REFRACTIVE ERRORS

DR. KEMAL DKC

PHYSICAL OPTICS
AFFECTING VISION

WAVELENGHT OF LIGHT
FREQUENCY OF LIGHT WAVES
VELOCITY OF LIGHT WAVES
INDEX OF REFRACTION
PHOTONS
LOSS OF LIGHT BY REFLECTION (ABSORBTION)
COLOR OF LIGHT
REFLECTION
REFRACTION OF LIGHT

WAVELENGHT OF LIGHT

The visible portion of the spectrum

occurs between the ultraviolet and
infrared portion,from 380nm at the
violet end of the spectrum to 760
nm at the red end.

VELOCITY OF LIGHT
WAVES

Electromagnetic radiation travels

at a speed 186.000 miles/second
in vacuo

INDEX OF REFRACTION I

Although the frequency of light

does not vary with the density of
the medium in which it is traveling,
the speed is reduced in a dense
medium.
The ratio of the velocity in vacuo
in a particular medium is referred
to as the index of refraction for
that medium

INDEX OF REFRACTION II

The wavelenght in a dense

medium is less than it is in air and
is propotional to the change in
speed.
Each medium,therefore,has a
different refractive index for each
wavelenght.

INDEX OF REFRACTION III

Short wavelenghts,or blue light are

slowed down or refracted more
than long wavelenghts, or red
light.
This accounts for the CHROMATIC
ABERRATION present in the eye.

QUANTO OR PHOTONS I

The energy in electromagnetic

radiation is measured in units
called QUANTA or PHOTONS.
The energy of an individual
photon is proportional to the
frequency or inversely proportional
to the wavelenghts

QUANTO OR PHOTONS II

The energy of a photon at 400nm

is twice as great as that of a
photon at 800 nm.
Red light is innocuous (harmless),
ultraviolet light produces burns,
and x rays produce severe
damage to tissues.

ABSORBTION

The light incident on the retina from a

light source is decreased by loss from
reflection at the cornea,lens and retinal
surfaces.
Although the cornea is quite transparent
from 400 -1200 nm,the crystalline lens
does absorb some of the radient
energy,particulary short wavelenghts.

ABSORBTION II

This absorbtion at the blue end of

the spectrum increases with age
as xanthochromic ( yellow-brown)
proteins accumulate in the lens.
Some of the short wavelenght
radiation is also absorbed by the
yellow pigment in the macular
region of the retina.

COLOR OF LIGHT

The physical stimulus that is

responsible for the sensation of
color is the wavelenght of the
radiation.
Wavelenght in the region around
430 nm produces VIOLET
SENSATION
around 460 nm BLUE,520 nm
GREEN
575 nm YELLOW,600 ORANGE, 650

A mixture of wavelenghts such as

occurs in sunlight produces a white
sensation.

REFLECTION I

When light waves strike a smooth

surface they may bounce off the
surface,or be reflected,rather than pass
through.
Using the cornea as a reflective surface
can olso be employed in KERATOMETRY
to measure the curvature of the cornea
for contact lens fitting or for diagnosing
KERATOCONUS

REFLECTION II

By comparing object and image

sizes produced by an instrument
referred to as a KERATOMETER.
The cornea is also employed as a
reflecting surface when checking
for irregularity with a
KERATOSCOPE,by examining for
distortion the reflected images

REFRACTION OF LIGHT

When rays of light traveling

through air enter a denser
tranparent medium,the speed of
light is reduced and the light rays
proceed at a different angle, they
are refracted

SNELLS LAW OF
REFRACTION

Indicates that the angle of

incidence and the angle of
refraction are related to the
density of the medium for a
specific wavelength.When light
passes from a medium of low
density to a medium of high
density, the angle of refraction is
less than the angle of incidence .

MEASUREMENT OF LENS
POWER

Lenses are measured in DIOPTERS

(d)
The power of a lens in diopters is
the reciprocal of its focal length(f)
in meters
d=1/f

TYPES OF CORRECTIVE
LENSES

SFERICAL LENSES
TORIC LENSES
PRISMS

SFERICAL LENSES

Have equal curvature in all

meridians.
CONVEX OR PLUS LENSES,they
refract light rays so as to make
them more convergent.A
MENISCUS FORM,in which the front
surface is more convex then the
back surface is concave, results in
the desirable lens form for

PLUS LENSES

Plus lenses are used for the correction

of HYPEROPIA, PRESBYOPIA and
APHAKIA.
If the lens is moved slightly from side to
side,the object appears to move in the
direction OPPOSITE to the movement of
the lens.
They are THICKER in the middle and
THINNER at the edges.

