OPTIC : GENERALITIES

Lecturer
Pr. Malika ÇAOUI
Médecine Nucléaire

Semester : 2 Module
BIOPHYSICS

Academic Year : 2021-2023 Module Element

BIOPHYSIC OF VISION

www.um6ss.ma
 Overview of the course

• Geometric Dioptric
• Dioptric of the normal eye
• Spherical ametropias
• Non-spherical ametropias: Astigmatism
• Diagnosis of ametropias
• Visual acuity
• Study of refraction: subjective and objective methods
• Perception of the retinal image
• Color vision
2
General course objectives

• Distinguish the different transparent medium of the normal eye and their optical characteristics
• Differentiate between spherical and non-spherical ametropia
• Identify a spherical ametropia and an astigmatism
• Determine a power, the different parameters of accommodation and the degree of ametropia
• Approach the study of refraction by subjective methods
• Recognize the characteristics of a corrective lens

3
Review of basic notions in optics
Generalities on the sense organs

4
 Diopter (US)/Dioptre (GB)
• Dioptre : optical surface of any form separating 2 media of different (¹) refractive indexes
Dioptrique Oculaire et Amétropies : Aspects biophysiques –
• It has - at least one center of curvature C and a radius of curvature (ex. R = CI) Pr. Michel Zanca –Montpellier

- at least one vertex S : which is the point where the surface intersects with the optical axis
- A spherical dioptre has the same radius of curvature along all meridians
- A non-spherical dioptre has ¹ radii of curvature along ¹ meridians : as many types of meridians ¹ as R ¹

• A dioptre is an interface that can be: Transparent that deflects light: refraction
Opaque which absorbs and/or reflects it
• A ray of light passing through C is not deflected because it is perpendicular (⊥) to the diopter (zero incidence)
• P and P' are Conjugate Points in the diopter :
• I being the point of incidence,
• the point (object) P is "transformed", via the diopter, into its conjugate (image) P'
5
 Meridian

• The meridian → a line passing through the center of a definite structure.

• In ophthalmology, the meridian → the lines that pass through the center of the cornea
• A meridian is defined by its axis (in degrees).
• By convention the horizontal meridian has an axis oriented at 0°/180°.
• A hemi meridian is a half meridian. 6
www.gatinel.com
 Descartes' laws in optics
Reflected Ray

Refracted Ray

The perpendicular to the interface at the point of incidence

Incident ray

Normal to the dioptre: The axis perpendicular to the diopter, through the point of incidence
Dioptrique Oculaire et Amétropies : Aspects biophysiques – Pr. Michel Zanca –Montpellier 7
 Physical Message Electromagnetic Ray
Generalities
Reception of external Enargy Ocular Glob
o The sensory functions create an interface between our
environment and the cerebral representation that we
Transduction: transformation of E into have of it.
Nerve Impulse (NI)
Retina
o The human being receives information on the external
world via the sense organs: Hearing - Vision - Touch -
Transmission NI via optic ways Optic ways
Smell - Taste
o Sense organs: receptors of energy that they receive in
Sup Nerve Centers : Interpretation Cortical areas different forms
o A sensory function is a chain of measurement that
consists of the reception, transformation and analysis of
Elaboration of sensorial a specialized form of energy
message: memorization Visual Sensation

Schematic representation of visual function AURENGO André - PETITCLERC Thierry - KAS Aurélie - Biophysique (4° Éd.)
8
 The eye: Generalities

• The eye picks up energies of electromagnetic radiation of wavelength λ:

400 nm < l < 700 nm

• Vision is the elaboration of a sensation from light information.

• Two main parts:

• The transmission of light from the outside to the retina: a step that obeys the laws of geometric optics: ocular dioptric

• The transduction of light into nerve impulses inside the retina, its propagation and the elaboration of a sensation by
the Superior Nervous Center : Perception of the retinal image
 Geometric Optics

Lecturer
Pr. Malika ÇAOUI
Médecine Nucléaire

Semester : 2 Module
BIOPHYSICS

Academic Year : 2021-2023 Module Element

BIOPHYSICS OF VISION

www.um6ss.ma
 Plan
• Basic definitions
• Spherical dioptric : General relationship
Power of the diopter
Focal length of the diopter
Role of the sign of the power
• Cylindrical diopter - Toric diopter
• Association of several diopters : Spherical diopters
Cylindrical or toric diopters
• Converging spherical lenses
11
• Divergent spherical lenses
 Geometric Optics : generalities
Index of refraction or the refractive index
• In a homogeneous environment, light always propagates in a straight line.
• In a transparent medium x ¹ of vacuum, light propagates at a speed vx < c : velocity (speed of light in vacuum)
• The index of refraction nx in this transparent medium x is by definition : c nair = 1
nx = ----
vx nwater= 1,336
Diopter
• Dioptre : surface that separates 2 transparent mediums with different refractive indexes : n1 and n2

• Refraction : Light propagates in a straight line in space, but when it meets a surface separating two transparent mediums
of index ¹ , its direction changes: this phenomenon of deviation is called : refraction.

