Refractive Errors

University of Baghdad
College of Medicine
2022-2023
Title: Refractive Errors
Grade: 5th
Module: Ophthalmology
Speaker: Lecturer Ahmed Shakir Al-Wassiti
Date: Oct 12 2022
University of Baghdad/ College of Medicine 2022-2023
REFRACTIVE ERRORS
Learning Objectives University of Baghdad/ College of Medicine 2022-2023
❑ To identify the optical principles of refraction

of the eye
❑ To define accommodation, amplitude of
accommodation and presbyopia
❑ To list, classify and differentiate between the
types of refractive errors
❑ To describe the clinical features and outline
the treatment of different refractive errors
Reflected rays
N
o
r Refracted rays
m
a
l Absorption
Incident rays
AP= 24 mm
7.8 mm
10 6
mm mm
More curvature = less radius and vice versa

Infinity ( 6 meter & more )

Less than 6 meter University of Baghdad/ College of Medicine 2022-2023
More near = more divergent
Accommodation
Amplitude of accommodation
43 17
D D
60 D
Amplitude of Accommodation
Early in life:
14D
Can focus objects

7cm from their
eyes
Amplitude of Accommodation
At age of 36y: 6D only, so the nearest object which can be

focused is at a distance of ≈ 15cm from eye.
At age of 45y: 4D only, and the nearest focus point is 25cm away
from eye.
At age of 60y: 1D only, and the nearest focus point is 1m.
Presbyopia
Recession of the near point due to decreased amplitude

of accommadation
Presbyopia
Reading glasses
Emmetropia (normal refraction):
Ammetropia:
→ Hypermetropia
Spherical
→ Myopia
refractive errors
→ Astigmatism
Hyperopia
6 meters
Etiological classification:
1- Axial Hypermetropia
2- Refractive Hypermetropia
a- Curvature Hypermetropia
b- Index Hypermetropia
c- posterior dislocation of lens

d- Aphakia
Etiological classification: University of Baghdad/ College of Medicine 2022-2023
Axial Hypermetropia
Aphakia
Index Hypermetropia
Posterior dislocation of the lens
Curvature Hypermetropia
Index Hypermetropia
Nucleus
Cortex
1.42
1.40
1.38
0.04
0.02
Index Hypermetropia
1.42
1.38
1,40
0.04
0.02
Clinical classification
 Facultative Hypermetropia
 Absolute Hypermetropia
 Manifest Hypermetropia
 Latent Hypermetropia
 Total Hypermetropia
HowCycloplegic eyehypermetropia??
to measure total drops
Clinical features of hypermetropia University of Baghdad/ College of Medicine 2022-2023
Blurred vision
Eye strain
General symptoms like nausea and

fatigue
NEAR REFLEX University of Baghdad/ College of Medicine 2022-2023
Accommadation
Miosis
Convergence
NEAR REFLEX University of Baghdad/ College of Medicine 2022-2023
Accommadation 1D 3-5 prism diopter

Miosis
Convergence
+
Treatment:
1- Convex lens in spectacles.

2- Contact lenses.
3- Photorefractive surgery
4- Laser thermal keratoplasty (LTK): (Holmium- YAG)
5- Implantable intra ocular lens (AC IOL).
Photo refractive surgery

Phakic IOL
MYOPIA
1- Axial Myopia
2- Refractive Myopia
a- Curvature Myopia
b- Index Myopia
c- anterior dislocation of lens

1- Axial Myopia
a- Curvature Myopia
b- Index Myopia
c- anterior dislocation of lens

Clinical classification:
1- Simple (stationary):
2- Pathological (progressive):
Clinical features
Blurring of distance vision
Clinical features
Pinhole effect
Eye strain and headache
-
Treatment:
• Concave lens in spectacles.
• Contact lenses.
• Photorefractive surgery
• Implantable intra ocular lens (Phakic IOL).
• Clear lens extraction in high myopia
Photorefractive Surgery University of Baghdad/ College of Medicine 2022-2023
Flattening of central cornea

Intraocular Refractive surgery

ASTIGMATISM
Astigmatism
1- Curvature astigmatism:
2- Decentering astigmatism:
3- Index astigmatism:
Clinical classification:
1- Regular: a- Simple astigmatism:

b- Compound astigmatism:
c- Mixed astigmatism:
2- Oblique Astigmatism
3- Irregular astigmatism:
Irregular Astigmatism
Irregular Astigmatism
Keratoconus
Corneal trauma
Cylinderical lenses
Sphero -Cylinderical lenses

Phakic eye
Aphakia
Pseudophakia

Refractive Errors

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University of Baghdad

Title: Refractive Errors

❑ To identify the optical principles of refraction

More curvature = less radius and vice versa

Infinity ( 6 meter & more )

More near = more divergent

Can focus objects

At age of 36y: 6D only, so the nearest object which can be

Recession of the near point due to decreased amplitude

Emmetropia (normal refraction):

c- posterior dislocation of lens

General symptoms like nausea and

Accommadation 1D 3-5 prism diopter

1- Convex lens in spectacles.

Photo refractive surgery

c- anterior dislocation of lens

c- anterior dislocation of lens

Flattening of central cornea

Intraocular Refractive surgery

1- Regular: a- Simple astigmatism:

Sphero -Cylinderical lenses

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