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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

Convergent

Concave Lens
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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

Plano-Concave

Concave-Meniscus

Divergent
Lenses

Biconcave

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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

Lachrymal
Papillae

Superior
Tarsal Lid

Semilunar
Fold
Lateral
Canthus

Caruncle
Medial
Canthus

Sclera

(Conjunctiva)

Limbus

Cornea
Pupil

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Iris

Internal Eye Anatomy

Ciliary
Muscle

Zonular
Fibers

Superior
Fornix

Macula
(Fovea)

Cornea

Vitreous
Face

Iris
Pupil
Lens
Limbus

Optic
Nerve

Vitreous
Body

Inferior
Fornix
Anterior
Chamber

Ocular
Muscles

Posterior
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Chamber

Sensory
Retinal
Layer

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

{500 - 550

0
70

00
9
-

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
Substance

Index of
Refraction

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

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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

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

Against-The-Rule
Astigmatism

Steep Axis Vertical

90

Steep Axis Horizontal

90

45 D

42 D
45 D
42 D 180

42.00 / 45.00 X180

42.00 / 45.00 X090

Steep K & Axis

180

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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

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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

Anisometropia:

perbedaan sferis equivalen

Aniseikonia:

beda ukuran dan bentuk bayangan

Unilateral aphakia:

hiperopik anisometropia koreksi kacamata aniseikonia

25%; KL 7%

Akomodasi :

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

Miopia:

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

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
Anak koreksi penuh
Dewasa coba penuh

Kacamata anak:

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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Kontak lensa
Beda dari kacamata:

Jarak vertex pendek

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

Anisometopia: lebih kecil

Akomodasi: miopia akomodasi >>; plus
akomodasi <<
Materi: HEMA,MMA,NVP
Jenis:

soft KL, RGP KL, toric soft KL, bifokal KL, keratokonus / kornea
abnormal KL, gas permeable scleral KL

Therapeutic lens:

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:

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

Transmisi HIV: desinfeksi trial lens:

Hard: hidrogen peroxid, desinfeksi panas (78*-80*/10 min)

RGP: idem kecuali desinfeksi panas
Soft: idem
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