Abdullah Matar

Topics
 Errors of Refraction (ametropia):
- Hypermetropia
- Myopia
- Astigmatism
- Presbyopia

 Refractive Surgery
- Excimer Laser
- Photorefractive Keratectomy ( PRK )
- Laser Assisted in situ Keratomileusis ( LASIK )
- Laser Assisted Subepithelial Keratomileusis ( LASEK )
 Keratoconus
Introduction
 Light is a visible part of electromagnetic radiation
(spectrum) that has a wavelength of 390 – 700 nm
for the human eye .
 Retina is the sensitive part of the eye to light , i.e.
light must be focused on retina to generate
accurate visual information .
 The Focus should be an adjustable one
 2/3 of focus  cornea ( air/tear interface ) ,
1/3  crystalline lens
Cont’d
 Cornea + crystalline lens  converge light as :
- they are spherically convex
- Refractive Index ( Cornea > Air ) , ( lens > Aquesous
Humor ) .
Cont’d
 Emmetropia = Light focused on Retina at rested eye
- Sharp Vision
Ametropia = Light not focused on Retina at rested eye
- Refraction changes needed to achieve sharp vision
 Ametropia has 3 major types :
1- Myopia
2- Hypermetropia ( hyeropia )
3- Astigmatism
 Accommodation
Myopia ( Short-Sightedness )
 Patient can see clearly close up but their distance
vision is blurred.
 focal point is anterior to ( in front of ) Retina
 the optical power of the eye is too high (usually due to
an elongated globe) .
 Causes :
- Axial Myopia ( most common)
- Refractive Myopia ( rare )
 Correction :
- Minus Glasses
Hypermetropia ( Long – Sightedness )
 Patient can see clearly in the distance but not near
 Focal point is posterior to (behind) Retina
 the optical power is too low (usually because the eye is
too short)
 Causes :
- The axial length is too short .
 Correction :
plus glasses
Astigmatism
 part of the image in one plane is out of focus due to
unequal refraction.
 The parallel incoming rays deform and do not focus at
a single point ( multiple focal points ) , causing a
blurred retinal image
 Cause : Corneal Curvature ( non-spherical )
 Correction : Sphero Cylindrical glasses , corneal
surgery or laser .
Accommodation and Presbyopia
 Accommodation : ciliary muscle contraction, which
relaxes zonular tension on the lens equator and allows
the lens to take up a more spherical shape.
Presbyopia
 Decrease in the ability of accommodation with age;
becomes symptomatic in early 40s with asthenopic
symptoms ( eye strain ) and need for reading glasses .
 Earlier in hypermetropic patients
 Theories :
- Helmholtz: zonular tension decreases, lens becomes more spherical,
focusing power increases; presbyopia is due to loss of lens elasticity

- Tscherning-Schachar: equatorial zonular tension increases, lens

diameter increases, central lens steepens, focusing power increases; lens
grows throughout life, decreasing the working distance between lens and
ciliary body; presbyopia is due to decreased ciliary muscle effectivity
Keratoconus
 This is usually a sporadic disorder but may
occasionally be inherited.
 Thinning of the centre of the cornea leads to an
ectatic, conical corneal shape, with marked myopia
and an irregular astigmatism.
 Vision is affected but there is no pain
 The condition is due to a failure of adhesion between
the collagen fibrils of the stroma, responsible for its
mechanical strength
Keratoconus
 Current treatment is directed to cross - linking of the
stromal collagen, which is achieved by exposing the
stroma to UVA radiation in the presence of ribofl avin;
the generation of free radicals results in cross - linking
and inhibits progression of the disease. In severe cases
a corneal graft may be required.
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