REFRACTIVE ERROR

BY
DR COKORDA DEWIYANI PEMAYUN
DEPT OF OPTHALMOLOGY
UDAYANA UNIV

REFRACTIVE ERRORS

Emmetropia absence of refractive errors

When image of distant objects focuses in the retina in
the unaccomodated eye
Naturally optimal focus for distance vision
Ametropia the presence of refractive errors

(Vaughan, 2004)

Ametropia

o
o
o
o

Myopia
Hiperopia
Astigmatism
Presbyopia

MYOPIA (NEARSIGHTEDNESS)
When image of distant objects focuses in front

of the retina in the unaccomodated eye

Types of myopia:

Axial myopia
Refractive / curvature myopia
Index refractive myopia
Myopia caused by change in lens position

(Gracia, 1989; PERDAMI 2006)

Cause of myopia: anatomy of the eye, heredity,

life styles
Simple Myopia (School myopia) school age,
mild to moderate myopia
Pathologic Myopia high myopia with vitreoretinal
changes
Symptom:

Blurred at distance vision

Tendency to squint to see distance object
Like to read / extensive near work activity
(Garcia, 1989)

 Treatment :
weakest concave spherical ( minus ) lenses
that give maximal correction
Complication:

Retinal detachment high myopia

Strabismus
Amblyopia
(Garcia, 1989)

HYPEROPIA (FARSIGHTEDNESS)

When image of distant objects focuses

behind the retina in the unaccomodated eye

Types of hyperopia:

Axial Hyperopia
Refractive / curvature hyperopia
Index of refraction Hyperopia
Hyperopia caused by alteration of lens position
(Garcia, 1989; PERDAMI 2006)

Types of Hyperopia based of accomodation

Latent hyperopia completely corrected by

accomodation and is not apparent or measurable
by manifest refraction when no cycloplegic is used
Manifest hyperopia apparent or measurable by manifest
refraction
Facultative hyperopia may be corrected by convex
lenses but also may be corrected by accomodation in
absence of lenses
Absolute hyperopia not compensated for by
accomodation & need convex lenses
(Garcia, 1989)

Symptoms of hyperopia:

Blurred vision at near noticeable if the

person is tired, indistinct printing and
inadequate lightning
Distance vision is impaired for high hyperopia
(>3.00D) or older patients
Headache in the frontal region exaggerated
by prolonged use of the eye for near vision

Symptoms of hyperopia:
Uncomfortable vision asthenopia
Increase sensitivity to light
Spasm of accomodation cramp of cilliary
muscle accompanied by intermittent
blurred vision and its clears if the patient is
given minus lens (Psudomyopia)

Treatment of hyperopia:
Strongest convex ( plus ) lenses that give
maximal correction
Complication:

Glaucoma ( shallow anterior chamber)

Esotropia ( high hyperopia )
Amblyopia ( especially in children, could be
bilateral )

(Garcia, 1989, Vaughan 2004)

ASTIGMATISM

Term astigmatism from Greek, means: without

a point
Condition in which rays of light are not refracted
equally in all meridians
Astigmatic eye have 2 principal meridians that is
usually at right angles to each other
Cause of astigmatism: abnormalities of the corneal
shape

Forms of Astigmatism

Regular Astigmatism

two principal meridians

with constant power
and orientation across
the pupilary aperture
resulting in two focal
lines
can be corrected with
cylinders

Irregular Astigmatism

the principal meridians

are
not
90
apart
because of irregularity
of the corneal curvature
cannot be corrected
with cylinders

regular astigmatism:

With the rule the greater refractive power is

in the vertical meridian

Against the rule the greater refractive

power is in the horizontal meridian

Oblique astigmatism the principal

meridians are more than 20 from the
horizontal and vertical meridians

Types of regular astigmatism

Symptoms of astigmatism:
Blurred vision high astigmatism
Good VA but asthenopia & frontal headache
especially while patient is doing precise work at
a fixed distance with prolonged periods low
grade astigmatism
Transient blurred vision at near, relieved by
closing or rubbing the eyes
Tilting / turning of the head high degree of
oblique astigmatism
Squint to achieve a pinhole effect at distance
and near

The letters seen by astigmatic

patients

Astigmatic Clock Dial

The uses of Jackson Cross

Cylinder for Astigmatism

Test for astigmatism:

Astigmatic Clock Dial
Jackson Cross Cylinder
Treatment of astigmatism:
Cylinders lenses
Rigid Gas Permeable (RGP) contact lens
Toric Contact lens

(Garcia, 1989, Vaughan 2004)

PRESBYOPIA
Loss of accomodation that comes with aging
A person grows older, the lens larger & thicker

becomes less elastic decrease the ability to change

shape
Clinically noted after age of 40, usually around 44 or 45
years
Symptoms:

Receded distance for reading

Inability to do close work (eg: Reading newspaper or telephone
directory)
Excessive light required for reading

Near Vision Test: Jaeger Chart

Treatment of presbyopia:
Convex (plus) lenses

40 years + 1.00 Dioptri & Increase 0.50 D

of every 5
years of age
Types of glasses for presbyopia:

Reading glasses
Bifokal lenses
Trifokal lenses
Progressive lens
(Garcia, 1989, Vaughan 2004,Guyton,2000)

ANISOMETROPIA

A difference of refractive error between the two

eyes.
A major cause of amblyopia because the eyes
cannot accommodate independently and the more
hyperopic eye is chronically blurred
Difficult to give refractive correction due to
aniseikonia and oculomotor imbalance
(Vaughan, 2004)

 Aniseikonia differences in size of retinal

image
Spectacle lenses 25 % aniseikonia rarely
tolerable
Choices:

Contact lens 6 % aniseikonia

IOL < 1 % aniseikonia
(Vaughan, 2004)

CORRECTION OF REFRACTIVE ERRORS

Spectacle lenses safest method

Contact lenses soft CL, RGP, Toric CL
Refractive Surgery

Keratorefraktif surgery, eg: LASIK

Refractive Lens Exchange
Phakic IOL
Clear Lens Extraction

(Vaughan, 2004)

Contact lens
Types of Contact Lens

SOFT CONTACT LENS:

Extended Wear Contact Lenses. Disposable
(Replacement Schedule) Contact Lenses ,toric
Rigid Gas Permeable (RGP) Contact Lenses
Specialized Uses of Contact Lenses

Orthokeratology (Ortho-K)

Indications n contraindications of contact lens

INDICATIONS:

-Optical indication
-Medical indications
(keratoconus,iregular astigmat,corneal
opacification,unilateral afakia,anisometropia,after
refractive surgery,after penetrating KPL)
-cosmesis
-Therapeutic (bandage lens)

CONTRAINDICATIONS:
Acute or subacute inflamatory the ant segment of the

eye
- acute n chronic infections of the eye
-eye disease of eye lid conjungtiva n cornea
-corneal hypestesia
-uncontrolled glaucoma

spectacles
CLE
Contact lens

LASIK Procedure (Keratorefractive Surgery)

Phakic IOL

Thank You