• A stigmatic optical system gives a point image of a point object, which means that all the light rays coming from the same
point converge on the same point. 12
 Spherical Diopter
• It is a spherical surface separating 2 homogeneous transparent mediums of n ¹ , separated by :
• a single center C and a single radius of curvature R , a vertex S,
• A single type of meridian, all identical because R unique
• It is a Transparent Interface which deflects the light (refraction)
• The principal axis is the SC ray passing through the vertex S. NI is the normal to the diopter at the point of incidence
• A spherical diopter is a stigmatic system.
13
Dioptrique Oculaire et Amétropies : Aspects biophysiques – Pr. Michel Zanca –Montpellier
 Spherical Diopter n1 n2
Positive direction

P1
P2
1. General relation
• It is a spherical dioptre
S 0 Op#c Axis

• O is the center of the dioptre

• S the top of the dioptre
• P1 : Object focus: location of an object whose image is at infinity
• P2 : Image focus: location of a point located at infinity
• p1 = SP1 : Distance Dioptre - Object
• p2 = SP2 : Distance Dioptre - Image n1 n2 n2 – n1
• r = SO : Radius of the Dioptre in the plane - ----- + ----- = ----------- : General Law of Descartes
p1 p2 r 15

14
Spherical Diopter
2. The power of the dioptre is : p
n2 – n1 The power π reflects the importance of the deviation of the
• Dimension : Length -1 . p = ----------
• Unit of p : m-1 = Diopter : D
r beam (so its convergence or divergence)
If r = ∞, π = 0 => plane dioptre : no vergence

3. Focal length of the diopter

• If the object is at infinity, by definition, the image is at the image focus F2 of focal length: f2 = SF
n1 n2. n2 – n1 n2 n2
- ----- + ----- = ---------- = p so f2 = ----- = --------- .r
¥ f2 r p n2 – n1
• In the same way , in the medium n1 , we determine the object focus F1 of focal length f1
¥ n1 n2
n1 n2 – n1 n1 n1
- ----- = ---------- = p so f1 = - ----- = - ----------- . r S 0 F2
f1 r p n2 – n1
• Object point: the point from which the light leaves (comes)
• Image point: the point where the light goes (where it arrives) 15
Spherical Diopter

4. Role of the power sign

n1 n2 n1 n2

S. O F2 F2 O S
i i
Sense Sense

n2 > n1 : r > 0 ® p > 0 n2 > n1 : r < 0 ® p < 0

n2 is always positive Þ the sign of f2 is the sign of the power p :

• p > 0 Þ f2 = SF2 > 0 and F2 is in medium n2 : the diopter is convergent and the focus is real
• p < 0 Þ f2 = SF2 < 0 and F2 is in medium n1: the diopter is divergent and the focus is virtual
• Real space, before the diopter for the objects, after the diopter for the images (in the direction of the light)
• Virtual space, after the diopter for the objects, before the diopter for the images (in the direction of the light) 16
 Convergent spherical lenses

Biconvex Convex plane

Convergent Spherical lens

Convergent meniscus
17
 Divergent spherical lenses

Divergent spherical lens

Concave Plane Convergent meniscus

18
Cylindrical Diopter

• If we give a vertical translation movement to a circular diopter

situated in a horizontal plane : the circle describes a portion of
cylindrical surface (cylinder of vertical axis and radius r ) :
ß
• Cylindrical diopter: it is a stack of circular diopters
• The image of a point is a stack of points: so a line // axis of the
cylinder: the image (is not a point) is distorted / object.
• It is an astigmatic system: the radius of the cylinder does not have the
same value in all directions and therefore the power also varies

Biophysique Médicale Tome1 Fascicule 2: Jacques Llory 19

 Cylindrical Diopter
Faisceau aplati
Let a horizontal beam arriving in a plane ⊥ the axis of the cylinder
n2 – n1
• it reaches the dioptre along a circle of radius r and power ¹ 0 : p = ---------
r
• p > 0 : convergent diopter
• p < 0 : divergent diopter
• This plane cylinder axis ® Principal Meridien (PM) : MH

