Refracti

ve
Errors
Siska
I11112019

Refractive Errors
No. ICPC-2 : F91 Refractive errors
ICD-10 CODE

Disorder

SKDI Skill

H52.0

Hypermetropia

4A

H52.1

Myopia

4A

H52.2

Astigmatism

4A

H52.4

Presbyopia

4A

Anatomy
Refractive medium:
Cornea
Aqueous Humour
Lens
Vitreous Humour

Eye ball Length

Refractive Medium Function

Refraction

Refraction
Refraction: Ratio of the refractive power of the lens
and cornea (the refractive media) to the axial length
of the globe.
Emmetropia (Normal sight):
Eye axial length to Cornea &
Lens refractive power ratio is
balanced Parallel light rays
meet at a focal point on the
retina

Punctum Proximum &

Remotum

Punctum proksimum : titik terdekat dimana

seseorang masih dapat melihat jelas.
Bagi usia muda, sekitar 25 cm dan meningkat
dengan pertambahan usia, dan dapat menjadi
sekitar 40 cm untuk orang-orang usia 40.
Punctum remotum : titik terjauh dimana
seseorang masih dapat melihat jelas.
Seperti yang kita lihat bintang, titik jauh
normal adalah tak terhingga.

Accommodation
The eyes refractive power must alter to allow visualization of both
near and distant objects with sharp contours.
Accommodation mechanism allows to alter eyes refractive power
through lens elasticity.
Structures that take roles in accommodation:
Lens
Zonule Fibers
Ciliary muscle

Accommodation

Ametropia
Ametropia (Refractive error): There is a mismatch
between the axial length of the eye and the refractive
power of the lens and cornea.
The ametropia is either axial, which is common, or
refractive, which is less frequently encountered.
The most common disorders are nearsightedness,
farsightedness, and astigmatism.

Ametropia

Lens Type

Myopia

Definition

Nearsighted
ness

A
discrepancy
between
the
refractive power and axial length of
the eye such that parallel incident
light rays converge at a focal
point anterior to the retina

Epidemiology
Approximately 25% of persons
between the ages of 20 and 30
have refraction less than 1
diopters.

Classifications based on Etiology

Eyeball too long (Axial myopia)

Excessive
refractive
power
(refractive myopia)
Classifications based on Dioptri

Mild Myopia: 1-3 Dioptri

Moderate Myopia: 3-6 Dioptri
Severe Myopia: > 6 Dioptri

Form of Myopia
Simple myopia (school-age
myopia): Onset is at the age of 10
12 years.
Myopia does not progress after 20 th
Refraction rarely > 6 D
a benign progressive myopia also
exists, stabilizes only after 30th
Pathologic myopia: This disorder
is largely hereditary and
progresses continuously
Independently of external influences.

Patophysiology

Pemeriksaan Fisik
Pemeriksaan Fisik
Pemeriksaan
visus
dengan
Snellen chart
Pemeriksaan refraksi dengan trial
lens dan trial frame
Pin hole

Treatment
Diverging
lenses
concave lenses)

(minus

or

Konseling dan Edukasi

Membaca dalam cahaya yang
cukup
Tidak membaca dalam jarak
terlalu dekat
Kontrol setidaknya satu kali
dalam setahun untuk
pemeriksaan refraksi, bila ada
Kriteria
rujukan
keluhan

1. Kelainan refraksi yang progresif

2. Kelainan refraksi yang tidak maju dengan
koreksi atau tidak ditemukan ukuran lensa
yang memberikan perbaikan visus
3. Kelainan yang tidak maju dengan

Hypermetropia

Definition

Farsightedn
ess

A
discrepancy
between
the
refractive power and axial length of
the eye such that parallel incident
light rays converge at a focal
point posterior to the retina

Epidemiology
Approximately 20% of persons
between the ages of 20 and 30
have refraction exceeding +1
diopters.
Most newborns exhibit slightly
hyperopia (newborn hyperopia) It
decreases during the first few
years of life.
In advanced age, refraction
tends to shift toward the myopic
side due to sclerosing of the lens

Etiology
Axial hypermetropia
Curvature hypermetropia
Refractive hypermetropia
Classifications based on Dioptri
Mild Hyperopia: +0.25 D until +3.00 D
Moderate Hyperopia: +3.25 D until
+6.00 D
Severe Hyperopia: > +6.25 D

Form of Hypermetropia
Congenital hypermetropia
Simple hypermetropia
Acquired hypermetropia

Patophysiology

Pemeriksaan Fisik
Pemeriksaan Fisik
Pemeriksaan
visus
dengan
Snellen chart
Pemeriksaan refraksi dengan trial
lens dan trial frame
Pin hole
Funduskopi

Treatment
Converging
lenses
convex lenses)

(plus

or

Konseling dan Edukasi

Memberitahu
keluarga
jika
penyakit ini harus dikoreksi
dengan bantuan kaca mata.
Karena jika tidak, maka mata
akan
berakomodasi
terus
menerus
dan
menyebabkan
komplikasi (esotropia, amblyopia,
dan glaukoma).
Kriteria rujukan
1. Rujukan dilakukan jika timbul komplikasi.

