LECTURE NOTES: Visual Optics

14. Ocular Correction of Ametropia - Part 1

References
Bennett and Rabbetts’ Clinical Visual Optics: ‘Laser ablation’ pages 433-434, 4th
Edition,‘Laser Keratoplasty’ and ‘Lasik’ pages 418-419/500, third edition/2nd edition,
‘The Aphakic eye’ till ‘Practical approximate formulae’ pages 236-240/223-225 /
268-273, 4th edition/ 3rd edition / 2nd edition. Also have a read of the Bennett and
Rabbetts Schematic eye described in pages 223-225/ 209-211, 4th edition/3rd edition
and which is ‘The Gullstrand-Emsley schematic eye and a proposed revision’ pages
252-255 in the second edition. .

14.1 Surgical Modification of the Cornea

Ametropia may be corrected by surgically altering the power of the cornea. In refractive
surgery, the front surface power of the cornea is altered by changing the radius of
curvature of the front surface. Knowing the front surface radius before surgery we can
calculate the required radius of curvature after surgery to provide correction.
In recent times LASIK (Laser assisted in situ keratomileusis) has become increasingly
popular. In this procedure, a microtome is used to create and lift a corneal flap of
epithelial layer. Then the underlying stroma is sculpted using a laser beam to correct the
refractive error. The surgery is performed in a region of about 5 to 7 mm diameter at the
centre of the cornea. To provide correction for a myopic eye the cornea is flattened by
removing more material from the central region than from the peripheral region (see Fig.
14.1a). To provide correction for a hyperopic eye, the cornea is steepened in the centre by
removing more material from the periphery (see Fig.14.1b)

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Fig. 14.1a) Surgical correction of myopia b) Surgical correction of hyperopia

Using the exact sag equation, the amount of material to be removed at any given distance
y from the centre can be calculated (see Fig. 14.2).

The Exact equation for the Sag

Fig. 14.2 Calculation of the sag of a surface

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Let yc be the radius of the zone in which surgery is carried out. Then for the myopic eye
( Fig. 14.3), thickness of the material to be removed for a given y may be calculated as
follows:

Fig. 14.3 Calculation of the thickness to be ablated in Myopia

Sa = sag of the cornea at y after surgery

Sb = sag of the cornea at y before surgery
Thickness of the cornea removed at the centre = to = Sbmax  Samax
Thickness of the cornea removed at any point = ty = to + Sa  Sb

Fig. 14.4 Calculation of the thickness to be ablated in hyperopia.

For a Hyperopic eye no material is removed at the centre. Thickness of the material

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removed at any other point within the useful region can be seen from Fig. 14.4 to be
given by:
Thickness of the cornea removed at any point = ty = Sa  Sb

Exercise 14.1
For a cornea, r1 = 7.70 mm, n = 1.376. K = -10.00 DS. Calculate the axial thickness of
cornea to be removed to establish emmetropia if the diameter of the altered zone is
5 mm. Ans. 0.089 mm

14.2 Implant Lenses

In a cataractous eye, the crystalline lens becomes highly scattering and vision
deteriorates. Removal of the crystalline lens is a solution to the problem. A subject with
the eye lens removed is said to be aphakic. In this state, the only refracting element is
the cornea and the subject is rendered highly hyperopic. For a standard emmetropic eye,
the corneal power is 43.08 D and the total eye length is 24.09 mm. This corresponds to a
refractive error of 12.38 D at the cornea. Often an artificial lens is implanted after the
removal of the natural lens.
To calculate the power of this implanted lens we need to know the corneal power, the
axial length of the eye, and the location of the implant lens. The corneal power is
obtained using the keratometer, the axial length of the eye is determined using
ultrasonsography. The current practice is to place the implant inside the lens capsule after
the natural lens has been removed.

Fig. 14.5 Rays leaving the implant lens within the eye should go to a focus on the retina.

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Using step along vergence analysis, the power of the implant lens can be calculated. For
clear vision, rays leaving the implant lens within the eye should go to a focus on the retina
(Fig. 14.5). This implies that if L2 is the vergence of the rays leaving the implant lens,
then
L2 = 1336 / [x  (d+t)],
where all the distances are expressed in mm.
For a fixed front surface power F1 and thickness t of the impant, the back surface power
F2 of the implant lens can be arrived at. Please note that the power of the implant lens in
air will be very different from its power within the eye.
A simple formula called the SRK formula is sometimes used to calculate the implant lens
power F as follows,
F = A  2.5x  0.9Fc
Where x is the axial length of the eye in mm, A is a lens constant given by the
manufacturer and it depends on the lens type, and Fc is the corneal power. This empirical
formula was the outcome of a statistical analysis of several thousand cases and works well
for eyes with average axial lengths.
Although the power of the implant lens is calculated carefully, the subject may be left
with some residual error of refraction after the surgery, which could be due to post
operative corneal changes, for example. Auxiliary lenses may be used to correct the
residual error. Generally, the implant lens is designed for emmetropia. However, if the
subject has some refractive error in the other eye and if the other eye does not require
cataract surgery in the near future, then the implant lens may be designed to leave similar
amount of residual error of refraction to avoid problems of anisometropia. The auxiliary
lens may also be needed to correct corneal astigmatism.

Exercise 14.2
Refracting power, Fc, of a cornea, = +45.00D. n2 = naqu = 1.336. n4 = nvitre = 1.336. Actual
length of the eye = 24.00 mm. nimplant = n3 = 1.490. r2 (implant front surface) = +50 mm.
d1 = location of the front surface of the implant from the cornea = 3.60 mm. Implant
thickness = d2 = 1.0 mm. Calculate Fsp in the aphakic condition (SA1 = 14 mm, where A1
represents the corneal apex) and the required FE of the implant (i) in the eye and (ii) when
measured in air.
Ans. +9.28DS, +15.58D, +49.39D

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