Faisceau plan

If this Planar Beam arrives in a plane // the axis of the cylinder

• it meets the diopter along a straight line, so zero power : p = 0 in this direction
(beam not deviated)
• This plane cylinder axis® Principal Meridien : MV

Biophysique Médicale Tome1 Fascicule 2: Jacques Llory

• An object point situated at infinity ¥, the cylindrical diopter will produce 2 images in the form of straight lines: focal lengths
• Vertical focal point due to power p ¹ 0: // axis of cylinder ® PM : MH ( cylinder axis)
• Horizontal focus due to power p = 0 ⊥ cylinder axis and situated at ¥ PM : MV ( // cylinder axis) 20
 Cylindrical lens with horizontal axis

Horizontal Focal

Cylindrical lens with vertical axis

Vertical Focal

21
A toric Diopter
• A circular diopter in the horizontal plane is given a rotational motion of radius r' (r'¹ r)
around a horizontal axis xis SO
r
• The circle of radius r describes a portion of surface named toric characterized by 2 radii :
r’ • r and r’ ¹ ; so power p ¹ 0 (≈ buoy) p n –n
= p H = ----------
2 1 ® Vertical Focal : F
r V

p = p V = n----------
2 – n1 ® Horizontal Focal : F
S 0 r H

• A torus has 2 orthogonal PM :

- A Horizontal PM (contains the portion of the circle of radius r) of power πH . The focal
length it generates is named F : vertical, thus orthogonal to MH
- A Vertical MP (contains the portion of the circle of radius r'), of power πV . The focal
length it generates is the focal length F : horizontal orthogonal to MV
• Each of the 2 focal lengths is plane of the radius that generated it
22
A toric diopter combines two orthogonal cylindrical diopters

Horizontal Focal Vertical Focal

Dioptrique Oculaire et Amétropies : Aspects biophysiques – Pr. Michel Zanca –Montpellier 23

 A convergent toric diopter where pH <pv

Horizontal Focal

Vertical Focal

Dioptrique Oculaire et Amétropies : Aspects biophysiques – Pr. Michel Zanca –Montpellier 24

 Non-astigmatic Cornea
A non-astigmatic cornea: like a football:
each meridian has the same radius of
curvature (therefore the same power)
http://www.mguedj.com/Astigmatisme.html
An astigmatic Cornea
• An astigmatic cornea: like a rugby ball: absence of symmetry of revolution,
the curvature of the PM varies between 2 values: min (least curved PM),
and max (most curved PM).
• The curvature is ¹ according to the meridian of the ball considered.
• Each corneal meridian has an optical power ¹ according to whether it is
more or less curved 25
 Non astigmatic Cornea Astigmat ic Cornea

Regular cornea Astigmatic cornea

The image of an object point is no more punctual, but spread

The image of an object point is punctual and clear on the retina between several "image foci" situated at different focal lengths.
http://www.mguedj.com/Astigmatisme.html 26
 Meridians and focals

Astigmatic cornea
Astigmatic cornea

The beam of red rays is refracted by the most arched meridian The beam of green rays is refracted by the horizontal meridian and
(vertical) and focused in a point in front of the retina. focused on a point behind the retina.
http://www.mguedj.com/Astigmatisme.html 27
 Summary
• Refractive index of the considered medium: n = v/c; with v: speed of light in the medium, c the celerity of light (in vacuum)
• Diopter = index / distance
• Object point: the point from which the light leaves (comes from)
• Image point: where the light goes (where it comes)
• Real space, before the diopter for objects, after it for images (in the direction of light)
• Virtual space, after the diopter for objects, before it for images (in the direction of light)
• Conjugate points: object and image points in relation to a diopter

Nature of diopter Spherical Cylinder Toric

1 radius r 1 radius r
Geometric Characteristics 1 rayon
1 radius ¥ 1 radius r’
Stigmatic yes No Non
p ¹0 p¹0
Power 1 seule p
p =0 p’ ¹ 0
Image of a point at infinity 1 focus 1 focal // cylinder axis ; 1 focal ¥ 2 focal lines between them
28
Association of Diopters
Spherical Diopters :
• Principle :
• If the light passes through several spherical diopters not far from each other:
• The set behaves as a single diopter of power p = p1 +p2 + p3….

