Presbyopia and

Astigmatism

By: Group 2
Scenario

Male 40 years by accepting blur while looking far and while

reading close. Past medical history, never wear glasses. There
is no diabetes and hypertension.
Additional data

Physical examination: Refraction Examination:

• VOD 1/300 Tension OD n/palpation
• Visus ODS corrected
• VOS 6/20 Tension OS n/palpation
• Cilindris -1, 00 6/6
External eye examination:
• Palpebra • Due to age 40, plus +1.00
• Conjunctiva additions
• Cornea • With a bright jagger card
• COA: n • Diagnose ODS astigmatism
• Iris : n
• Presbyopia
• Pupil :n
• Lens :n
• Fundus refleks : + normal
Keywords

• Male 40 years old

• Eyes blur while looking far and reading close
• OD = 6/15
• OS = 6/15
• Refraction examination
• Visus ODS corrected
• Cilindris -1, 00 6/6
• Due to age 40, plus +1.00 additions with bright jagger card
Mind Mapping
Hypothesis

Based on anamnesis and physical examination, the patient is

suspected of presbyopia and astigmatism.
Learning Objective

• Physiology of vision
• Diagnoses and diagnoses of case appeals from those scenarios
• Etiology and case risk factors of the scenario
• Pathophysiology of the case of the scenario
• Clinical manifestations of the scenario
• Management of the scenario
• Supporting examiner of the scenario
• Complications and the prognosis of the scenario
• Prescription of glasses
• Islamic view of the scenario
Physiology of Vision

The light source  cornea  through the pupil whose width

is regulated by the iris refracted by the lens  formed a
shadow on the retina that is real, inverted and scaled the
rod cells and cone cells pass on light signals through the optic
nerve  reverse brain longer visible shadow on the retina 
the objects appear in accordance with the original
Diagnosis and Differential
Diagnosis

– Myopic
– Hypermetropic
– Astigmatism
– Presbyopia
Ethiopathophysiology of astigmatism

– A common cause of astigmatism  corneal deformity. The

crystalline lenses may also play a role for the emergence of
astigmatism. 
– In the normal eye, the curved surface of the cornea will regularly
focus the rays at one point. In astigmatism, the refraction of light
is not focused on one point. The rays of the astigmatism are
refracted in all directions so that the retina does not have a focal
point of focus on the retina. Some of the rays may focus on the
front of the retina while some of the other rays are focused
behind the retina
Etiopathophysiology OF Presbyopia

Disturbance accommodation on age continue 
– Weakness muscle accommodation
– Lens eyes that do not chewy or reduced its elasticity due
to lens sclerosis

Under normal conditions there is an increase in refraction of the

eye due to a balance between the elasticity of the lens and
camera matrices. In a harder way to become harder (sclerotic)
and lose its elasticity to become convex, thus the ability to see
closer decreases
Risk Factors

Presbyopia astigmatism
– Age is the major risk factor for – preschool age
development of presbyopia – the prevalence increases with age among
– systemic disease, cardiovascular Caucasians from 28% among individuals in
their 40s to 38% among individuals in
disease
their 80s
– drug side effect – 20% higher among men than women
– Occupation – prematurity or low birth weight, and with
– Gender retinopathy of prematury
– associated with eyeball length and
– Geographic factors
corneal flatness and that weight is
– others associated with hyperopic refraction
Clinical Manifestations
Presbyopia
– Blurred vision and the inability to see
fine details at the customary near
working distance are the hallmarks of
presbyopia
– delays in focusing at near or distance,
ocular discomfort, headache,
asthenopia, squinting, fatigue or
drowsiness from near work, increased
working distance, need for brighter
light for reading, and diplopia.
– Brighter light for reading benefits the
patient by causing pupillary
constriction, resulting in an increased
depth of focus
Astigmatism
– Distortion or blurring of images at all
distances
– There can be indistinctness of objects,
circles become elongated into ovals and a
point of light begins to tail off.
– Symptoms of eye strain such as,
photophobia, and fatigue are also among
the most common astigmatism symptoms.
– Reading small print is difficult with
astigmatism.
– Other symptoms may include: squinting,
eye discomfort, irritation, sore or tired eyes,
distortion in the visual field, monocular
diplopia, glare, difficulty driving at night
Presbyopia Examination

1. Pinhole check
2. Refraction test
a. Subjective: Optotype of Snellen & Trial lens
b. Objective
• Autorefractometer
• Keratometry
3. Blurring test
4. Keratoskop
Management of Presbiopy

– Positif Lens
– S+ 1.00 D for 40 year
– S+ 1.50 D for 45 year
– S+ 2.00 D for 50 year
– S+ 2.50 D for 55 year
– S+ 3.00 D for 60 year
– Other lens: Bifocal, trifocal, bifocal contact, monovision
contact, monovision modified
– Refractive surgery
Management of Astigmatism

– Corrective lens
– Cylinder lens
– Contact lens
– Refractive surgery
Prescription of glasses

the minimal recipe that should be listed are:

place and date of prescribing
-recipes for sunglasses look far / close
- right eye or left eye
-display / arc axis for cylindrical lens
-When looking far, write the spherical size on the top row
-When looking closely, write the size below the size row to see far away
-if you need a cylindrical lens, write the spherical size, along with the axis
-If you need a prism lens, write next to the cylindrical size and base
-the distance of the pupils to see far and near
-to / pro (name of the patient)
-patients
-signature
Complications

– Conjunctival scarring
– Trikiasis
– Entropian
– Corneal ulceration
– Ptosis
– Obstruction of the nasolacrimal ducts
– Dacryocystitis
Prognosis

If not treated properly with oral antibiotics, symptoms may

increase and lead to blindness, which is the result of ulcers
(wounds or irritation) and scarring of the cornea. Surgery may
also be needed to correct the deformity of the eyelid