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Bending Light
Prism A triangular piece of glass, plastic, etc with an Apex & a Base Light is bent (refracted) toward the base of the prism
Apex

Apex

Apex

Base

Base

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Base

Refractive Lenses
Refractive lenses are combinations of different shaped prisms

Convex Lens

Concave Lens
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Convergent

Divergent

Optics Terminology
Parallel Light Rays Assumed to be parallel if they emanate from a distance source

Divergent Light Rays Appear to be spreading apart in relationship to their close proximity to the eye

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Refractive Lens Configurations

Convergent Lenses

Biconvex

Plano-Convex

Convex-Meniscus

Divergent Lenses

Biconcave

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Plano-Concave

Concave-Meniscus

Focal Length
The distance from the center of the lens at which light rays Converge The power of the lens is measured in Diopters (D) Higher power lens move the focal point closer to the lens
Paraxial Rays
1.0 D Lens = Focal length of 1 meter

Axial Ray
No Refraction

Focal Point 4.0 D Lens = 0.025 meter

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External Eye Anatomy

Superior Tarsal Lid Lachrymal Papillae

Semilunar Fold

Lateral Canthus
Sclera
(Conjunctiva)

Caruncle
Medial Canthus

Cornea
Pupil

Limbus Iris

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Internal Eye Anatomy

Ciliary Muscle Superior Fornix Cornea Iris Pupil Lens Limbus Inferior Fornix Vitreous Face Vitreous Body Zonular Fibers Ocular Muscles

Macula (Fovea) Optic Nerve

Anterior Chamber

Posterior Chamber BAGIAN MATA FK UKI

Sensory Retinal Layer

Corneal Morphology
Corneal Diameter 11 - 13 mm Central Corneal Diameter 5 - 7 mm

{500 - 550
Intraocular Pressure 13-19 mm Hg

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Corneal Curvature
Average Cornea 44.00 Diopters

Steep Cornea 47.00 Diopters

Flap Cornea 40.00 Diopters

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Index of Refraction
As light travels through glass, water or tissue, it slows down Light is bent as it strikes a material at an oblique angle A higher Index yields greater refraction
Index of Refraction
1.00 (186,000 miles/sec) 1.33 (146,000 miles/sec) 1.336 1.37 (136,765 miles/sec) 1.38 1.40 1.49 (124,832 miles/sec) 1.52 1.65

Substance

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Air Water Aqueous Cornea Lens Cortex Lens Nucleus PMMA Plastic Crown Glass Flint Glass

Tajam penglihatan dapat diperiksa dengan menggunakan : Kartu Snellen Hitung jari Senter
AV : NLP/ No Light Perception 1/~ proyeksi 1/300 1/60 5/60 6/40 6/15 6/6 6/6 E
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Emmetropia
Distance Vision

Parallel (distant images) light is refracted by the Cornea & the Lens

Light is focused on the Fovea & images are clear

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Emmetropia
Near Vision
Divergent (near images) light rays focus behind the retina The lens changes shape (more convex) to focus near images on the retina (accommodation)

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Presbyopia
Decreasing Accommodation
The aging eye starts to lose its ability to accommodate
The lens can not accommodate enough to focus near images Bifocals or reading glasses are required

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Myopia
Nearsightedness

The Cornea is too Steep &/or the eye is too Long for its refractive capability

Parallel (distant images) rays are focused in front of the fovea

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Correcting Myopia
Contact Lenses or Glasses

A CONCAVE lens diverges parallel light rays

The focal point moves back & distant images are clear

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Correcting Myopia
Laser Refractive Surgery

The cornea is reshaped, decreasing its convergent power Parallel rays of light focus on the fovea

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Myopia
Near Vision
The Divergent rays of objects near the eye are focused by the cornea & lens

Nearsighted people, without their glasses, can often focus near objects on the retina with little or no accommodation
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Hyperopia
Farsightedness

The Cornea is too Flat &/or the eye is too Short

Light focuses in back of the Fovea

Both Distant & Near images are blurred

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Hyperopia
Latent or Manifest Hyperopes
Young farsighted people can use accommodation to focus distant objects

Latent or Manifest Hyperopes will eventually need distance & reading glasses as their accommodative potential decreases with age
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Correcting Hyperopia
Absolute Hyperopes
Full accommodation does not have enough power to focus distant images on the retina

A Convex lens is required to converge light rays on the fovea

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Correcting Hyperopia
Laser Vision Correction
The peripheral cornea is reshaped with the excimer laser A Convex lens is required to converge light rays on the fovea

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Hyperopia
Near Vision

Latent or Manifest Hyperopes usually need glasses to read because they have used all their accommodative potential to correct their distance vision

