Refraction

and
Error of Refraction
Reported by:
Barbie Jean S. Pabilonia
Mary Kamher Herradura-Pascua
Objectives:
To define the following terms:
Refraction
Accommodation
Emmetropia
Refractive error
To enumerate and discuss the different
refractive errors
To enumerate the signs and symptoms of
refractive error
To discuss the measurement of refractive error
To discuss the different optical devices
Refraction
Passing of light from one transparent
medium to another
When the transparent medium is more
dense or less dense, velocity changes.
When the transparent medium is
bounded by surfaces that is not
perpendicular to light, direction changes.
This change in direction is called
refraction
Diopter
Diopter is the standard unit to express
the refractive power of optical lenses. (D)
Reciprocal of the distance between a lens
and its focus (focal length)
A diopter is derived by dividing 1 by the
focal length of a lens expressed in
meters.
(1/0.20m(20cm)= 5.0 D)
 The ray of light entering the eye is
refracted by:
The cornea aqueous humor
crystalline lens
Cornea has a fixed focal length (focus)
Lens changes in curvature known as
accommodation
Crystalline Lens consist of
transparent protein having different
densities.
 Accommodation
Process by which the refractive power of the
anterior lens segment increases so that
near objects may be distinctly imaged

Stimulus for accommodation: blurred

image

Ciliary muscle is attached to the lens

capsule by zonular fibers
Accommodation
Contraction of the circular portion of the
ciliary muscle Increased curvature of
the central portion of the anterior surface
of the lens increase in refractive power

