Reduced Schematic Eye

 Gullstrand (Swedish Professor  Nobel Prize in 1911)

treat the eye as if it were a single refracting element
Nodal point s of the cornea and lens combined into a single nodal point for the
eye
 Reduced Schematic Eye
 Calculate the retinal image size of an object in space

Retinal image height Nodal point to retina distance

=
Snellen letter height Chart to eye distance

Ex: Nodal point to retina : 17mm

Chart to eye distance :20 ft (6000mm)
Height of Snellen chart : 60 mm
↓
Resulting image size on the retina : 0,17 mm.
 Important axes of the eyes
line connecting fixation point
and fovea
line perpendicular to corneal
surface & passing through the
midpoint of the entrance
pupil.

Between
optical
axis and
visual the line passing
axis through optical
centers of
cornea, lens &
fovea.
 Pupil size & effect on visual
resolution
 Size of blur circle on retina
>> when size pupil>>
 Pinhole placed in front of an
eye  artificial pupil  size
blur circle <<
 Pinhole  measure pinhole
visual acuity
 If improve  refractive error
present
 Pinhole size  1.2 mm (-5 D
to +5D)
 Error >5D  add lens that
correct refractive error
Pupil size & effect on visual
resolution
 Dilated pupil  after best refractive
correction determined
 If improve  optical irregularities present
 If worse  macular disease
 Entrance pupil  Refractive effect of
cornea, image of pupil, viewed by clinician.
It is 13% larger than actual
 Visual Acuity
• measure of ability to
discriminate two
Definition stimuli separated in
space

• determined by
discriminating
Clinically letters on a chart
Minimum legible threshold
• Patient’s ability to recognize progressively smaller letters or forms

Minimum visible threshold

• The minimum brightness of a target may be distinguished
from its background
Minimum separable threshold
• The smallest visual angle at which 2 separate objects can be
discriminated
Vernier acuity
• The smallest detectable amount of misalignment of 2 line
segments
Numerator
• is the testing distance (in feet or meters)

Denominator
• is the distance at which a letter subtends the standard visual
• angle of 5 arcmin.
Snellen Chart
Bailey-Lovie Chart
 convert • MAR
Snellen chart
• LogMAR
 The letters of the lower lines are
more crowded

Widely acccepted, Snellen Certain letters are

harder to recognize ; C,
but not perfect chart D, O, G

The letters from different

lines are not related to
one another by size 
geometric or logarithmic
CONTRAST SENSITIVITY AND
THE CONTRAST SENSITIVITY
FUNCTION

 Def: A measure of the ability of the visual system to

distinguish an object against its background

brighter
background
good illumination (white), easier to read
↑ contrast (black)
 Contrast = I max – I min
I max + I min

Imin = brightness of an object

Imax = brightness of its background

Contrast 100%  Snellen chart

black ink (Imin= 0) on white paper (Imax=100)
 Contrast Sensitivity
 A measure of
the ability of the
visual system to
distinguish an
object against
its background

 Target :
◦ Sufficiently large
to be seen
◦ High enough
contrast with
its background
Modulation Transfer Function (MTF)
 Bar graph with softened edges

 Spatial frequency
◦ the number of light bands per unit length or
per unit angle

 Snellen acuity 100% contrast = 30 cycle

per degree
Contrast Sensitivity Function
 Contrast threshold
Minimum resolvable contrast
 Contrast sensitivity
Reciprocal of contrast threshold
 Changes of contrast sensitivity as a
function of spatial frequency of targets 
Contrast Sensitivity Function (CSF)
Contrast Sensitivity Function
 Luminance must be kept constant
 Mean luminance  shape of the normal
CSF
 ↓ luminance  low spatial frequency
falloff  shift to lower frequencies
 Normal room illumination = 30-70 foot
Lamberts
Conditions affect contrast
sensitivity
 Corneal Pathology  distortion/edema
 Lens Changes  incipient cataract
 Retinal Pathology  RP, central serous
retinopathy, macular degenerations
 Glaucoma  loss in midrange
 Retrobulbar Optic Neuritis  notch-type
loss
 Amblyopia  generalized attenuation of the
curve
 Pupil size
The Vistech contrast sensitivity test
The Pelli-Robson Letter Chart
REFRACTIVE STATES OF
THE EYES
 CONCEPTS

The focal point concept

• The location of the image formed by
an object at optical infinity through a
nonaccomodating eye
The far point concept
• The far point is the point in space
that is conjugate to the fovea of the
nonaccomodating eye
 Emmetropia

Parallel rays of light from a The far point of the

distant object are brought to emmetropic eye is at infinity,
focus on the retina in the and infinity is conjugate with
nonaccomodating eye the retina
Ametropia

• The axial length

increases (myopia) /
Axial decreases (hyperopia)

• The refractive power

of optical elements
Refractive increases (myopia) /
decreases (hyperopia)
 Myopia

Results from an eye Similarly, the far

having excessive point of the eye
refractive power for images in front of
its axial length and the eye, between
light rays focus in the cornea and
front of the retina optical infinity
 Hyperopia

