KELAINAN REFRAKSI

ALVIN PRATAMA JAUHARIE

I11111063

Anatomy
Refractive
medium:
Cornea
Aqueous
Humour
Lens
Vitreous
Humour

Refraction

Refraction of light occurs when light passes

from one medium to another of different
refractive index

Refractive physiology
Light rays are focused on the retina
because they are refracted by passing
through cornea and lens (Snells Law)
Corneal refractive power is constant
The eye changes refractive power to focus
on near objects by a process called
accommodation. Lens refractive power is
modifiable with accomodation
Axial length of the eye is constant except
under certain conditions

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

Lens type

Emmetropia

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

Ametropia (refractive
error)
Mismatch between axial length and
refractive power.
Parallel light rays dont fall on the retina

Nearsightedness (Myopia)
Farsightedness (Hyperopia)
Astigmatism
Presbyopia

Myopia
Parallel rays converge at focal point anterior
to the retina
Etiology : not clear, genetic factor
Causes :

Excessive long globe (axial myopia) more

common
Excessive refractive power (refractive myopia)
Increase in the curvature of the cornea or the
surface of the crystalline lens

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 1012 years.
Myopia does not progress after 20 th
Refraction rarely > 6 D
a benign progressive myopia also exists, stabilizes
only after 30th
Congenital myopia
myopia > 10 D
Increase slowly each year
Pathologic

myopia: This disorder is largely

hereditary and progresses continuously
Independently of external influences.

Patophysiology

Anemnesis
Typically do not have eye-strain, watering of the
eyes or headaches as often as hypermetropes do
Usually detected by the young age when they
discover they cannot see things at a distance as
well their friends do
Ask for risk factors : genetic, read too close
The teacher complains that the child makes too
many mistakes copying things from the black-board

Blurred distance vision

Squint in an attempt to improve uncorrected visual acuity
when gazing into the distance
Headcahe
Amblyopia uncorrected myopia > 10 D

Physical examination

Visual acuity, Snellen chart

trial lens and trial frame
Pin hole

Treatment

Diverging lenses (minus or concave lenses)

Counseling
Education

Pathological cause of
myopia

Keratoconus

Cataract

Hyperopia

Parallel rays converge at a focal point

posterior to the retina

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

Patophysiology

Treatment

Converging lenses (plus or convex

lenses)

Pathological cause of Hyperopia

Astigmatism

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
correction.

Classification based on
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

Treatment
Regular astigmatism : cylinder lenses with
or without spherical lenses (convex or
concave)
Irregular astigmatism : rigid CL, surgery

Treatment

Converging lenses (plus or convex

lenses)

Presbyopia
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.
2.

Snellen Chart
Jaeger Card. Concav lens (+) correction
target 20/30.

Tatalaksana

Pada pasien presbiopia, kacamata atau adisi

dengan lensa + diperlukan untuk
membantu membaca dekat dengan
kekuatan:
+1,0D
+1,5D
+2,0D
+2,5D
+3,0D

untuk
untuk
untuk
untuk
untuk

usia
usia
usia
usia
usia

40
45
50
55
60

tahun
tahun
tahun
tahun
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
In anisometropia, there is a difference in
refractive power between the two eyes.

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.