CONCAVE OR MINUS
LENSES

Minus lenses are used for the correction

of MYOPIA.When a object is viewed
through a minus lens,the oject looks
smaller. If the lens is moved slightly
from side to side,the object appears to
move in the SAME direction as the lens.
They are THINNER in the middle and
THICKER at the edges.

TORIC LENSES

Are shaped like a section through a

football.One meridian is is more
curved than all the others.
Toric lenses are prescribed to
correct ASTIGMATISM
Toric lenses can be plus lenses,or
minus lenses

PRISMS I

A prism is an optical device composed

of two refracting surfaces that are
inclined toward one another so they are
not parallel.
The line at which the two surfaces
intersect is the APEX OF THE PRISM.
An object viewed through a prism
appears to be DISPLACED IN THE
DIRECTION OF THE PRISM APEX

PRISMS II

Prisms are usually prescribed to

assist a patient with an extraocular
muscle imbalance,which results in
a deviation of one visual axis
relative to the other,so that the
patient may achieve single
binocular vision or do so more
comfortably.They may be oriented
in the spectacle correction

PRISMS III

The strength of a prism is

measured in prism diopters,each
prism diopter displacing a ray of
light 1cm at a distance of 1 meter.
Two prism diopters of displacement
are approximately equal to 1
degree of arc.

ABERRATIONS I

Optical systems generally contain

imperfection referred to as
ABERRATIONS.
CHROMATIC ABERRATION
SPHERICAL ABERRATION
DISTORTION

CHROMATIC ABERRATION

The index of refraction for any

transparent medium varies with
the wavelength of the incident
light.
The chromatic dispersion occurs
when white light is passed through
a prism and a rainbow effect is
produced.

SPERICAL ABERRATION

The light rays that are parallel to

the axis but that pass through the
periphery of the lens are usually
refracted more than the paraxial
rays.
Every object point on the axis of
the lens will then be represented
by a blur circle rther than a point
focus.The size of this blur circle

DISTORTION

is the result of differential

magnification in an optical system.
The shape of the image formed
does not correspond exactly to the
shape of the object.
High plus lenses produce
PINCUSHION, and high minus
lenses result in BARREL (f)
distortion.

THE EYE AS AN OPTICAL DEVICE

The anology of the eye and the

camera is a useful one.
The focusing elements of the eye
are the cornea and the crystalline
lens and the film is the retina.

THE CORNEA

Contributes approximately twothirds of the refracting power of

the eye.
The cornea has an index of
refraction of 1.376 and contributes
+43d to the eye.

The lens has an index of refraction

of 1.41,with a poxer of +20 D.
The pupil reduces the omount of
light that enters the eye and
aberrations ond increasing the
depth of focus when it constricts.
The retina contains rods and color
-sensitive cones

REFRACTIVE ERRORS OF
THE EYE

1. EMMETROPIA
2 AMETROPIA

EMMETROPIA

The eye is considered to be

emmetrohpic if parallel light
rays,from an object more than 6
meters away are focused at the
plane of the retina,when the eye is
in a completely relaxed state
Most emmetropic rays are
approximately 24 mm in length.

AMETROPIA I

In an ametropic eye parallel light

rays from an object 6 meters or
more distant will focus in FRONT of
or BEHIND the plane of the
retina.This obviously results in
some blurring of the image.

AMETROPIA II

Ametropia can occur because the

globe is larger or smaller than
normal,referred to as AXIAL
AMETROPIA,or because the optical
elements are stronger or weaker
than normal, referred to as
REFRACTIVE AMETROPIA

THE FAR POINT

The far point of an eye is that

point concident with the retina
when accomodation is inactive.
For emetropia,the far point would
be infinity.
For a myope,the far point would be
nearer to the eye than 6 meters.
For a hyperope; behind the eye

TYPES OF AMETROPIAS.

