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Media Refraksi :
Kornea Humour Aqueous Lensa Badan Kaca (Vitreous) n = 1.33 n = 1.33 n = 1,41 n = 1.33
Proses Akomodasi
Kemampuan menambah kekuatan refraksi dengan menambah kecembungan lensa mata
Jika jarak obyek < 5m, sinar tidak datang sejajartetapi menyebar (divergen). Jika mata dalam keadaan beristirahat, bayangan benda akan jatuh di belakang retina, sehingga akan terlihat buram. Bayangan ini harus digeser ke depan dan difokuskan di retina dengan meningkatkan kecembungan lensa. Proses ini disebut Akomodasi
This accommodation process happens as a result from the contraction of M. ciliaris in the ciliary body
Refraction Anomalies
Normal : Emetropia Anomalies : (ametropia)
Myopia Hypermetropia Astigmatism Presbiopia
Emmetropia
Is the condition when the parallel rays focused exactly on the retina of the eye in relax condition ---> the visual acuity is maximum
Ametropia
Is the condition when the parallel rays are not focused exactly on the retina of the eye in relax condition. The focal point may be behind or in front of the retina
Myopia
Refractive condition in which, with accommodation completely relaxed, parallel rays are brought to a focus in front of the retina. Myopic eye : refractive state over plus power
Curvature :
The size of the eye ball ---> normal, but there is a increasing of the cornea/lens curvature The change of the lens e.g. : intumescens cataract
Clinical findings :
Farsightedness are blurred, nearsightedness are normal Asthenopia On high myopia : hemeralopia occurred caused by periphery retinal degeneration Floating spots visualization caused by vitreous degeneration screw up the eye lids together, in order to get a better vision
Funduscopy : Tigroid fundus ---> thin retina and the choroid, myopic crescent arround the papilla area, sthaphyloma posterior
Complication :
Commonly occurred on high myopia 1. Degenarated and liquefied vitreous 2. Retinal detachment 3. Pigmentation changes + Macular bleeding 4. Strabismus
Myopia classification :
< 3.00 D = low myopia 3.00 - 6.00 D = moderate myopia > 6.00 D = high myopia/gravis
Treatment :
Low and moderate myopia : full correction with weakest spherical lens that give the best visual acuity
Example : VOD = 5/60 S -2.50 D = 6/7 S -2.75 D = 6/6 S -3.00 D = 6/6 S -3.25 D = 6/7
On high myopia, usually full correction are not given due to headache that may occurred. If necessary, reading glasses can be given ---> bifocal glasses
Prognosis :
Simplex/stationer, after puberty will be constant
occurred
Hypermetropia
Is a refraction anomaly that without accommodation parallel rays will be focused behind the retina Divergent rays from near object, will be focused farther behind the retina
Etiology :
Axial ---> eye ball diameter < N
Deminished convexity of cornea/lens curvature Decreasing Refractive index Changed lens position
Clinical manifestation :
H. Manifest ---> is detected without paralazing accommodation and is represented by the strongest convex glass needed , the patient sees most distinctly. It correspons to the amount of accommodation which he relaxes when a convex lens is placed before the eye. Devided into two types :
Facultative : Can be overcome by an effort of accommodation Absolute : Can not be overcome
hypermetrop
Hypermetrop
Latent Hypermetrop
Hypermetrop manifest
Clinical finding :
Nearsightness are blurred
High hypermetropia at old age : farsightedness also blurred Astenophia accommodative (eye strain) Children : high hypermetropia usually occurring convergent strabismus (convergent squint)
Treatment :
If foria/tropia not present, apply strongest positive spherical lens that give the best visual
acuity
If foria/tropia present, total hypermetrop correction. If necessary : bifocal eye glasses
astigmatism
Refractive condition of the eye in which there is a difference in degree of refraction in diferent meridian, each will focused parallel rays at a different point. The shape of the images : Line, oval, circle, never a point
Manifestation :
Regular astigmatism
Difference in the degree of refraction in every meredian. Two principles meridian :
Maximmum refraction
Minimum refraction
Right angle to each other
Irregular astigmatism
Difference in refraction not only in different meridians, but also in different parts of the same meridian.
