulus: titik potong sinar di belakang retina
Reseptor: cone & rod (bayangan kabur)
Aferen: n. opticus
Eferen: n. oculomotor
Proses: ciliary muscle kontraksi
diameter mengecil ligamen
mengendor lensa mencembung.
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 Near point: titik jelas terdekat, pada usia
10 tahun 9 cm, 60 tahun 83 cm.

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 Emmetropia;
mata normal

Myopia;
rabun jauh

Hyperopia;
rabun dekat

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 Astigmatism: 90% karena curvatura
cornea & 10% karena curvatura lensa tdk
uniform bayangan di retina kabur.
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 LASIK (laser-assisted in-situ keratomileusis)
to correct the curvature of the cornea for conditions
such as farsightedness, nearsightedness,
& astigmatism.

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 Etiologi kelainan refraksi
Genetik
Perilaku
Macam2:
- Diameter bola mata (aksis bola mata)
- Kurvatura kornea/lensa
- Indeks refraksi
- Posisi lensa

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 Visual Acuity
Visual acuity: distinctness or discrimination of objects
All assessments of acuity depend on some estimation of
the angle subtended at the eye by two line which can
just be seen to be separated from each other.
The greater that angle, the less acuity
The standard of reference used is the best possible
discrimination made by normal young subjects in bright
light; this requires that the distinguishable line subtend
an angle of 1 minute at the eye.
The commonest way of measuring a persons acuity is to
display rows of letters or symbols of different sizes
(Snellens chart) at standard distance. The components
of 6 or 20 row of letters are of a width each subtend
an angle of 1 minute at the observers eye when he is 6
m (20 feet) away.

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 A person whose vision rated 20/20 is
seeing details at a distance of 20 feet as
clearly as a normal individual could.
Vision noted as 20/15 is better than
average, for at 20 feet the person is able
to see details that would be clear to
normal eye only at a distance of 15 feet.
Conversely, a person with 20/30 vision
must be 20 feet from an object to discern
details that a person with normal vision
could make out at a distance of 30 feet.
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 Visus

V = 6/6 V < 6/6

Emetropia/hipermetropia miopia

Lensa +

Lebih Visus
jelas mengecil

hipermetropia emetropia

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 Refleks Pupil

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 Refleks Pupil

Pupil konstriksi utk mengurangi sinar yg masuk,

pupil sebelahnya ikut konstriksi (consensual light
reflex).
Jalur reflex pupil berbeda dg akomodasi
Pupil Argyll-Robertson: akomodasi intact tetapi
refleks pupil hilang sebab adanya lesi di
midbrain (misalnya syphilis)
Lengkung refleks: n opticus brachium of the
superior colliculus pretectal nucleus ipsilateral &
contralateral Edinger-Westphal nucleus ciliary
ganglion (N. III) sphincter pupilae (otot
sirkularis).
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 Lengkung Refleks Pupil

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 Visual Pathway
Stimulus (ligth)

Rods & Cones

Retina Bipolar Cells
Gangglion Cells
Optic nerve

Thalamus Lateral Geniculate Nucleus

Pathway

Visual Cortex
Cortex
Visual Association Cortex

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 Pusat Penglihatan

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 Visual Fields
The technique of
perimetry allows
precise mapping out
visual fields
The visual fields are
determined by the
position of the orbits,
the extent and shape of
the retina in each eye
and the external
obstruction to the
incidence of light (nose
& brow).

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 Proyeksi lapang pandang dapat digunakan utk
menentukan lokasi kerusakan di jaras penglihatan
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 Monocular & Binocular Vision

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 Depth Perception

If you close your right eye then open it and close

your left, you will notice that the picture changes
somewhat.
Each eye receives a slightly different image,
because their foveas are 2-3 inches apart. For
one thing, each eye provides some visual
information that is unavailable to the other
because your nose and eye socket block its view
of the opposite side.
Each eye sees the world from a slightly different
angle. The association & integrative areas of the
cortex compare these views and use them to
provide us with depth perception.
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 Stereoscopic Vision

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 Otot-otot bola mata

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 Eye Movements
1. Saccades movement: melihat dg cepat &
meloncat-loncat
2. Smooth persuit movement: mengikuti
gerak objek
3. Convergence movement
4. Vestibular movement

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 Eye Movement Disorders
Strabismus: uncoordinated extrinsic eye muscles,
primary symptom: diplopia
Diplopia (double vision), results when the contraction
of the extrinsic muscles is not coordinated. The eyes
focus on different area of the visual field & two images
are seen.

Nystagmus: involuntary unilateral or bilateral rhytmic

movement of the eyes.
Paralysis of extraocular muscle: ptosis: dropping of the
eyelid

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