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ERROR OF REFRACTION

Refraction
DEFINITION
Refraction is defined as the ratio of the refractive
power of the lens and cornea (the refractive media)
to the axial length of the globe.
Emmetropia is absence of refractive error, and
ametropia is the presence of refractive error.

EMETROPIA (NORMAL EYE)
Light cornea aqueous humor pupil
aqueous humor Lens Vitreous Humor
Retina Optic Nerves Brain
REFRACTION OF NORMAL EYE
There are four transitional refraction
media trought by light :

1. Transition between air anterior
surface of cornea

2. Transition between posterior
surface of cornea - humor aqueous

3. Transition between humor
aqueous-anterior surface of lens

4. Transition between posterior
surface of lens-vitreous humor
ERROR OF REFRACTION
Myopia
Hyperopia(Hypermetropia):
Astigmatism
Presbyopia
MYOPIA
Myopia
A discrepancy between the refractive power and
axial length of the eye such that parallel incident
light rays converge at a focal point anterior to the
retina

Myopia
Parallel rays converge at a focal point anterior to the
retina
Etiology : not clear , genetic factor
Causes
excessive long globe (axial myopia) : more common
excessive refractive power (refractive myopia)
Forms
Based on desease development
Stasioner Myopia/school age myopia
persistent when adult
Progressif Myopia progressif altought in adult,
because increase eye ball lenght
Malignant Myopia progressif, can make retinal
ablasion and blindness

Symptoms
Blurred distance vision
Squint in an attempt to improve uncorrected visual
acuity when gazing into the distance
Space between palpebra is decreased
Headache
Amblyopia uncorrected myopia > 10 D
Myopia Correction
The choosen lens should be the biggest positive
which can give the visus measurement 6/6.
For example, if correction with -3.00 can give
visus 6/6 and the correction with -3.25 can give
visus 6/6, we chose the the first one.


Hypermetropia
Hypermetropia
Hyperopia: there is a discrepancy between the
refractive power and axial length of the eye such that
parallel incident light rays converge at a focal point
posterior to the retina.

Symptoms
Visual acuity at near tends to blur relatively early
blurred vision is more noticeable if person is tired , printing
is weak or light inadequate
asthenopic acommodative symptoms : eyepain, headache
in frontal region, burning sensation in the eyes.
accommodative esotropia : because accommodation is
linked to convergence
Amblyopia uncorrected hyperopia > 5D
Special forms of refractive hyperopia:
Absence of the lens (aphakia) due to dislocation.
Postoperative aphakia following cataract
surgerywithout placement of an intraocular lens
Hypermetropia Correction
The choosen lens should be the biggest positive
which can give the visus measurement 6/6.
For example, if correction with +3.00 can give
visus 6/6 and the correction with +3.25 can give
visus 6/6, we chose the the second one.

Astigmatism
Astigmatism
Astigmatism : The disorder is characterized by a
curvature anomaly of the refractive media such that
parallel incident light rays do not converge at a point
but are drawn apart to form a line.
Astigmatism
Etiology : heredity
Cause : refractive media is not spherical refract
differently along one meridian than along meridian
perpendicular to it 2 focal points ( punctiform
object is represent as 2 sharply defined lines)

Classification
Astigmatism can be classified as follows:
External astigmatism: astigmatism of the anterior
surface of the cornea.
Internal astigmatism: the sum of the astigmatic
components of the other media.
Classification

Astigmatism can also be classified according to the
location of the meridian of greater refraction:
With-the-rule astigmatism (most common form): The
meridian with the greater refractive power is vertical,
i.e., between 70 and 110 degrees.
Against-the-rule astigmatism: The meridian with the
greater refractive power is horizontal, i.e., between
160 and 20 degrees.

Classification
Oblique astigmatism: The meridian with the
greater refractive power is oblique, i.e., between
20 and 70 degrees or between 110 and 160
degrees.

Treatment
Treatment of regular astigmatism: The
purpose of the correction is to bring the focal
lines of two main meridians together at one
focal point. This requires a lens that refracts in
only one plane. Cylinder lenses are required
for this application.
Once the two focal lines have been
converged into a focal point, additional
spherical lenses can be used to shift this focal
point on to the retina if necessary.
Treatment
Treatment of irregular astigmatism: This form
cannot be corrected with eyeglasses. External
astigmatism may be managed with a rigid contact
lens, keratoplasty, or surgical correction of the
refractive error.
Irregular internal astigmatism is usually lens-
related. In this case, removal of the lens with
implantation of an intraocular lens is indicated.
Presbyopia
Presbyopia
Presbyopia happens naturally in people as they age.
The eye is not able to focus light directly on to the retina
due to the hardening of the natural lens.
Aging also affects muscle fibers around the lens making
it harder for the eye to focus on up close objects.
The ineffective lens causes light to focus behind the
retina, causing poor vision for objects that are up close.
Presbyopia
Physiologic loss of accommodation
in advancing age
deposit of insoluble proteins in lens in
advancing age elasticity of lens
progressively decreasedecrease
accommodation
Decrease cilliary muscle contraction
Presbyopia
Treatment
convex lenses in near vision
Reading glasses
Bifocal glasses
Trifocal glasses
Progressive power glasses
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