DISORDER OF REFRACTION

Asep Saripudin, S.Ked 19360172

Preceptor :
dr. Rahmad Syuhada, Sp.M (K)

PERTAMINA BINTANG AMIN HOSPITAL

FACULTY OF MEDICINE OF MALAHAYATI UNIVERSITY
BANDAR LAMPUNG OCTOBER - 2020
EYES = can be thought of as cameras

The refractive system produces a small shadow, inverted image in

the retina (received by bacillus and cones cell) → optic nerve, N II
→ cerebral cortex (center of vision) → appears as an upright image.
Refraction medium:
• Cornea (n = 1,376)
• Aquos humor (n = 1,336)
• Lens (n ​= 1.386)
• Vitreous corpus (n = 1,336)

• Normal eye → focus image of distant objects drawn right on the retina
where the eye is at rest (without accommodation)
Accommodation:
The ability of the eye to increase its refractory power or the
ability of the lens to bulge, which occurs as a result of contraction m.
Cilia

Accommodation theory:
1. Helmholtz accommodation theory
zinii zonula loose → convex lens
2. Tsernig's accommodation theory
zonula zinii tense → the center of the convex lens
 Sharp eyesight (visus)
•Without and with glasses
•Each eye is examined separately
•Checks should be done at a distance of 5- 6 m

Used Snellen Card, E Chart, Landolt Ring, Allen Picture Card

•If 6/6 → has sharp eyesight, they can see letters at a distance of 6 m, which normal people
can see letters at 6 m

•If the visual acuity is 6/30 → the patient can only read the letters on the line indicating the
number 30 (can read letters at a distance of 6 m which normal people can read at a distance
of 30 m

•If you cannot recognize the largest letter, then do a finger count.
For example: If the patient can count fingers at
a distance of 3 m → vision 3/60

•If the patient can only see a hand waving at a distance of 1 m → vision 1/300

•When you can only see the light → visus 1 / ~

 DISORDER OF REFRACTION

Emetropia : all parallel rays that come from an infinite distance and
fall on the eye in a resting state will be refracted right on the retina
 DISORDER OF REFRACTION

Ametropia: all parallel rays that come from an infinite distance and
fall on the eye in a resting state, not refracted precisely on the retina.

Divided:
• Hypermetropia
• Myopia
• Astigmatigsm
 HYPERMETROPIA

(hyperopia, farsightedness) is parallel rays coming from infinite

distance by the eye at rest refracted behind the retina

Hypertrophy can be caused by:

- Refractive hypermetrophy → Due to weak refraction
- Axial Hypermetrophy → cause the eye wick is too short
 HYPERMETROPIA

•Patients with hypermetrophy often have accommodations. Continuous

accommodation causes eye fatigue, headaches, etc.

•Sometimes found in toddlers → reduced gradually.

Hipermetrop> which is left convergence strabismus

•In young people mild to moderate hypermetrophy can be treated with

accommodation.
 HYPERMETROPIA

•Patients with hypermetrops are given the strongest positive glasses that provide
maximum visual acuity

•In the elderly - hypermetropic coupled with presbiop is very much needed
eyeglass correction - because there has been reduced accommodation for close
viewing.
 HYPERMETROPIA

Types of hypermetrops:

1. Manifest hypermetrophy: Hypermetrops that can be seen with eyeglass

correction without cycloplegics

2. Total hypermetrophy: The hypermetrops obtained after giving

cycloplegics (accommodation is removed) - the result is greater than the manifest
hypermetrops

3. Latent hypermetrophy → difference between total hypermetrop and

manifest hypermetrop
 HYPERMETROPIA

Therapy
1. Glasses
• Largest positive spherical lens for good viewing without
accommodation → hypermetrop manifest
• If the correction is done with incapacitating accommodation with
cycloplegics then required + bigger lens:
• Total hypermetrophy Children with higher latent hypermetrophy and
decreases with age.
• Spherical lens feeding + corresponds to Manifest hypermetropy degree
• If no complaints are not given spectacles.

2. Contact lenses
3.Operation
 MYOPIA

( Nearsighted ) Is: parallel rays coming from afar by the eye in a

resting state refracted in front of the retina
 MYOPIA

Etiology:
- Elongated eyeballs
- Abnormal refractive index:
High sugar levels in eye fluids
Protein levels in eye fluid → because of inflammation
- Corneal disorders: keratoconus, keratoglobus
- Lens abnormalities: lens luctation, cataracts immature → convex lens
- Hereditary
 MYOPIA

Types of Myopia:
A. Physiological myopia often called myopia simplex or myopia of school
children B. Pathological myopia:
* Myopia progressive → myopia that increases continues to peak in
adolescence. Diopters> 6
* Malignant myopia → myopia progressive more extreme
 MYOPIA

Correct myopia by prescribing the lowest

Clinical signs: (especially in high myopia)
clear negative glasses prescription
- The eyeballs may be more prominent
- Inner front eye chamber
- Relatively wider pupils
- Glass body melt
- Turbid glass bodies / vitreous floaters
- Thygroid fundus in the posterior polus
- Choroid atrophy → myopia cresent
 MYOPIA

Therapy :

• Smallest negative (S -) spherical lens

• On anisometrop, with different OD & OS >3D then the biggest
correction is weakened
 ASTIGMATIGSM
Refractive error in which the focus of the light beam is not
located at a single point, as a result of diffraction through one
meridian.
ASTIGMATIGSM
 ASTIGMATIGSM

Astigmatic is divided into:

 Regular astigmatism: although each meridian has its own refractive
power, the differences are regular

A.Myopicus simplex astigmatism

B.Compositus myopic astigmatism
C.Hypertropicus simplex astigmatism
D.Compositus hypertropic astigmatism
E.Mystical astigmatism

Irregular astigmat: there are irregular differences in each meridian

 ASTIGMATIGSM

Etiology:

- Corneal disorders → corneal brush, surgery (most)

- Lens abnormalitie → incipient cataracts, immature

Therapy
• Cylindrical lens
• For irregular astigmat: contact lenses
 PRESBYOPIA

Are reduced accommodation power (reduced ability of the lens to bulge)

→ normal physiological state

Complaints:
- Blurred time reading close
- Watery tired eyes quickly
 PRESBYOPIA

The presbyop is given a positive lens that is added to the distance, usually:

+1 D for 40 years old

+ 1,5 D for 45 years old
+2D for 50 years old
+ 2,5 D for 55 years old
+3D for 60 years old

Since the reading distance is usually 33 cm, the + 3 D addition is the strongest
positive lens given
 ALLPPT THERAPY
1.Layout
Eyeglasses 3. Surgery
2.Clean
Contact Text
lens A. Cornea refractive surgery
two kinds: -Radial keratotomy
Slide
a. Hard / rigid / hard contact lens . -Keratomileusis
forb.your
Soft lens / soft contact lens . -Keratofaki
Presentation -Photorefractive keratectomy
-Laser laser assisted insitu
keratomileusis (lasik)

B. Lens refractive surgery

-Clear lens extraction
-Still clear lens extraction
Modern Portfolio -Intraocular lens implantation
-Facoemulsification refractive surgery
Presentation -Anterior chamber lens implantation
Thank You