• Thin lenses :
• It is a system consisting of 2 diopters, not far from each other, with equal indices of the media:

Cylindrical or toric diopters

The same principle applies but under two conditions:
• The MP of the associated ¹ diopters must be in the same directions
• The algebraic sum of the powers must be done in each PM
• It is often useful to represent the p on a diagram. 29
Association of Diopters
Spherical diopters
n2 – n1 The light passes from n2 to n1; the power of the lens : p
p’ = ----------
r’ n1 r’’ n2 r’ 1. 1
p = p’ + p’’ = (n2 – n1) (----- - ----- )
n1 – n2 r’ r’’
p’’ = ----------
r’’

Cylinder Diopters Toric Diopters

0 C1 : p of diopter due to the PM n°1

C2 : p of diopter due to the PM n°2

C
+3 +2 +5
+1 + 0 +1
30
 References

• Ocular Dioptric and Ametropias : Biophysical aspects - Pr. Michel Zanca - Faculty of Montpellier
• Medial Biophysics : Volume 1 Fasciucle 2: Elements of Radiation Physics - Jacques Llory - Faculty of Montpellier
• Refraction and refractive anomalies - 2013- Collège des Ophtalmologistes Universitaires de France (COUF) - UMVF - Université Médicale Virtuelle
Francophone
• Polycopié National du Collège des Ophtalmologistes Universitaires de France 2009-2010 - Université Pierre et Marie Curie- France
• http://www.gatinel.com/recherche-formation/astigmatisme/
• https://www.cinenow.fr/tutoriels-guides/2107-un-peu-de-physiologie

31
 Dioptric of the Normal Eye

Lecturer
Pr. Malika ÇAOUI
Médecine Nucléaire

Semester : 2 Module
BIOPHYSICS

Academic Year : 2021-2023 Module Element

BIOPHYSICS OF VISION

www.um6ss.ma
 Plan: Dioptric of the Normal Eye

• Description of the eye globe

• Transparent media of the eye and their respective powers
• The reduced eye
• The emmetropic eye
• Convention of medical signs
• Accommodation: Mechanisms of accommodation
Characteristics of accommodation: Amplitude of accommodation
Accommodative Pathway
Punctum Proximum and Punctum Remotum
• Presbyopia 33
 Visual Pathway

https://www.perkins.org/the-visual-pathway-from-the-eye-to-the-brain/ The Visual Pathway of the Brain 34

The visual pathway from the eye to the brain

https://www.perkins.org/the-visual-pathway-from-the-eye-to-the-brain/

35
 Description of the eye globe
• Sphere of wall constituted by 3 concentric tunics:
• Ext fibrous tunic: sclera which in front takes a domed (convex) shape and becomes transparent: cornea
• Middle tunic, vascular: including the choroid, the ciliary body and the iris (color varies according to individuals).
• Internal tunic, nervous: retina

• Lens, deformable structure for a focus, is connected to the ciliary muscle by fibers: the zonule. It divides the contents of the
eye into 2 chambers:
• Anterior: in front containing the aqueous humor (composition close to the physiological serum)
• Posterior: back containing the vitreous humor (gel rich in proteins)

• The transparent mediums of the eye through which the light passes to reach the retina are: the cornea, the aqueous
humor, the lens and the vitreous humor

• The iris, of variable color (not transparent) is located between the anterior chamber and the lens
• It is pierced by a central orifice: Pupil which has the role of a diaphragm
• Pupil: diameter varies, from 2 (myosis) to 8 mm (mydriasis), by reflex reaction to the light or during accommodation
36
Retina
• Transducer and 1st step of the visual message processing. Extension of the brain. Very complex organization
• Circular symmetry of visual axis shifted / optic axis: joins the top of the corneal dioptre to the center of the retina: Fovea.
• Papilla: zone of emergence of the vessels and departure of the optic nerve: devoid of receptor cells: Blind spot
• Macula: central area of the retina covers 15 - 20° of the visual field: max thickness: 500 𝝁m composed exclusively of cones+++.
• In macula center, the fovea forms a small depression covering 5° of the visual field: where visual acuity is the highest: Foveola
• The photoreceptors of the retina: cones more concentrated in the macula / rods : in the periphery
Rods Cones
Topography Péripheral retina Supecially Fovea
Vision domain Nocturnal scotopic Diurnal photopic
Visuual Acuity Low High
Variance Single vision uncolored variant Trivariant colored Vision
Adaptation Important and slow Fast and low
Pigment Rhodopsine 3 different pigments
AURENGO André - PETITCLERC Thierry - KAS Aurélie - Biophysique (4° Éd.) 37
Transparent mediums of the eye
• Before arriving on the retina, the light crosses, in the eye, several transparent mediums of different indices
responsible for the convergence which ensures a luminous image on the retina.
• These different media normally constitute spherical diopters.
The cornea : Upper and transparent part of the sclera of n = 1,377 (/nair = 1)
o r ext = 7,8 mm nair = 1 1,377 1,337
o r int = 6,5 mm
7.8 mm; 6.5 mm 1,377 – 1
o The anterior corneal dioptre is of power p = ----------------- = + 48 D
7,8 . 10-3