Etiology of astigmatism :
Corneal curvature disturbances ---> 90% Lens curvature disturbances ---> 10%
Type of Astigmatism :
Ast. M. Simplex
Ast. H. Simplex Ast. M Compositium Ast. H Compositium Ast. Mixtus
C-2.00 X 90
C+2.00 X 45
0 0
Ast. M. Simplex
Ast. H. Simplex
Ast. M Compositium
Ast. H Compositium
Ast. Mixtus
Presbiopia
Physiological changes because accommodation capability is lowering at old age
Accommodation 16
10 6
2
10 20 40 50 60
Age
Presbiopia correction :
40 years old 45 years old 50 years old 55 years old 60 years old S + 1.00 D S + 1.50 D S + 2.00 D S + 2.50 D S + 3.00 D
Objective :
Children, incooperative, difficult correction, strabismus :
Ophthlamoscopy Retinoscopy Refractometer
Subjective
Check firstly just one eye : OD Distance : 5 or 6 meters VOD : ...(basic right eye visus) a. Trial and error
apply S + 0.50, better visus , add S+ until visus = 6/6 S +0.50, lower visus, change to S -, increase S - until visus = 6/6 S +/- not working ----> cylindrical With astigmatism dial, stenoplic slit, cross cylinder astigmatism dial :
Blurred line ----> C negative lens axis
Example :
ODS 6/6 I. AVOD 2/60 S - 3.50 = 6/6 headache, eye strain AVOS 3/60 S - 3.00 = 6/6 ODS 6/6 II.AVOD 2/60 S - 3.00 = 6/7 w/o headache, eye strain AVOS 3/60 S - 2.75 = 6/7 read ADD S + 1.50 Give Eye Glasses according to II
Objective
Use cyclopegic 1. Ophthlamoscopy : papilla clearly seen with which lens 2. Retinoscopy :
Ordinary ---> light source outside streak -----> light source inside
3. Refactometer
Computerized Lensmeter principal
Ideally :
Subjective Objective with cyclopegic Subjective once more without cyclopegic
Lens meter
Measuring lens power Measuring focus distance
Eye Glasses
Monofocal Bifocal Progressive
Antimetropia
Vision in Anisometrop
difference < 2.50 D : still get fusion + single binocular vision difference > 2.50 D : fusion difficulties ----> weak eye suppression ---> amblyopic alternans vision : left and right alternate
Aniseikonia :
The difference of shape and size of the images between right and left eye
Contact lens :
Indication :
High anisometropia irregular astigmatism Front asymmetry, orbit Aniridia Descemetocele Sports Cosmetics
Refraksi
Consists of :
General Optics The optical system of the eye Clinical anomalies : refractive errors
Optic
Dioptri (D) : Lens power unit, is an inverse of focal distance in meters D = 1/f 1 D lens, parallel light will be directed into focal spot in 1 meter distance 2 D = 1/f ----> f = ? If f = 25 cm , ----> D = ?
Parallel rays will be converged to the focus ---> Plus lens (+)
or will be diverged as if it comes from the focus ----> Minus Lens (-)
Principles
Rays coming from distance > 5 m parallel rays Rays coming from distance < 5m divergent rays
Spherical lens
Is a lens with the same curvature diameter in all meridians
A convex lens may be regarded as a series of prisms bases toward the middle of the lens A concave lens may be regarded as a series of prisms apex toward the middle of the lens
Spherical Lens :
Plus sphere : Convex
characteristic : makes larger and nearer images
+2
+2
+4
+5
-1
Biconvex
Plano K
Concave K
-2
-2
Bi Concave
Plano K
Convex K
Cylindrical Lens
Is a kind of lens that have two meridians that are perpendicular to each other The meridian that has no power is called the axis The other meridian, has the power
Spherocylindrical Lens
Is a combination between spherical lens and cylindrical lens Example :
S + 2.00 D
+ 2.00 0.00
C + 1.00 D X 90 0
+ 2.00 0.00 + 1.00 + 2.00 + 1.00
+ 2.00
+ 2.00
+ 3.00
Transposition
Methods : Sphere : Sum with algebra ways SPH + CYL Cylinder : replace power marks (Neg Pos), axis change 90 degrees Example : S + 2.00 C + 1.00 X 900
S + 3.00 C - 1.00 X 1800