SSMH (2019-2020)

Refraction and Optometry

Saeed A. Alghamdi, MB;BCh, ICO, FRCSC, MMedEd

 Learning Objectives

By the end of the lecture the student should be able to describe:

– Basic Optics
– Refraction , Diffraction & Reflection, basic phenomenon and some
practical examples
– The Human Eye as an Optical System.
– Refractive Errors.
– Subjective Vision testing (Subjective Refraction).
– Objective Vision testing (Objective Refrction).
– Refractive Error Correction.
 Optics

• Optics is the properties of light as it is acted on

by optical systems

• Geometric optics: uses line diagrams to depict

the behavior of light

• Wavefront optics: uses principles of waves to

describe the behavior of light
 Optics

Light can be described as a wave

 Optics

• All naturally occurring sources of light are

divergent

• Light rays traveling parallel have zero vergence

• Light rays that focus on a point are convergent

Physical and geometrical optics - principles

• Diffraction
• Interference.
• Polarized light
• Aberrations:
– spherical aberration
– chromatic aberration
• Refraction.
Diffraction
Diffraction
• Is the ability of light to bend and create waves
when encounters an obstacle or a slit
Diffraction
Interference
Interference
Interference
• In physics, interference is a phenomenon in
which two waves superpose or interact to
form a wave of greater or lower amplitude.
Polarization
Polarization
• Polarizing sunglasses are sometimes useful in
reducing the glare from reflected sunlight.
• In boating, for example, sunlight reflected from the
water surface is partially polarized. Because the
predominant polarization is horizontal , the
sunglasses are constructed to pass only the vertical
polarization.
• Similarly, in driving, the light reflected from the road
surface and from the painted or glass surfaces of
other automobiles is also partially polarized, usually
horizontally.
Polarized light
Chromatic aberration
• A type of distortion were the lens focuses
colors to different points.

• Why? lenses have different refractive indices

for different wavelengths of light
Chromatic aberration
Chromatic aberration
• Why less in human eyes???
– Due to narrow spectral sensitivity bands of long
and mid wavelength cones.
– Foveal lack of blue cones.
Spherical aberration
• Increased refraction of light strike a lens near
its edge, in comparison with those that strike
nearer the center.
Spherical aberration
• Why less in human eyes???
– Human cornea is periphery is flatter than centre.
– In human lens, central portions have greater
density and greater curvature.
– Iris blocks the peripheral rays, only paraxial rays
enter the system.
Refraction
• Bending of the light as it passes from one
medium to another medium with different
refractive index.
Refraction
Refraction
Refraction:
Human Eye vs Camera
Refractive Components of the Eye

• Cornea: responsible for the majority of the

refractive power of the eye (40 D)
• Lens: 20 D of refractive power, changes with
accommodation
• Axial length
Refractive Errors in the clinic
 Refraction
• What is Refraction?
Determination of the refractive status (prescription)
of the eye.
• OBJECTIVE: by Retinoscopy
• SUBJECTIVE: to determine by subjective means
the combination of spherical and cylindrical lenses
necessary to provide best visual acuity (with
accommodation relaxed)
How do you screen for refractive error

Visual Acuity: snelen chart Pinhole

Objective Refraction
• “objective refraction” is used when the refractive
error of an eye is determined without input by the
patient .
• Retinoscopy is a form of objective refraction in which
the judgment of a human operator is required to
determine the refractive error by using the
retinoscope and trial lenses. See next slide
• Autorefrctometer: a computer-controlled machine
used to provide an objective measurement of a
person's refractive error and prescription for glasses
or contact lenses
 Objective Refraction

Retinoscopy

Trial lenses

Used for Vision testing in Infants, Pre-verbal cases

Retinoscope
Objective Refraction
• Autorefrctometer:

Used for screening (as in optical shops or eye clinics), usually need to
be verified by the subjective refraction in adult.
Subjective refraction
• Subjective Refraction is an attempt to
determine, by trial and error using the
patient’s cooperation, the combination of
lenses that will provide the best corrected
visual acuity (BCVA).
• It is a clinical examination used by orthoptists,
optometrists and ophthalmologists to
determine a patient's need for refractive
correction, in the form of glasses or contact
lenses.
Subjective refraction
 Refractive errors
• Emmetropia: refers to an eye that has no visual defects.
Images formed on an emmetropic eye are perfectly focused,
clear and precise. Do not require vision correction.
• Ametropia: a refractive error is present.
• Myopia: Near sightedness.
• Hyperopia(Hypermetropia): Far sightedness.
• Presbyopia: Loss of accommodative ability of the lens resulting
in difficulties with near tasks.
• Astigmatism: the curvature of the cornea and/or lens is not
spherical and therefore causes image blur on the retina.
 Refractive errors
• Anisometropia: a refractive power difference
between the 2 eyes (> 2D)

• Aniseikonia: a difference of image size between

the 2 eyes as perceived by the patient

• Aphakia: (Phakos=lens), aphakia is no lens

• Pseudophakia: artificial lens in the eye

Refractive errors
Myopia(Nearsightedness)
• Image is focused in front of the retina
• Why?
– Axial myopia
– Refractive myopia
• Correction?How
Myopia: correction

Concave Lense
Hyperopia(Farsightedness)
• Image is focused behind the retina
• Why?
– Axial hyperopia (small Eye)
– Refractive hyperopia
• Correction? How?
Hyperopia: correction

Convex Lens
Astigmatism
• Image is focused in multiple
points instead of a single
point on the retina
• Why?
– Abnormal curvature of the
cornea or lens (rarely)
• Correction? How?
Astigmatism correction

Spherocylindrical Lens: for glasses

(aka:Toric Lens for contact lenses)
THANK YOU
 LASER
• L: Light
• A: Amplification
• S: by Stimulated
• E: Emission
• R: Radiation
Structure of a Laser
Laser beam characteristics
• The light emitted from a laser is
monochromatic, that is, it is of one
color/wavelength.
• Lasers emit light that is highly directional, that
is, laser light is emitted as a relatively narrow
beam in a specific direction.
• The light from a laser is said to be coherent,
which means that the wavelengths of the laser
light are in phase in space and time.
Types of Laser Tissue Effects:
• Photochemical/Photoablation: Ultraviolet and visible light
absorption induces the formation or destruction of chemical
bonds. e.g: Excimer Laser.
• Thermal: Absorption of laser energy results in a 10 to 20 C
temperature rise which denatures the absorbing tissue. e.g
photocoagulation (PRP)
• Vaporization: Visible or infrared laser energy absorption
create a micro-explosion when the temperature of water goes
above the boiling points, e.g: CO2 laser
• Optical break down/disruption: Infrared light from the
Nd:YAG laser physically disrupts tissue from plasma induced
shock wave.
Ophthalmic Laser Applications:

• Retinal Photocoagulation:

• Act by thermal burns , indications e.g.:

• Proliferative DR
• Macular Edema
• Retinal tears
Ophthalmic Laser Applications:

• Laser Trabeculoplasty for Glaucoma:

Ophthalmic Laser Applications:

• Laser Iridotomy: Laser iridotomy providing an alternative route

for the aqueous flow from posterior to anterior chamber of the eye.
Ophthalmic Laser Applications:

• Posterior Capsulotomy: Laser iridotomy providing an

alternative route for the aqueous flow from posterior to anterior
chamber of the eye.
Ophthalmic Laser Applications:

• Refractive Surgery (Excimer Laser):

Ophthalmic Laser Applications:

• Cataract Surgery