Results when the eye The far point of the

has insufficient eye (virtual point) is
refractive power for located behind the
its axial length and retina
attempts to focus
light behind the retina
Astigmatism
Simple
myopic

Compound
Mixed
myopic

Astigmatism

Compound Simple
hyperopic hyperopic
 Astigmatism
2 focal lines
• Variations in the curvature of the cornea or lens
at different meridians  light rays do not focus to
a single point

Simple myopic astigmatism

• 1 focal line lies in front of the retina
• The other is on the retina

Compound myopic astigmatism

• Both focal lines lie in front of the retina
Simple hyperopic astigmatism
• 1 focal line lies behind the retina
• The other is on the retina

Compound hyperopic
astigmatism
• Both focal lines lie behind the retina

Mixed astigmatism
• 1 focal line lies in front of retina
• The other lies behind the retina
 Regular astigmatism
If:
- The principle meridians (or axes) of
astigmatism have constant orientation at
every point across the pupil
- The amount of astigmatism is the same at
every point

Correctable with cylindrical spectacle lenses

 Regular astigmatism
With-the- • The vertical meridian is steepest
• Children >>
rule • A correcting plus cylinder should be used
astigmatism at or near axis 90o

Against-the- • The horizontal meridian is the steepest

• Older adults >>
rule • A correcting plus cylinder should be used
astigmatism at or near axis 180o

Oblique • The principal meridians lie near 45o and

astigmatism 135o
 Irregular astigmatism

 The orientation of the principal

meridians or the amount of astigmatism
changes from point to point across the
pupil.
 Binocular state of the eye
 Single vision is the ability to focus the eye on one thing and
then combine the two shadows into one

 Binocular vision disorders:

- Anisometropia refers to any difference in the spherical
equivalents between the 2 eyes
- Aniseikonia unequal image size, can be due to a
difference in the shape of the images formed in the 2 eyes
- Unilateral afakia extreme example of hyperopic
anisometropia arising from refractive ametropia
Accomodation and
Presbyopia
 Accomodation

Mechanism by which the eye change refractive

power by altering the shape of its crystalline lens
 Accomodation effort

Parasympathetic Tension on lens

stimulates ciliary Zonular fibers capsule ↓ & lens
muscle to relax become more
contracts convex
 Changes With Accomodation
With Accomodation Without Accomodation
Ciliary muscle action Contraction Relaxation
Ciliary ring diameter Decreases Increases
Zonular tension Decreases Increases
Lens shape More spherical Flatter
Lens equatorial diameter Decreases Increases
Axial lens thickness Increases Decreases
Central anterior lens Steepens Flattens
capsule curvature
Central posterior lens Minimal change Minimal change
capsule curvature
Lens dioptric power Increases Decreases
Presbyopia
 Loss of accomodation due to aging

Crystalline lens becomes more sclerotic and

resists deformation when the ciliary muscle
contracts.

Measurement of lens
Increasing lens rigidity
position & curvature in
&sclerosis with age
the intact eye
Epidemiology of Refractive Errors
 Lens
power

Determines
Corneal individual’s Axial
power refractive length
status

Anterior Change
chamber continuously as
depth the eye grows
 Born with 3.0 D of 1st few month→increase
hyperopia slightly

End of 2nd year→anterior

1 year old→declines to
segment attains adult
1.0 D of hyperopia
proportion

Age 3-14 years →

Curvatures of refracting
corneal power decreased
surface continue to
0.1-0.2 D + lens power
change
decreased 1.8 D
 Axial length grows ± 5 High prevalence of
Birth to 6th years
mm myopia in infants

Most children actually emmetropic

• 2% incidence of myopia at 6 years

Emmetropization mechanism
 Emmetropization mechanism

1st 6 years of life → eye grows by 5 mm

Compensatory Compensatory
loss of 4 D loss 2 D of Emmetropia
corneal power lens power

Immature human To reduce

eye develops refractive errors
Developmental Myopia
USA Taiwan, Singapore, Japan

3% : children 5 –
7 years 12% : 6
8% : children 8 – years old
10 years 84% : 16 –
14% : children 18 years old
11 – 12 years
25% : children
12 – 17 years
 Juvenile-onset myopia

Onset: 7-16 yo  due to growth in axial length

Risk factors: esophoria, against-the-rule astigmatism,

premature birth, family history, intensive near work

The earlier the onset of myopia, the greater the degree of

progression. + 0.50 D / year (US)

75% : stabilize at age 15 or 16

Adult-onset myopia

• Onset : 20 years of age

• Risk factor : near work

• Related to the degree

of initial refractive error
Developmental Hyperopia
•In Caucasian →
Prevalence of
hyperopia
increases from
about 20 % among
those in their 40s ,
about 60 % in their
70s & 80s.
Treatment of refractive errors

Depends on patients symptoms & visual needs

Patients with low refractive errors  may not

require correction

Small changes in refractive correction in

asymptomatic patients  not recommended
Correction option

Spectacles
Contact lenses
surgery