HYPEROPIA
MYOPIA
ASTIGMATISM
PRESBYOPIA
APHAKIA

HYPEROPIA

When the focused image is formed

behind the plane of the retina,the
eye is too short and is
considered hyperopic
This is also referred to as
FARSIGHTEDNESS

MYOPIA

When the focused image is formed

N front of the plane of the
retina,the eye is too long and is
considered myopic
This is also referred to as
nearsightedness

ASTIGMATISM I

Many optical systems are toric

surfaces,in which the curvature
varies in different meridians,
resembles a section through a
football.
The steepest and flattest
meridians of the eye are usually at
right angles to one another,
resulting in regular astigmatism.

ASTIGMATISM II

CORNAL TORICITY accounts for

most of the astigmatism of the
eye.If the vertical meridian is
steeper it is referred to as
astigmatism with the rule,and if
the horizontal meridian is steeper
it is referred to as astigmatism
against the rule,

ACCOMODATION

The lens is capable of increasing

its power.This is referred to as
FOCUSING,or ACCOMODATION

PRESBYOPIA I

With aging, changes occur tin the

lens that result in a decreased
elasticity of the lens fibers or a
hardening of the lens.
When the eye attempts to
accomodate, there is less of a
change in the curvature of the lens
for each unit of contraction.

PRESBYOPIA II

By the early forties, accomodative

amplitude has usually decreased
to less than 5d,and objects less
than 20 cam away cannot be
brought into focus.
This is referred to as presbyopia

APHAKIA

Removal of the lens produces a

condition referred to as aphakia.
The eye in this state is extremely
farsighted and lacks of
accomodation

CORRECTION OF APHAKIA

STRONG PLUS (CONVEX) LENSES

APHAKIC CONTACT LENSES
INTRAOCULAR LENSES

REFRACTION TECHNIQUES

REFRACTION is the term applied to

the various testing procedures
employed to measure the
refravtive errors of the eye in order
to provide the proper correction.
Refractive error is by far the most
common cause of poor vision.

REFRACTION TECHNIQUES
II

RETINOSCOPY
AUTOMATED REFRACTION
CYCLOPLEGIC REFRACTION

RETINOSCOPY

A retinoscope is a handheld
instrument that the examiner uses
to shine a light trough the pupil to
observe the reflex created from
the retina.The light reflected from
patients retina is refracted by the
ocular media and focused at the
far point of the patients eye.

RETINOSCOPY II

By placing plus or minus lenses in

front of the patients eye,the
patients focal point can be altered
until it is brought to the examiners
pupil, which produces a visible end
point.

AUTOMATED REFRACTION

In order to provide valid data,the

instrument must be properly in line
with the patients visual
axis,accomodation must be
relaxed,the pupil must be of
satisfactory size end the media
must be sufficiently clear.

CYCLOPLEGIC REFRACTION

Cycloplegia is the employment of

pharmaceutic agents such as
atropine,tropicamide,cyclopenthola
te to paralyze the ciliary muscle
temporarily in order to stabilize the
refraction of the eye.Methods
include cyclopentholate
1%,tropicamide, 1 drop , 2 or 3
applications before
refraction,atropine;3 days prior to

GLASSES IN CORRECTION
OF AMETROPIA

Plus (concvex) lenses are used to

correct HYPEROPIA,PRESBYOPIA
and APHAKIA
MINUS (CONCAVE) LENSES; myopia
TORIC LENSES;regular astigmatism

SINGLE AND MULTIPLE

POWER LENSES

SINGLE VISION CORRECTIVE

LENSES have the same correction
over the entire surface.
MULTIFOCALS:If one portion of the
lens corrects the distance vision
and the other corrects the near
vision,as in presbyopia,it is
referred to as a bifocal lens

If an additional portion is added

for intermediate range vision,it is
referred to as a trifocal lens

CONTACT LENSES

Contact lenses rest on the surface

of the cornea.
RIGID (HARD) CONTACT
LENSES;will usually eliminate
astigmatism
DAILY WEAR SOFT LENSES
GAS PERMEABLE LENSES
(SLICONE)
EXTENDED WEAR CONTACT

IOL IMPLANTS
KERATOREFRACTIVE SURGERY
KERATOMILEUSIS
HYPEROPIC KERATOTOMY
EXCIMER LASER