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Refraction and

Accommodation
of the eye
1) Normal refractive condition
and accommodation
 (1). Ocular refractive system
The ocular refractive system is composed
of the cornea,the aqueous humor,the lens
and the vitreous.
Refractive system
1) Normal refractive condition
and accommodation
 People can see object clearly,for the light
rays sent out by object pass through eye
refractive system,form images on retinal
macula.
Refractive condition is decided by the
refractive power and length of ocular axis.
Reduced eye : Including a node,a
principle node(refracting surface) and two
foci
Refractive power
 Refractive power is diopter (D), if the focal
length of a spherical lens is 1m, its refractive
power is one diopter ( D ) .
D =1/ f
 Corneal refractive system : 43.05D
 Lens refractive system : 19.11D
 Total refractive power of globe : 58.64D
( 2 ) Emmetropia and
accommodation
 Emmetropia: The condition is the
absence of refractive error. Or
nonaccommodated paralle light rays
refracted by ocular refractive system
accurately focus on the retina which
is called emmetropia.
( 2 ) accommodation
 Accommodation : in order to see near
object clearly,the eye increases lens curvature
to strengthen ocular refractive power to
make near object form clear image on the
retina.
accommodation
 Accommodation is the eye’s way of
changing its focusing distance: the
lens thickens, increasing its ability
to focus at near. A young person’s
ability to accommodate allows him
or her to see clearly far away and
up close. At about the age of 40,
the lens becomes less flexible and
accommodation is gradually lost,
making close-range work
increasingly difficult. This is
known as presbyopia.
( 2 ) accommodation
 Accommodative scope : the differce
between far and near points .
 Far point: Under nonaccommodated
condition,the farthest point the eye can see
clearly is called far point.
 Near point:Under largest accommodation,
the point the eye can see nearest distance
is called near point.
( 2 ) accommodation
 Near reflect : When both eyes gaze at
a quite near object simultaneously,
besides accommodation,and
corresponding diminution of binocular
pupils,there are contraction of both
medial rectus muscles and adduction
of both eyes( convergence).
2) Ametropia ( nonemmetropia )
 Ametropioa : The refractive power
and the length of the globe are not
correlated so that parallel light
rays refracted by ocular refractive
system do not come to focus on the
retina(fovea centralis). Including
hyperopia,myopia and
astigmatism.Or is the presence of
refractive error.
( 1 ) Myopia(nearsighted
)
 Under nonaccommodated
condition,parallel light rays refracted
by ocular refractive system come to
focus in front of the retina
 Classification:
★ Mild : below -3D
★ Moderate : from-3D to -6D
★ High myopia : more than -6D
The far point is in finited distance
( 1 ) Myopia(nearsighted
)
( 1 ) Myopia(nearsighted
)
 Nearsightedness or myopia, occurs
when light entering the eye focuses in
front of the retina instead of directly
on it. This is caused by a cornea that
is steeper, or an eye that is longer,
than a normal eye. Nearsighted
people typically see well up close, but
have difficulty seeing far away.
( 1 ) Myopia(nearsighted
)
 This problem is often discovered in
school-age children who report
having trouble seeing the
chalkboard.
( 1 ) Myopia(nearsighted
)
 Detection
Nearsightedness is detected with a
vision test and refraction.
《 Etiology 》
 ‹1›.Axial myopia: Axial of the eye
is quite long,but the refractive
power is normal.
*The eye longer than average
*Most high myopia are axial
《 Etiology 》
 ‹2›.Refractive myopia: The axis is
normal but the refractive power
increases.
Refractive myopia
* The curvature of cornea is large
*The curvature of lens increase
* Spasm of accommodation
《 Clinical findings 》
 ‹1›.Visual acuity Near vision may be
in normal, distance vision is bad.
 ‹2›. Asthenopia It is as a result of the
disturbance of balance between
accommodation and convergence,
overusing of convergence, not or less
use of accommodation.
《 Clinical findings 》
 ‹3›. Exotropia Due to contradiction
between accommodation and
convergence, with the time going,
hypofunction of convergence is induced
to bring about exotropia .
《 Clinical findings 》
 ‹4›.Fundus chang A grey crescent
in temporal side of the disc may be
occurred , choroidal atrophy,
posterior sclera staphyloma, macular
hemorrhage, lattice degeneration,
retinal tear and retinal detachment
may be seen.
 ‹5›.Vitreous liquefaction and opacity
《 Correction of myopia 》
 In order to let the parallel light
rays focus on the retina, it is
necessary to place a concave lens
in front of the eye. Besides wearing
of glasses,there is contact lens
which is worn onto the cornea .
《 Correction of myopia 》
Treatment
 The treatment for nearsightedness
depends on several factors such as the
patient’s age, activities, and occupation.
Vision can corrected with glasses, contacts,
or surgery. Refractive procedures such as
LASIK can be considered for adults when
the prescription has remained stable for at
least one year.
Treatment
Refractive procedures
 Clear Lens Replacement (CLR)