Aqueous humor (HA): n = 1,337 : (close to water) is distributed in 2 spaces by the iris: extension of the choroid..
ü The iris (not transparent) is pierced by the orifice: pupil diameter varies from 2 to 8 mm by reflex
ü Posterior corneal dioptre is of power 1,337 – 1,377
p = ---------------------- = - 6 D AH
+ 6,5 . 10-3
38
 Transparent mediums of the eye
Lens :
• Biconvex lens, of complex constitution (onion bulb): n varies from the center to the periphery Þ n average = 1.42
• Radii of curvature of the 2 faces change during accommodation. Normal eye at rest: : rant = 10 mm /rpost = 6 mm
• Anterior lens dioptre : 1,42 – 1,337
p = ------------------- = + 8 D
10 . 10-3

The vitreous humour : n = 1,337

• Same optical properties as aqueous humor, although its viscosity is higher (» gel)
• Posterior lens Diopter : 1,337 – 1,420
p = --------------------- = + 14 D
- 6 . 10-3
Total power of the eye at rest
• pT = 48 – 6 + 8 + 14 = 64 D » 60 D (experimental mean value)
• Total Power pT is mainly due to the Anterior Corneal Dioptre 39
The normal eye = the emmetropic eye
• For the normal eye, there is always a correlation between length and power, so that the image focus of the eye is
on the retina.
• " Whatever the value of its pT , a normal eye at rest, gives an object at infinity, an image on retina: Emmetropic Eye
• The light penetrating in the eye meets successively a series of dioptres ± spherical : surfaces of refraction
o Anterior corneal diopter: the most powerful: 48 D
o Post corneal diopter, of low power because it separates media of very close refractive indices
o Anterior and posterior crystalline diopters (12 to 14 D)

PR : ¥ R
S
Fovea

direction +: Medical The medical direction of the light is the opposite of the physical direction 40
Reduced Eye
• All the spherical diopters of the eye can be » assimilated to a single spherical diopter: Reduced Eye
• The reduced eye is then a spherical diopter of p = 60 D separating air (nair = 1) from water (neau = 1.337), we define :
1,337 – 1,000
o The power : p = --------------------- = + 60 D Þ radius Þ r = 5,6 mm
r
1,337
o The focal length image of this diopter is: f2 = ----------- = 22 mm
60
o The radius r varies with accommodation between a πmin (rest) of +60 D for distance vision (Pr), and a πmax for near
vision (Pp), which decreases with age (presbyopia).

n1 = 1,00 S n2 = 1,337
Reduced Eye
r = 5,6 mm Retina

If2I = 22 mm

World of real objects World of real images 41

Medical sign convention

In physics: All linear distances are measured from S in algebraic values

Positive direction in physics, that of the path of the light (object to image)
In medicine: The distances of objects and images are: Positive for points in front of the eye
Negative for points behind the eye
n1 n2 n1 n2
- ------ + ------ =p become ------ - ------ = p
p1 p2 p1 p2
In physics In medicine

• The powers p (being the sign according to the convention of physicists) : Positives for convergent diopters
Negatives divergent diopters
42
The accommodation
Necessity of accommodation
• The reduced eye has a power of 60 D and a length l = of 22 mm
• The image of an object located at infinity (beyond 5 meters) is formed on the retina and will be clear
• If this eye observes a close object situated at 20 cm (p1 = + 0,20 m), the image will be blurred at a distance p2
1
situated behind the retina (virtual image): ------ 1,337
+ -------- = 60 D Þ p2 = -24 mm (2 mm behind the retina)
0,2 p2
• The eye must then modify its characteristics to see clearly the close objects

R p2
p1 S

20 cm

Direction + : in medicine 22 cm 43
The accommodation
Mechanism of accommodation :
• It is a k of the power of the eye by k of the power of the lens whose radius of curvature (especially anterior) m :
• It is a very fast reflex phenomenon ( important in children 15 D) : " focus " in a fraction of a second

