Emmetropia

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Emmetropia is the state of vision where a faraway object at infinity is in sharp
focus with the eye lens in a neutral or relaxed state. This condition of the normal
eye is achieved when the refractive power of the cornea and the axial length of the
eye balance out, which focuses rays exactly on the retina, resulting in perfect
vision. A human eye in a state of emmetropia requires no corrective lenses; the
vision scores well on a visual acuity test (such as an eye chart test). For
example, on a Snellen chart test, emmetropic eyes score at "6/6"(m) or "20/20"(ft)
vision, whereas myopic (near-sighted) eyes might score at 20/40 and hyperopic (far-
sighted) eyes might score at 20/15.

Contents [hide]
1 Overview
2 Emmetropization
3 Etymology
4 References
5 Further reading
Overview[edit]
Emmetropia is a state in which the eye is relaxed and focused on an object more
than 6 meters or 20 feet away. The light rays coming from that object are
essentially parallel, and the rays are focused on the retina without effort. If the
gaze shifts to something closer, light rays from the source are too divergent to be
focused without effort. In other words, the eye is automatically focused on things
in the distance unless a conscious effort is made to focus elsewhere. For a wild
animal or human prehistorical ancestors, this arrangement would be adaptive because
it allows for alertness to predators or prey at a distance.

Accommodation of the lens does not occur in emmetropia. In emmetropia, the lens is
about 3.6 mm thick at the center; in accommodation, it thickens to about 4.5 mm. A
relatively thin lens and relatively dilated pupil are also associated. The lens
usually stiffens with age, causing less ability to focus when the eyes are not in a
state of emmetropia.[1]

Corrective eye surgery such as LASIK and PRK aims to correct anemmetropic vision.
This is accomplished by ensuring the curvature of the cornea, the shape of the lens
and their distances from each other and the retina are in harmony. By shaping the
cornea, emmetropic vision can be achieved without corrective lenses. The correction
for only emmetropic vision is often why patients are still advised to wear glasses
to read as they age due to presbyopia.[2]

Newborns begin hypermetropic and then undergo a myopic shift to become emmetropic.
[citation needed]

Emmetropization[edit]

Eyeball lengths: far-sighted (hyperopic), emmetropic, and near-sighted (myopic).

The development of an eye towards emmetropia is known as emmetropization. This
process is guided by visual input, and the mechanisms that coordinate this process
are not fully understood.[3] It is assumed that emmetropization occurs via an
active mechanism by which defocus drives growth of the eye[4] and that genetic
factors and emmetropization both influence the growth of the eye's axis.[5]
There has been some research on causal factors involved in the development of
myopia and of hyperopia. In particular, statistics show that prolonged near work
correlates with the development of myopia, but it is still unclear whether there is
a causal relation.[6] Furthermore, outdoor activity has been found to have a
protective effect on myopia development in children.

It has long been assumed that wearing corrective spectacles might possibly perturb
the process of emmetropization in young children, with this assumption being
supported in particular also by animal studies. For this reason, a refractive
undercorrection is sometimes held to be advantageous in specific cases.[7] However,
it is not yet fully understood for which patient groups, if any, the wearing of
corrective spectacles in childhood actually impedes emmetropization.[8] In
hyperopic children, yet more factors are to be considered: Hyperopia is known to be
a significant risk factor for esotropia, therefore undercorrection may have the
side effect of increasing this risk.[9] There is widespread consensus that
undercorrection is counterindicated for children with accommodative esotropia.[7]
It is still unclear for which hyperopic, non-strabismic children corrective
spectacles may translate to a lower strabismus risk.[4][8] There are indications
that emmetropization is relevant for hyperopic children who have at most about 3.0
diopter, whereas children with stronger hyperopia seem to not change their
refraction independently of whether the refractive error is corrected or not.[10]

A Cochrane Review of three trials seeking to determine whether spectacle correction

reduced the occurrence of strabismus in children[11] included one study which
suggested that spectacle correction perturbed emmetropization in children,[12]
while a second study reported no differences.[13]

Etymology[edit]
"Emmetropia" is derived from Greek ?et??? emmetros "well-proportioned" (from ??
en "in" and ?t??? metron "measure") and ?? ops "sight" (GEN ?p?? opos). Translated
literally, the term indicates the condition of an eye's having in itself (i.e.,
without recourse to corrective lenses or other instruments) the capability to
obtain an accurate measurement of an object's physical appearance.