 Photo Refractive Keratectomy (PRK)

 Radial Keratotomy (RK)

 LASIK (LAser in SItu Keratomileusis)


 RK ( Radial Keratotomy ) is
used to treat low to moderate
levels of nearsightedness. It was
first performed in 1973 by a
Russian eye surgeon. Microscopic
incisions are placed in radial
pattern on the cornea, causing it
to flatten.
RK
Radial keratotomy
 Radial keratotomy: Eight to 16
radial incisions are made in
peripheral cornea to reduce ocular
refractive degree so that to get the
aim of correction of myopia .
 PRK(
Photo Refractive Keratectomy
) is the original procedure that
first used the Excimer laser to
correct low to moderate amounts
of nearsightedness.
 The patient's data is entered into a
computer that controls the laser. The laser
sculpts the central optical area of the
cornea as the surgeon carefully monitors
the procedure through a microscope
attached to the system. Tissue is removed
or ablated until the cornea is shaped into
the desired curvature.
 LASIK (LAser in SItu Keratomileusis)
is a procedure used to correct vision
problems such as myopia
nearsightedness), hyperopia
(farsightedness), and astigmatism. A
special instrument called a keratome is
used to gently lift a flap of corneal
tissue, then laser is used to reshape
the cornea. The corneal flap is
carefully repositioned.
 This procedure allows light to
focus more precisely on the
retina, resulting in clearer vision.
For many patients, LASIK
means a new lifestyle - free from
the restrictions of glasses.
LASIK
LASIK
LASIK
 If you are at least 21 years old
and your glasses haven't required
a significant prescription change in
one year, you may be a candidate
for LASIK.
《 Prevention of juvenil
myopia 》
 ‹1›.Culture good health habit to
use eyereading distance is about
30-35cmnot to read lying in
bedin dark place or in sunto
avoid long-term readingworking
or watching TV in near distance as
possible.
 ‹2 ›. To examine visual acuity and
eye regularly.
《 Prevention of juvenil
myopia 》

 ‹3›. To strengthen constitution to


pay attention to nourishment  let
eye and whole body develop
normally.
( 2 ) .Hyperopia
 Hyperopia is the state in which the
unaccommodated eye would focus
the image behind the retina.
 Parallel light rays refracted by
ocular refractive system focus
behind the retina, not form clear
image.
Hyperopia
Hyperopia
Hyperopia
 Farsightedness or hyperopia, occurs
when light entering the eye focuses
behind the retina, instead of directly
on it. This is caused by a cornea that
is flatter, or an eye that is shorter,
than a normal eye. Farsighted people
usually have trouble seeing up close,
but may also have difficulty seeing far
away as well.
Hyperopia
 Young people with mild to moderate
hyperopia are often able to see clearly
because their natural lens can adjust, or
accommodate to increase the eye’s
focusing ability. However, as the eye
gradually loses the ability to
accommodate (beginning at about 40
years of age), blurred vision from
hyperopia often becomes more apparent.
Hyperopia
 Signs and Symptoms
 Difficulty seeing up close
 Blurred distance vision (occurs with
higher amounts of hyperopia)
 Eye fatigue when reading
 Eye strain (headaches, pulling
sensation, burning)
Hyperopia
 Classification
Mild: less than+ 3D,
 moderate: +5D or less than +5D
 High: more than +5D
《 Etiology 》

