FISIOLOGI OPTIK

Reduced
REDUCED Schematic
SCHEMATIC EYE 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 → a single nodal point for the eye
 Reduced Schematic Eye
 Calculate the retinal image size of an object in space

Retinal image Nodal point to retina

height = distance

Snellen letter Chart to eye

height 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
 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
 Visual Acuity
Minimum legible threshold
• Patient’s visual ability cannot further distinguish progressively smaller
letters or forms from one another (Snellen chart)
Minimum visible threshold
• The minimum contrast of a target at which the patient can
distinguish the target from the 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
 • MAR
Snellen chart convert
• LogMAR
 CONTRAST SENSITIVITY AND
THE CONTRAST SENSITIVITY FUNCTION

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)
Sumber :
https://www.aoa.org/Documents/optometric-
staff/Articles/Contrast-Sensitivity.pdf
 • 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
• The sensitivity of an
observer to
differences in
luminance between
an object and the
background

• Target :
– Sufficiently large to
be seen
– High enough contrast
with its background
Modulation Transfer Function (MTF)
• Relationship between spatial frequency and contrast
sensitivity at each spatial frequency

• Spatial frequency
– the number of light bands per unit length or per
unit angle
Campbell-Robson contrast sensitivity
 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
• Retrobulbar Optic Neuritis
• Amblyopia
• Pupil size (miotic → diffraction reduce CSF;
dilatation → optical aberrations)
The Vistech contrast sensitivity test
The Pelli-Robson Letter Chart
REFRACTIVE STATES OF THE EYES

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

Refractiv optical elements
increases (myopia) /
e 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 its located behind the
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 (2 focal lines)

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 at
astigmatism or near axis 90o

Against-the- • The horizontal meridian is the steepest

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

Oblique • The principal meridians lie near 45o and 135o

astigmatism
 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 & PRESBYOPIA

Accomodation

Mechanism by which the eye change refractive

power by altering the shape of its crystalline lens
 Accomodation effort

Parasympatheti Tension on lens

c stimulates Zonular fibers capsule ↓ &
ciliary muscle to relax lens become
contracts more 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
DEVELOPMENTAL MYOPIA

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 1stst 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 → corneal

Curvatures of refracting
power decreased 0.1-0.2
surface continue to
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 lens Emmetropia
corneal power power

Immature human To reduce

eye develops refractive errors
 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
Adult-onset hyperopia

• Associated with increasing age

• Separate with nuclear sclerotic cataract

• Less educational environment

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
THANK YOU