References[edit]
Jump up ^ Saladin, Kenneth S. "16." Anatomy & Physiology: the Unity of Form and
Function. New York, NY: McGraw-Hill, 2012. Print.
Jump up ^ "Photorefractive Keratectomy (PRK) Eye Surgery"
Jump up ^ Mutti, DO (2005). "Axial Growth and Changes in Lenticular and Corneal
Power during Emmetropization in Infants". Investigative Ophthalmology & Visual
Science. 46 (9): 30743080. doi:10.1167/iovs.04-1040. ISSN 0146-0404. PMID
16123404.
^ Jump up to: a b Babinsky E, Candy TR (2013). "Why do only some hyperopes become
strabismic?". Investigative Ophthalmology & Visual Science (Review). 54 (7):
494155. doi:10.1167/iovs.12-10670. PMC 3723374?Freely accessible. PMID 23883788.
Jump up ^ Siegwart JT, Norton TT (March 2011). "Perspective: how might
emmetropization and genetic factors produce myopia in normal eyes?". Optometry and
Vision Science : Official Publication of the American Academy of Optometry. 88 (3):
E36572. doi:10.1097/OPX.0b013e31820b053d. PMC 3075852?Freely accessible. PMID
21258261.
Jump up ^ Pan, CW; Ramamurthy, D; Saw, SM (January 2012). "Worldwide prevalence and
risk factors for myopia". Ophthalmic & physiological optics : the journal of the
British College of Ophthalmic Opticians (Optometrists). 32 (1): 316.
doi:10.1111/j.1475-1313.2011.00884.x. PMID 22150586.
^ Jump up to: a b Creig Simmons Hoyt; David Taylor (2012). Pediatric Ophthalmology
and Strabismus, Expert Consult - Online and Print,4: Pediatric Ophthalmology and
Strabismus. Elsevier Health Sciences. pp. 3334. ISBN 0-7020-4691-4.
^ Jump up to: a b Jones-Jordan L, Wang X, Scherer RW, Mutti DO (2014). "Spectacle
correction versus no spectacles for prevention of strabismus in hyperopic
children". The Cochrane Database of Systematic Reviews (Review). 8: CD007738.
doi:10.1002/14651858.CD007738.pub2. PMC 4259577?Freely accessible. PMID 25133974.
Jump up ^ "Children with a greater degree of hyperopia are at a greater erisk to
become esotropic; thus, a dilemma exists in presribig convex lenses to prevent the
deviation as opposed to a possible interference with the emmetropization process."
Quoted from: Robert H. Duckman (2006). Visual Development, Diagnosis, and Treatment
of the Pediatric Patient. Lippincott Williams & Wilkins. p. 71. ISBN 978-0-7817-
5288-6.
Jump up ^ Birgit Lorenz; Anthony Moore (31 January 2006). Pediatric Ophthalmology,
Neuro-Ophthalmology, Genetics. Springer Science & Business Media. p. 15. ISBN 978-
3-540-31220-8.
Jump up ^ Jones-Jordan L, Wang X, Scherer RW, Mutti DO (2014). "Topical Spectacle
correction versus no spectacles for prevention of strabismus in hyperopic
children". Cochrane Database Syst Rev. 8: CD007738.
doi:10.1002/14651858.CD007738.pub2. PMC 4259577?Freely accessible. PMID 25133974.
Jump up ^ Ingram RM, Arnold PE, Dally S, Lucas J (1991). "Emmetropisation, squint,
and reduced visual acuity after treatment". Br J Ophthalmol. 75 (7): 414416.
doi:10.1136/bjo.75.7.414. PMC 1042408?Freely accessible. PMID 1854694.
Jump up ^ Atkinson J, Anker S, Bobier W, Braddick O, Durden K, Nardini M, et al.
(2000). "Normal emmetropization in infants with spectacle correction for
hyperopia". Invest Ophthalmol Vis Sci. 41 (12): 37263731. PMID 11053269.
Further reading[edit]
Bernard Gilmartin, 1998. Myopia and nearwork Pg 33-34, Elsevier Health Sciences.
ISBN 0-7506-3784-6
Categories: EyeVisual system
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