Characteristic of accommodation :
• AAccommodation Amplitude (AA in Diopter) is the k max of the p of the eye during accommodation AA = pmax - p min
• p2 : Distance Dioptre - Retina (the image in case of accommodation or not, is formed on the retina)

Pr 1 1
PR PP P2 R pmax - p min = AA = ----- - ------
S Pp Pr
Pr PA Pp Pp

pmin AA pmax 44
Characteristics of Accommodation: PR – PP – AA - PA
The Punctum Remotum : PR The Punctum Proximum : PP
• Conjugate point of retina when eye is at rest (does not • Conjugate point of the retina when eye accomodates to the max
accommodate)
• Pp is the distance from PP to t eye. P2 : Distance Dioptre - Retina
• Pr: Distance from PR to the eye. For a normal eye: Pr → +¥
• The power in accommodation is maximum :
• The power of the eye at rest is minimal : 1 n2
----- + ------ = pmax (accommodation max)
1 n2 Pp P2
----- + ------ = pmin (at rest )
Pr P2

• The amplitude of accommodation AA mesurée en (D) 1 1

pmax - p min = ----- - ----- = AA
Pp Pr
• Accommodation Path: AP (distance PR-PP): Range of distance in which the object must be to be seen clearly
• Images are seen sharp when they belong to the retina: S - Retina = 22 mm
• But they are seen blurred when they form before or after the retina.
• Thus, in clear vision, distance S - Image = S - Retina ∀ Object ∈ AP 45
Accommodation
Example 1: - A normal person (Pr → +¥) has an AA = 5D ; what is his PP?
1. 1 1
- AA = ----- - ------ = 5 Þ Pp = ----- = + 0,20 m
Pp Pr 5
- The PP is 20 cm in front of the eye
- The PA is situated between 20 cm (PP) and infinity (PR):
- The subject sees clearly the objects situated between +20 cm in front of the eye and infinity

Example 2: - A normal person (Pr → +¥) has a n AA = 1D;

- The PP is 1 m in front of eye
- The PA is situated between 1 m (PP) and infinity (PR)
46
Presbyopia
Variation of AA with age: Presbyopia
• The lens, responsible for accommodation, loses its flexibility with age and its ability to accommodate, decreases
• This is Presbyopia: an accommodationm : age-related physiological vision disorder → Consequences :
• The subject can no longer see close objects: his vision is disturbed, because:
o The PA m Þ pmax m (not enough or insufficient Power) Þ AAm
o Since pmax m Þ PP: moves away from the eye and is at a distance : S - Pp k > 25 cm → PP moves nearer to the PR
o Only pmax is affected, pmin is not affected (fixed PR).
o Presbyopia sets in as soon as AA < 4 D (on average, from the age of 45)

Correction of presbyopia:
• The eye has insufficient power to see close-up objects: close-up vision (reading) is difficult, if not impossible.
• The power of the eye is increased by converging spherical lenses that the subject uses only for near vision
47
AA
Presbyopia
14
Variation of AA with age and situation of PP
12
Age AA S-PP Age AA S-PP
10 (Ans) (D) (cm) (Ans) (D) (cm)
10 14 7 40 4,5 22
8
15 12 45 3,3 30
6 20 10 50 2,5
25 8,5 55 1,7
4
30 7 14 60 1 100
2 35 5,5 65 0,50
70 0,25 400
0
10 20 30 40 50 60 70 Age en années

Decreased accommodative amplitude with age 48

 Accommodation an convergence
Binocular vision
• Human vision is binocular: an object seen clearly, its image is formed on the retina: fovea (the eye fixes the object).
• To observe close objects, the 2 eyes turn on themselves using the ocular muscles, the fovea-cornea axis always passes
through the object.
• This rotation of the eyes is the convergence of the eyes which occurs in a reflex way
• To observe a close object, each eye accommodates and the 2 eyes converge: there is a relation between accommodation
and convergence.
• The cerebral centers provide from 2 retinal images a unique sensation: there is a fusion of the 2 images
• If this fusion does not exist, the subject perceives simultaneously 2 distinct images: there is diplopia 49
 Binocular Vision : Eye convergence

Disorders of eye convergence:

• Evident defect: the axis of one eye is strongly deviated inward or outward → convergent or
divergent strabismus
Objet at infinity
• Simple difficulty to converge which leads to secondary disorders: headaches, tired when
reading... → Need for re-education (Orthoptics)
Distant Object

Very close Object

50