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Z A L D I

FAKULTAS KEDOKTERAN
UNIVERSITAS ISLAM SUMATERA UTARA
MEDAN
2014

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Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.

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I. TUJUAN INSTRUKSIONAL UMUM

3

Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa kelainan refraksi
dan dapat memberikan koreksi terbaik bagi pasien
dengan melakukan pemeriksaan sederhana yang
akan dipelajari selama masa perkuliahan secara
baik dan benar .

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II. TUJUAN INSTRUKSIONAL KHUSUS

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa dan memberikan
koreksi kacamata yang sesuai bagi pasien miopia ,
hipermetropia , astigmatisma dan presbiopia
dengan baik dan benar sesuai dengan
kompetensinya

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VISUAL EXAMINATION
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VISUAL ACUITY
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SNELLEN CHART = 6/6 6/60

FINGER COUNTING ( FC ) = 5/60 0,5/60
HAND MOVEMENT ( HM ) = 1/300
LIGHT PERCEPTION ( LP ) = 1/
NO LIGHT PERCEPTION ( NLP ) = 0

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MAGNITUDE OF VISUAL
IMPAIRMENT
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(Visual Acuity <6/18)

153 Million

161 Million

Uncorrected
Refractive Errors

Eye Diseases

= 314 Million
People severely visually impaired
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In addition, recent studies indicate that there are:

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517million uncorrected presbyopes

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EMMETROPIA
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=
=
=

REFRACTIVE DISORDERS
ANOMALI REFRAKSI
KELAINAN REFRAKSI

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CLASSIFICATION
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REFRACTIVE ERRORS :
A. FAR VISION
1. MYOPIA
2. HYPERMETROPIA
3. ASTIGMATISM ( 5 )

B. NEAR VISION : PRESBYOPIA

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FOCUS NODE IN MACULA

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THE ROLE OF OPTICAL DEFOCUS

Positive Treatment
Lens

Optically Imposed Myopia

To compensate, the eye must
become more hyperopic.

Negative Treatment
Lens

Optically Imposed
Hyperopia
To compensate, the eye must
become more myopic.

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EMMETROPIA
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Is the condition when the

parallel rays focused
exactly on the macula of
the eye in relax condition
---> the visual acuity is
maximum

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MYOPIA
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Refractive

condition
in which, with
accommodation
completely relaxed,
parallel rays are
brought to a focus in
front of the macula.
Myopic
eye
:
refractive state over
plus power
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ETIOLOGY
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Axial : The antero-posterior axis of the eye ball > normal

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

Increasing of the refraction index

in this case, the refraction power of the cornea, lens and the lens position
are normal. The eye usually looks like proptosis

could occur on Diabetic patient

Changes of the lens location

changes of the lens position to the anterior after glaucoma surgery

lens subluxation

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SIGNS & SYMPTOMS

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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

On high myopia -> proptosis simulation, deep Anterior Chamber

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COMPLICATIONS
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Commonly

occurred on high myopia

1. Degenarated and liquefied vitreous
2. Retinal detachment
3. Pigmentation changes + Macular bleeding
4. Strabismus
5. Amblyopia

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CLASSIFICATION
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Myopia classification :
<

3.00 D
= low myopia
3.00 - 6.00 D = moderate myopia
> 6.00 D
= high myopia/gravis

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MANAGEMENT
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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

The glasses are ???

Contact Lens
Laser ( LASIK , PRK )
Clear Lens Extraction
Phakic IOL

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HYPERMETROPIA
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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

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ETIOLOGY
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Axial

---> eye ball diameter < N

Deminished
Decreasing
Changed

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convexity of cornea/lens curvature

Refractive index

lens position

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CLINICAL MANIFESTASION
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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

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CLINICAL MANIFESTATION
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Total

Hipermetrop : detected after the accommodation

has been paralyzed with cylcopegic agents

Latent

Hypermetrop : is the diference of the total

hypermetrop with the manifest hypermetrop

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CLINICAL MANIFESTATION
Hypermetropia

Latent Hypermetropia

Manifest Hypermetropia

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CLINICAL FINDING
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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 :
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Glasses !!!!!
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ASTIGMATISM
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Refractive condition of
the eye in which there is
a difference in degree of
refraction in different
meridian,
each
will
focused parallel rays at
a different point.
The shape of the
images :

Line, oval, circle, never

a point

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ETIOLOGY
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Etiology of Astigmatism :
Corneal
Lens

curvature disturbances ---> 90%

curvature disturbances ---> 10%

0
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CLINICAL FINDING
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Nearsightness or farsightedness are blurred

Astenophia (eye strain)

Headache

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TYPE OF ASTIGMATISM
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Ast.

M. Simplex

C-2.00 X 90

Ast.

H. Simplex

C+2.00 X 45

Ast.

M Compositium

S-1.50 C-1.00 X 60

Ast.

H Compositium

S+3.00 C+2.00 X 30

Ast.

Mixtus

S+2.00 C-5.00 X 180

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CLINICAL MANIFESTATIONS
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Ast. M. Simplex

Ast. M Compositium

Ast. H. Simplex

Ast. H Compositium

Ast. Mixtus

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MANAGEMENT
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Glasses
Contact Lens
LASIK
Refractive Surgery ( Keratotomi Radial )

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PRESBYOPIA
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Physiological changes because accommodation

capability is lowering at old age

Accommodation
16

10
6

2
10

20

40

50

60 Age

PRESBYOPIA CORRECTION
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Presbiopia additions :
40

years old
45 years old
50 years old
55 years old
60 years old

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S + 1.00 D
S + 1.50 D
S + 2.00 D
S + 2.50 D
S + 3.00 D

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GLASSES PRESCRIPTION
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FAR CORRECTION PLUS ADDITION

EXAMPLE ; MALE , 50 YEARS
RE : S -1,50 D
AND LE : S +1,00 D
ADDITION : S +2,00 D
R/ RE : S -1,50 AND LE : S +1,00 D
NEAR CORRECTION : RE : S +0,50 D
AND LE : S +3,00 d
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REFERENCES
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American Academy of Ophthalmology, Clinical

Refraction , 2011-2012
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p) Limited
Publisher, 2007.
Vaughan & Asbury's :
General Ophthalmology
17th Edition , Mc Graw- Hills Companies , May 2007

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38

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Segala puji bagi Allah, Tuhan semesta alam.

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