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Optics and refraction
VIBGYOR
Lowest wavelength Highest wavelength
Cornea Lens
43-45 D 13-17 D
1 2
Anterior and posterior surface of cornea
Aqueous humor Vitreous humor
3 4
Anterior and posterior surface of lens
IMSC 4 images
Mature 3 images
Abnormal refraction
MC cause of low vision/ ocular morbidity
Myopia Hypermetropia
Short sightedness Far sightedness
Etiology : 1. Increase in Axial length : Most imp Etiology : 1. Decrease in axial length
Increase in axial length by 1 mm will produce 3D myopia Decrease in axial length by 1 mm will produce 3D of hypermetropia
Ratio = 1:3 Ratio = 1:3
Index hypermetropia
MC : LASIK Hypermetropia
Dilates pupil
High myopia / Degenerative/ Pathological
For hypermetropia : refraction under cycloplegics and Mydriatics
Due to over stretching of eyeball outside normal biological variation
Give full treatment
Degenerative changes in eyeball
Posterior staphyloma
2. Choroid
Night blindness
Retinal hole
6. Fundus
Tigroid Fundus
Dissimilar images
1. 1D = 2% images magnification
10D = 20% images magnification : Not tolerable
5. Cosmesis
Astigmatism
Cylindrical error Different refractive power in at least 2 principle meridians
Strum’s conoid
The rays are not coming to a point focus rather forms focal lines
FV
FH
Types
Regular Irregular
2 meridians ( M1 & M2 ) are perpendicular to each other 2 meridians ( M1 & M2 ) are perpendicular to each other
Eg. Keratoconus
M2 Horizontal
Eg : Pterygium
M2 Horizontal
3. Oblique astigmatism
M1 M2
-2 +4
In terms is power
Myopia > emmetropia > hypermetropia
ATR ATR
More the myopia more is the power
Lesser the hypermetropia more is the power -5 0
Classification of astigmatism
One meridians is emmetropic Both meridians have different power with same signs One meridians myopic and other is hypermetropic
Other is myopic or hypermetropic
M2 M1 M1 M2 M1 M2 M1
M1 M2 M2
Simple myopic astigmatism Simple hypermetropic astigmatism Compound myopic astigmatism Compound hypermetropic astigmatism
O +2 -3 +2 +2
-2 O -2 +4 -4
Strum’s conoid
B. Vertical : Emmetropic
Horizontal : Converging
Simple hypermetropic astigmatism
G. Vertical : Diverging
Horizontal : Diverging
Compound hypermetropic astigmatism
-2 -3 -5
Power of cylinder acts at perpendicular plane
Compound myopic astigmatism with the rule
-2 -2
2. -2DS and -1 DC at 90
-2 -2
-2 -2
4. +3 DC at 180
+3
Refractive error = Retinoscopy - Distance factor - Tonus allowance of mydriatics and cycloplegics
Distance factor = 1
Distance ( in meters )
+3 -1 -1 +1
+5 -1 -1 +3
Retinoscopy
Dry Wet
Without mydriatics and cycloplegics Refraction under dilatation with mydriatics and cycloplegics
Refraction undilated
1. Atropine : 1% eye ointment : used in infants : Strongest and longest acting mydriatic
Onset : 3 days only at night
DOA : 2-3 weeks
2. Cyclopentolate
3. Hometropine
4. Adults : mc : Tropicamide : Shortest acting
Interpretation of Retinoscopy
Refinement of refraction
Spherical Cylindrical
- by Edward Jackson
More clearer - Combination of sphere and cylinder
Hypermetropia over Correction of myopia - Power of sphere = half the power of cylinder with opposite sign
-0.5 -0.5
-0.5 + 1 +0.5
During accommodation
Accommodate
A=P-R
1 1
A=
Near point ( meter ) Far point ( meter )
Usually at infinity 1 =0
In this case
1
A=
Near point ( meter )
More convergence
Pseudo myopia
Treatment : Cycloplegics
Insufficiency of accommodation
Due to ageing Lens
Ciliary muscle
Distance
Near
Trifocals
Distance
Intermediate
Near