Astigmatism

Definition

Lack of Focal
Point

The disorder is characterized by

a curvature anomaly of the
refractive media so that parallel
incident light rays do not
converge at a point but are
drawn apart to form a line.

Epidemiology
42% of all humans have
astigmatism greater than or
equal to 0.5 diopters.
In approximately 20%, this
astigmatism is greater than 1
diopter and requires optical
Classification
based on
correction.

Etiology

External astigmatism: astigmatism of

the anterior surface of the cornea.
Internal astigmatism: the sum of the
astigmatic components of the other
media.

Classifications according to the location of the

meridian of greater refraction:

With-the-rule astigmatism
Against-the-rule astigmatism
Oblique astigmatism

Form of Astigmatism
Regular astigmatism
Irregular astigmatism

Pemeriksaan Fisik
Pemeriksaan
visus
dengan
Snellen chart
Pemeriksaan refraksi dengan trial
lens dan trial frame
Pin hole

Treatment
Converging
lenses
convex lenses)

(plus

or

Konseling dan Edukasi

Memberitahu keluarga bahwa
astigmatisma
merupakan
gangguan
penglihatan
yang
dapat dikoreksi.

Kriteria rujukan :
1. Koreksi
dengan
kacamata
tidak
memperbaiki visus
2. Ukuran lensa tidak dapat ditentukan
(misalnya astigmatisme berat).

Presbyopia

Definition
Presbyopia inability of the eye to focus
(accommodate) due to hardening of the
crystalline lens with age or weakened
ciliary muscle.
When the eye can no longer accommodate
at the reading distance, positive spectacle
lenses of about 13 D are prescribed to
correct the difficulty.

Anamnesis
Keluhan
Penglihatan kabur ketika melihat dekat.
Gejala lainnya, setelah membaca mata terasa lelah,
berair, dan sering terasa perih.
Membaca dilakukan dengan menjauhkan kertas
yang dibaca.
Terdapat gangguan pekerjaan terutama pada malam
hari dan perlu sinar lebih terang untuk membaca.
Faktor Risiko
Usia lanjut umumnya lebih dari 40 tahun.

Pemeriksaan Fisik
1. Pemeriksaan refraksi untuk penglihatan
jarak jauh dengan menggunakan Snellen
Chart dilakukan terlebih dahulu.
2. Refraksi penglihatan jarak dekat dengan
menggunakan kartu Jaeger. Lensa sferis
+ (disesuaikan usia) ditambahkan pada
lensa koreksi penglihatan jauh, lalu pasien
diminta untuk menyebutkan kalimat
hingga kalimat terkecil yang terbaca pada
kartu. Target koreksi sebesar 20/30.

Tatalaksana
Pada pasien presbiopia, kacamata atau adisi
dengan lensa + diperlukan untuk membantu
membaca dekat dengan kekuatan:
+1,0D untuk usia 40 tahun
+1,5D untuk usia 45 tahun
+2,0D untuk usia 50 tahun
+2,5D untuk usia 55 tahun
+3,0D untuk usia 60 tahun

Konseling dan Edukasi

Memberitahu pasien dan keluarga bahwa
presbiopia merupakan kondisi degeneratif
yang dialami hampir semua orang dan
dapat dikoreksi dengan kacamata.
Pasien perlu kontrol setiap tahun, untuk
memeriksa apakah terdapat perubahan
ukuran lensa koreksi.

Anisometropia

Definition
In anisometropia, there
difference in refractive
between the two eyes.

is a
power

Epidemiology
Anisometropia of at least 4 diopters is
present in less than 1% of the
population.

Pathophysiology
Difference in refraction below 4 diopters
can be corrected separately for each eye
with different lenses.
Difference in refraction is greater than or
equal to 4 diopters, the size difference of
the two retinal images becomes too great
for the brain to fuse the two images into
one. Known as aniseikonia,
It can lead to development of amblyopia
(anisometropic amblyopia).

Pathophysiology

Symptoms
Usually
congenital
and
often
asymptomatic.
Children are not aware that their vision is
abnormal. However, there is a tendency
toward strabismus as binocular functions
may remain underdeveloped.
Where the correction of the anisometropia
results
in
unacceptable
aniseikonia,
patients will report unpleasant visual
sensations of double vision.

Treatment
The refractive error should be corrected.
Anisometropia
exceeding
4
diopters
cannot be corrected with eyeglasses
because
of
the
clinically
relevant
aniseikonia.
Contact lenses and, in rare cases, surgical
treatment are indicated.
Patients with unilateral aphakia or who do
not tolerate contact lenses will require
implantation of an intraocular lens.

Thank You