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Astigmatism

The Cornea is Steep in one axis & Flat in the other

F1
F2

Multiple focal points in the eye

Images are blurred &/or distorted

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Astigmatism
With-The-Rule Astigmatism Steep Axis Vertical 90 45 D Against-The-Rule Astigmatism Steep Axis Horizontal 90 42 D 45 D 42 D 180 180

42.00 / 45.00 X090

42.00 / 45.00 X180

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Steep K & Axis

Types of Astigmatism
Simple Myopic Simple Hyperopic
1 2

1 2

One focal point in front of retina Second focal point on retina

Mixed

One focal point on retina Second focal point behind retina

1 2

One focal point in front of retina MATA FK UKI retina Second BAGIAN focal point behind

Types of Astigmatism
Compound Myopic Compound Hyperopic

1 2

1 2

Both focal points in front of retina

Both focal points behind retina

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 Astigmatisma:

with the rule - against the rule - irreguler astigmatism perbedaan sferis equivalen beda ukuran dan bentuk bayangan

Anisometropia:
Aniseikonia:

Unilateral aphakia: Akomodasi :

hiperopik anisometropia koreksi kacamata aniseikonia 25%; KL 7%

amplitudo ( perobahan kuat lensa dpt) - range of amplitudo (jarak titik jauh dari titik dekat)

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Epidemiologi
Bayi
3.0 dpt hiperopia 1 thn: 1.0 dpt bayi 6 thn panjang bulbus okuli > 5 mm 5-7 thn 3%; 8-10 thn 8%; 11-12 thn 14%; 12-17 thn 25% Etnis cina miopia >> Juvenil onset (7-16 thn) 0,5 dpt/thn 75% stabil 15-16 thn Adult onset (20 thn) extensive near work

Miopia:

Genetik - lingkungan Edukasi tinggi prevalens miopia >> Hiperopia: lower educational, 20% umur 40 an; 60% umur 60an Prevensi: tdk ada rekomendasi pasti

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Refraksi klinis
Refraksi objektif: retinoskop Refraksi subjektif
sferis Astigmat dial tehnik - Cross cylinder tehnik Strongest plus - weakest minus maximum visual acuity

Balans binokular Sikloplegik - non Overrefraksi

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Koreksi kacamata ametropia

Lensa sferis titik jauh, jarak vertex Koreksi silinder Kacamata anak:
Anak koreksi penuh Dewasa coba penuh

bayangan jatuh pada retina Balans optimal akkomodasi dan konvergens Miopia: kongenital / developmental

Sikloplegik refraksi Koreksi penuh termasuk silinder Orang tua informasi progresivitas alami Hiperopia: rendah (-), silinder koreksi; esotropia koreksi penuh + sikloplegik Anisometropia: koreksi penuh; ambliopia th/ oklusi

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Problem akkomodasi
Presbyopia: respons akomodasi elastisitas lensa << mulai umur 40 thn Insufisiensi akomodasi asthenopik Ekses akomodasi: spasmus siliaris sakit kepala, sakit alis mata, kabur terutama dekat Lensa multifokal:
Penentuan kuat lensa tambahan:
Refraksi akurat Amplitudo akomodasi Pekerjaan (membaca, menjahit, komputer)

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 Beda dari kacamata:

Kontak lensa

Anisometopia: lebih kecil Akomodasi: miopia akomodasi >>; plus akomodasi << Materi: HEMA,MMA,NVP Jenis: Therapeutic lens:

Jarak vertex pendek Perbatasan lensa - kornea: airmata bukan udara Lapangan pandang: lebih besar Besar bayangan: minus lebih besar; plus lebih kecil

soft KL, RGP KL, toric soft KL, bifokal KL, keratokonus / kornea abnormal KL, gas permeable scleral KL bullous keratopathy, erosi rekurrens, bells palsy, keratitis (filamentary, posttrauma chemis), distrofi kornea, post operasi (KPL), nonhealing epithel defect, lid abnormalities, bleb leak posttrabeculectomy.

Orthokeratology reshape cornea-hard KL

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Pemeriksaan pasien KL
Palpebra, pergerakan palpebra, kedipan, film airmata, neovaskularisasi kornea, allergi Seleksi: soft-hard soft: adaptasi cepat, kenyamanan >> Problem:

Transmisi HIV: desinfeksi trial lens:

Kornea: abrasi, keratitis pungtata, pewarnaan jam 9 & 3, infiltrat steril, keratokonjungtivitis superior limbik KL, keratitis dendritik, neovaskularisasi kornea, corneal warpage, ptosis. Mata merah: pengepasan kurang, hipoxia, deposit , KL rusak, toksik / alergi larutan KL, dry eye Hard: hidrogen peroxid, desinfeksi panas (78*-80*/10 min) RGP: idem kecuali desinfeksi panas Soft: idem

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