Topic: OPTICS AND REFRACTION

Lecturer: Franz Marie O. Cruz, MD

Legend: ** NOTES
Refraction
Definition

Physics: change in the direction of a wave due

to change in its transmission medium
Bending of a light wave as it enters a
medium where its speed is different
Medicine: clinical test in which a
phoropter/loose lenses may be used to
determine the eyes refractive error and the
best corrective lenses to be described

2 Refracting Elements
1. Cornea
Acts like a converging lens
Accounts for 2/3 refractile power of the
eye
40 diopters
Focal length is constant/fixed
Corneal curvature

**The amount on bending depends on the indices

of refraction of the 2 media and is quantitatvely
described in Snells law

2. Crystalline Lens
Thicker at the center than at the
edges
Converging lens
1/3 refractile power
20 diopters
Focal length varies by changing the
shape of the lens allows eyes to
focus at different distances
Produces real, inverted image on
the retina
**The crystalline which is located in the anterior
segment of the eye is a converging lens. It is thicker

1 by ICEMAN Bastinen

**The eye has to refracting elements. The cornea

and the crystalline lens. The cornea which forms a
part of the ocular surface acts like a converging lens
and accounts for 2/3 refractile power of the eye.
This is equal to 40 diopters. The focal length of the
cornea is fixed or constant and is dependent on the
corneal curvature.

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Optics of the human eye

Eye is analogous to a camera
Cornea = lens filter
Iris = adjustable diaphragm
Pupil = adjustable aperture
Crystalline lens = lens
Retina = film
Sclera = camera body
**Eye is analogous to a camera. Image-forming
light enters the eye through the cornea and is
refracted by both the cornea and the crystalline
lens. The diameter of the incoming beam of light is
controlled by the iris and is analogous to the
adjustable diaphragm in the camera. The opening
of the iris is called the pupil and is likened to the
adjustable aperture in the camera. The light rays
meet to form an image of the retina. The image is
inverted as it is in a camera. The sclera houses all
these structures much like the camera body.

at the center than at its edges. It accounts for 1/3 of

the refractile power of the eye and this is
approximately equal to 20 diopters. Unlike the
cornea, the focal length of the lens varies. This is
achieved by changing the shape of the lens and this
allows the eye to focus at different distances. A
person with no refractive error can see clearing at
distance and near. The 2 converging lens system of
the eye produces images that are real and inverted
on the retina.
Pupil
-

Central opening of the iris

Diameter of the pupil changes with ambient
light
- Bigger pupil diameter in the dark
- Smaller pupil diameter in bright
light
Smaller pupil reduces spherical aberration
(causes image blur)

During accommodation, the ciliary body

contracts slackening of the zonule fibers
lens assumes a spherical shape lens
becomes more positive allows eye to
have a focused image of near object

Ciliary body is relaxed, lens zonules are taut,

Lens is flat

Refraction
Emmetropia
When parallel light rays are focused sharply on the
retina
Ametropia
When the eye is unable to bring parallel light rays
from a distant object into focus on the retina

**This is a diagramatic explanation on how changes

in the shape of the lens allow for clear distance and
close vision. Light rays from a distance object are
parallel when they reach the eye, so you do not
need much refraction or converging power to bring
them to a focus on the retina. On the other hand,
light rays from a near object diverges and you need
more refraction to focus properly

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Accommodation
Process by which the eye changes in optical
power to maintain clear image of an object
as its distance varies
Part of the near reflex triad: convergence
and pupillary miosis

by ICEMAN Bastinen

Ciliary body contracts, Lens zonules are relaxed,

Lens assumes a spherical shape

**There are 4 types of refractive errors. Refractive

Errors affects an estimate of 2.3 billion worldwide.
Of this, 670 million have uncorrected or
inadequately corrected refractive errors. 90% reside
in rural areas and low-income countries. Because of
this, WHO has named errors of refraction as one of
its 5 priority diseases in its advocacy to eliminate
avoidable blindness globally by year 2020
Determinants of Refractive Errors:
1. Corneal curvature
2. Axial length length of the eyeball
3. Loss of accommodation
**There are 3 determinants of refractive errors: the
corneal curvature, axial length of the eye of the
length of the eyeball from the cornea to the retina
and age-related decline in accommodation.

by ICEMAN Bastinen

**Hyperopia or farsightedness results from

insufficient convergence power of the eye to focus
the light rays on the retina. This occurs in people
with short eyeballs. The rays focus posterior to the
retina. Hyperopia is normally present in babies and

Ametropia
Types of Refractive Errors:
1. Hyperopia
2. Myopia
3. Astigmatism
4. Presbyopia
Incidence of Refractive Errors:
2.3 billion people worldwide suffer
from poor vision due to refractive
errors
670 million have uncorrected or
inadequately corrected refractive
errors
90% reside in rural areas and lowincome countries
One of 5 priority eye diseases of
Vision 2020: Right to Sight
program (WHO)

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**An eye is emmetropic when its converging lens

system is able to focus parallel light rights on the
retina resulting to a clear image. On the other hand,
ametropia is defined when the eye is . The focal
point may fall in front or behind the retina. This
results to a blurry image.