Relaxed circular muscle taut zonular

fibers minimal convexity of the lens
decrease refractive power
Refraction Testing
Subjective Refraction Testing
Objective refraction testing
Retinoscopy (shadow testing)
Refractometry
Automated refractometry
EMMETROPIA
Optical condition which an eye has no
error of refraction, rays of light parallel to
the optical axis are brought to focus by
the fovea centralis
EMMETROPIA
Refractive Errors
(Ametropia)
Optical condition in which parallel rays of
light from an object an infinite distance
from the eye do not come to focus
exactly to the fovea centralis
Refraction is due to the refractive power
of the cornea and the lens correlated with
the length of the eye.
REFRACTIVE
ERRORS
Axial ametropia
(AMETROPIA)
Ametropia is the result of an abnormality in
the length of the eye
Refractive ametropia
Ametropia is the result of a variation in the
refractive power of the cornea or lens
REFRACTIVE
ERRORS
Signs and Symptoms:
(AMETROPIA)
Decreased visual acuity
Blurry vision
Ocular discomfort
Burning
Itching
Tearing
REFRACTIVE ERRORS
(AMETROPIA)
Increased sensitivity to light
Decreased efficiency
Various aches
Fatigue
Droopy eyes
Headache
Refractive Errors
(Ametropia)
Examples:
Hyperopia (Farsightedness)
Myopia (Nearsightedness)
Astigmasism
Presbyopia
Correction of refractive
Errors
Eyeglass Lenses
- Monofocal
Spherical lenses: refract light equally along
every axis
Toric lenses (cylindrical lenses): refract light
only along one axis spherical and toric lenses
can be combined
Correction of refractive
Errors
-Multifocal lenses
Bifocal: upper and middle portion of the
lens is ground for the distance correction;
the lower portion is for the near-field
correction
Trifocals: third refractive correction
between the distance and near- field
portion.
Progressive addition lenses: minimize
abrupt image changes
HYPEROPIA
(Farsightedness)
There is a discrepancy between the refractive
power and axial length of the eye such that
parallel incident light rays converge at a focal
point posterior to the retina
Focal point lands behind/AFTER retina
HYPEROPIA
(Farsightedness)
Condition of the eye in which
accommodation is suspended , parallel
rays of light are intercepted by the retina
before coming into focus
(1.) The globe has a normal length, but the
refractive power is insufficient (refractive)
(2.) The refractive power is normal, but the
globe is too short (axial)
HYPEROPIA
Farsightedness)
HYPEROPIA
(Farsightedness)
Compensated by accommodation which
increases the refractive power of the
lens and if accommodation does not
compensate, vision is blurred.
HYPEROPIA
(Farsightedness)
Classification:
Total hyperopia paralysis of ciliary muscle
Manifest hyperopia corrected with convex
Latent hyperopia degree of hyperopia
overcome by accommodation
HYPEROPIA
(Farsightedness
Symptoms:
- Eye pain
- Headache
- Burning sensation in the eye
- Blurred vision
- Rapid fatigue
HYPEROPIA
(Farsightedness)
Correction:
1.Spectacles
-Convex lens (positive lens) or convergent
lens
-Decreases focal length to fall on retina
2. Contact lenses
- Convex lens or positive lens
 HYPEROPIA
(Farsightedness)
3.LASIK
-Laser applied to paracentral cornea
-Thins out peripheral cornea steeper/more
curved central cornea IOP will push the
center forward. Causing greater refractive
power lesser focal length.
-Focal point falls on retina
 HYPEROPIA
(Farsightedness)
4. Lens extraction with Multifocal Intra
Ocular Lens (IOL)
-Implanted lens which focus objects
at multiple distance into retina
-Multicentric grades of the lens that is
placed within the anterior chamber
-Diopteric powers of the lens differs
from center to periphery
MYOPIA
Condition in which rays of light entering
the eye parallel to the visual axis come to
focus in front of the retina
refractive power of the cornea and lens is
too great for the length of the eye
the eye is too long for the refractive
power of the cornea and lens
MYOPIA
MYOPIA
Divided into three:
Physiologic myopia Axial or refractive
Pathologic myopia Axial
Lenticular myopia Refractive
MYOPIA
Physiologic myopia
Most common type
Inadequate correlation of the refractive
power of the cornea and lens with the length
of the globe
Onset 5 10 year of age but may begin late
25 yoa
Rarely exceeds 6 diopters
MYOPIA
Pathologic Myopia (degenerative)
Abnormality in the axial length of the eye is
excessive (overgrowth of the two third of the
globe)
Begins with physiologic myopia, but rather
than stabilizing the eyes continues to grow
MYOPIA
First ophthalmologic sign is a Crescent of the
optic disk, begins in the temporal side and
progress to surround disk
MYOPIA
Lenticular myopia
Increase in refractive power of the anterior
segment of the crystalline lens
DM, Nuclear Sclerosis (aging change of he
lens), antihyperntisive drugs (hydralazine),
phenothiazide increases refractive power of
the lens
MYOPIA
Concave lenses neutralizes myopia
MYOPIA
Radial keratotomy (Radial Incision
partially to the thickness of the
peripheral cornea) and Photokeratectomy
(eximer laser ablasion of the central
corneal stroma)
Decreases the refracive power of the cornea
PRESBYOBIA
The loss of accomodation that comes
with aging to all people is called
Presbyopia.
All person with emmetropic eyes will
begin to notice inability to read small
print or close objects at bout age 44-46
Worse in dim, early morning, fatiqued
Increases in the age of 55
PRESBYOBIA
Corrected with Plus Lenses to makeup for
the lost automatic focusing.
May be used in several ways:
Reading glasses
Half Glasses
Bifocals
Trifocals
ASTIGMATISM
An optical condition in which refracting
power of a lens (or an eye) is not the
same in all meridians
ASTIGMATISM
Regular astigmatism - two principle
meridians with constant power and
orientation across the pupillary aperture
resulting in two focal lines

Irregular astigmatism - power or orientation

of the principal meridians changes across
the pupillary aperture; usual cause is
abnormalities is corneal shape
ASTIGMATISM
Simple: when one meridian is on the retina

Simple myopic: when the other meridian is

anterior to the retina

Simple hyperopic: when the other meridian is

intercepted by the retina before coming to focus
 Compound myopic astigmatism: both meridians are
in front of the retina

Compound hyperopic astigmatism: both meridians

in intercepted by the retina before coming to focus

Mixed astigmatism: one focal line is focused in front

of the retina and the other focal line is intercepted
by the retina