1. Hyperopia Far-sightedness
Causes:
- Insufficient convergence power (lens or
cornea) to focus light rays on the retina
- Short eyeballs
Rays focus posterior to the retina
Present in babies and young children;
outgrown as they get older and the eyeball
gets longer
Corrected by a plus (convergent) spherical
lens

young children but they as a rule outgrow them as

they get older and the eyeball gets longer. In
hyperopia, you would a plus or convergent spherical
lens to bring the focal point to the retina.
2. Myopia Near-sightedness
Causes:
- Excessive convergence power (lens or
cornea) to focus light rays on the retina
- Long eyeballs
Rays focus anterior to the retina
Genetically-inherited
Develops in children between the ages 812, progresses during teenage years,
stabilizes by age 20
Corrected by a minus (divergent) spherical
lens

4. Presbyopia
Progressive loss of accommodative
ability of the crystalline lens caused by
the natural process of aging (beginning
at the age of 40 y/o)
Progressive hardening of the lens, loss
of ability to change its shape

Difficulty with near visual work such as

reading, eye strain
Occurs in the presence of myopia,
hyperopia and astigmatism
Remedied optically with plus spherical
lens
**Patients complain that theyre arms are not long
enough

**When we measure visual acuity, we take visual

acuity at distance and visual acuity at near. These
are just reminders when taking the visual acuity.
One eye at a time, the other eye, non-tested eye
has to be fully occluded. Uncorrected/corrected VA

Well-lighted
room
Appropriate
distance
Wear reading
glasses
Proper labeling

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3. Astigmatism
Cornea and crystalline lens may not
have the same radius of curvature
in all meridians
More than 1 focal points
Results in distortion of vision at all
distances
Corrected by a cylindrical lens

by ICEMAN Bastinen

Well-lighted
chart
Appropriate
distance
One eye at a
time
Uncorrected/c
orrected/
pinhole VA
Proper labeling

the pinhole, Jaeger chart held 14 inches away, wear

reading glasses

2. Contact Lenses: spherical vs toric

Refractive Errors
Prescription of Lenses

1. Spectacle correction: monofocal vs bifocal

vs trifocal/multifocal

by ICEMAN Bastinen

**There are several ways to correct refractive

errors. The simplest and cheapest ways are thru the
prescription of spectacles or glasses or contact
lenses.

3. Refractive Surgeries
Corrective corneal surgeries
A. Corneal incisions
i. Radial Keratotomy
ii. Limbal relaxing incisions
iii. Partial thickness peripheral incisions

Correction of Refractive Errors

1. Spectacle correction: monofocal vs bifocal vs
trifocal
2. Contact Lenses
3. Refractive Surgeries
A. Corrective corneal surgeries
i. Corneal incisions
a. Radial keratotomy
b.Limbal relaxing incisions
ii. Corneal ablative surgeries
a. Photorefractive keratectomy (PRK)
b. Laser-in-situ-keratomileusis (LASIK)
c. Femtosecond LASIK (Intralase)
B. Lens surgeries
i. Cataract surgery
ii Clear Lens extraction
iii. Phakic intraocular lens implantation

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**Corrective eye surgeries

**Corrective glasses can be monofocal, bifocal or

trifocal. Monofocal glasses corrects for one distance
only, and its usually for far. Most if not all of you
who wears glasses will have monofocal correction.
Bifocal means there are 2 segments for correction
at 2 distances. Toric contact lenses has a treated or
ballasted are such that it lies at a certain way or
angle on the cornea and doesnt rotate allowing it
to correct the astigmatism.

b. Corneal ablative surgeries

i. PRK-Photorefractive Keratectomy
ii. LASIK
iii. Femtosecond LASIK

Intraocular Lenses
i. Monofocal
Monofocals are set to provide best corrected
vision at near, intermediate or far distances.
Most people who choose monofocals have their
IOLs set for distance vision and use reading
glasses for near activities. On the other hand, a
person whose IOLs were set to correct near
vision would need glasses to see distant objects
clearly.

ii. Toric
This is a monofocal IOL with astigmatism
correction built into the lens.

In the multifocal type, a series of focal

zones or rings is designed into the IOL.
Depending on where incoming light
focuses through the zones, the person may
be able to see both near and distant
objects clearly.

The design of the accommodative lens

allows certain eye muscles to move the IOL
forward and backward, changing the focus

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iii. Multifocal
These newer IOL types reduce or eliminate the
need for glasses or contact lenses.

by ICEMAN Bastinen

Lens Surgeries
i. Cataract Surgery with implantation of
intraocular
lens
ii. Clear Lens Surgery + IOL implantation
iii. Phakic IOL

It usually takes 6 to 12 weeks after surgery

on the second eye for the brain to adapt
and vision improvement to be complete
with either of these IOL types.

iv. Multifocal +Toric

v. Phakic IOL
a special kind of intraocular lens that is
implanted surgically into the eye to correct
myopia (nearsightedness). They are called
"phakic" because the eye's natural lens is left
untouched. This is in contrast to intraocular
lenses that are implanted into eyes after the
eye's natural lens has been removed during
cataract surgery.
Phakic intraocular lenses are indicated for
patients with high refractive errors when the
usual laser options for surgical correction (LASIK
and PRK) are contraindicated

The ability to read and perform other tasks

without glasses varies from person to
person but is generally best when
multifocal or accommodative IOLs are
placed in both eyes.

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by ICEMAN Bastinen

much as it would with a natural lens,

allowing near and distance vision.