 ‹1›.Axial hyperopia is indicated that


ocular axis is short but refractive power
is normal.
 ‹2›.Refractive hyperopia is indicated
that ocular axis is normal, but refractive
power is weak.
《 Clinical findings 》
 ‹1›.Visual acuity Mild hyperopia may be
compensated by accommodation, so far or
near vision may be normal in mild
hyperopia of juvenile,if the degree of
hyperopia is large or accommodative
power decreases with aging,both far and
near vision decrease in different
degrees,and near vision is much worse
than far one.
《 Clinical findings 》
 ‹2›. Asthenopia Long-term near work,
excessive accommodation often may induce
asthenopia, its symptom is blurred vision,
distending pain in superciliary arch.
 ‹3›. Esotropia Due to excessive
accommodation leading to more
convergence which is easy to induce
esotropia .
《 Clinical findings 》
 ‹4›. Fundus examation more than
moderate degree, the disc is
smaller than normal with blurred
margin ,a little elevated , quite
similar to papillitis or edema may
be seen.
Hyperopia
 Detection and Diagnosis
Hyperopia is detected with a vision
test called a refraction. Young
patients’ eyes are dilated for this
test so they are unable to mask
their farsightedness with
accommodation. This is called a
wet refraction.
Hyperopia
 Treatment
The treatment for hyperopia depends on several
factors such as the patient’s age, activities, and
occupation. Young patients may or may not
require glasses or contact lenses, depending on
their ability to compensate for their
farsightedness with accommodation. Glasses or
contact lenses are required for older patients.
Correction of hyperopia
 Corrected by convex lens which makes
parallel light rays become convergent
ones,so that the focus falls on the retina .
Contact lens may be used for correction
too.
Correction of hyperopia
( 3 ) . Astigmatism
 Due to the difference of refractive power
in every meridian of eye, so outside light
rays can’t focus on the retina to form
clear image.
( 3 ) . Astigmatism
 Astigmatism means that the cornea is oval
like a football instead of spherical like a
basketball. Most astigmatic corneas have
two curves – a steeper curve and a flatter
curve. This causes light to focus on more
than one point in the eye, resulting in
blurred vision at distance or near.
Astigmatism often occurs along with
nearsightedness or farsightedness.
《 Etiology 》
 Most common cause is that the
radii of curvature of cornea and
lens are different in each
meridian,generally, their difference
between two main meridians is
biggest.
 May be divided into two sorts:
regular and irregular ones.
Astigmatism
‹1›. Regular astigmatism

 Regular astigmatism indicates the


difference of refractive degree of cornea
on two meridian vertical each other, be
corrected by cylindrical lens. Divided
into 5 sorts
‹1›. Regular astigmatism
 1›. Simple hyperopic asstigmatism
 2›. Simple myopic astigmatism
 3›.Compound hyperopic
astigmatism
 4›. Compound myopic astigmatism
 5›. Mixed astigmatism
《 Clinical finding 》
 ‹1›Visual acuity Blurred both in
seeing far or near.
 ‹2›Asthenopia, distending
ophthalmalgia, head ache ,
tearing,nausea,vomiting.
 ‹3›fundus the disk is vertically
elongated with blurred margin.
 Astigmatism can be detected and
measured with corneal topography
, keratometry, vision testing and
refraction.
《 Treatment 》
 Astigmatism can be corrected with
glasses (cylindrical lens ), contacts,
or surgically. The most common
surgeries used to correct astigmatism
are astigmatic keratotomy (procedures
that involve placing a microscopic
incision on the eye) and LASIK. The
objective of these procedures is to
reshape the cornea so it becomes more
spherical or uniformly curved.
( 4 ) . Anisometropia
 Anisometropia indicates the difference of
binocular refractive power is more than 2D,if
the difference is more than 2.5D,because the
images on binocular retina are different in
size which arouse difficult in
fusion,destrying of binocular vision.
(5). Presbyopia
 Presbyopia, also known as the “short
arm syndrome,” is a term used to
describe an eye in which the natural
lens can no longer accommodate.
With aging, accommodative function
decreases gradually, at about 40-45
years of age,difficult takes place in
near work or reading,this decrease of
physiologic accommodation caused
by aging is known as presbyopia.
《 Clinical finding 》
 Most people first notice difficulty
reading very fine print such as the
phone book, a medicine bottle, or
the stock market page. Print seems
to have less contrast and the eyes
become easily fatigued when
reading a book or computer
screen. The symptom of presbyopia
is difficult to see near thing.
 Early on, holding reading material
further away helps for many patients.
But eventually, reading correction in
the form of reading glasses, bifocals, or
contact lenses is needed for close
work. However, nearsighted people
can simply take their glasses off
because they see best close-up.
Signs and Symptoms
 Difficulty seeing clearly for close work
 Print seems to have less contrast
 Brighter, more direct light required for
reading
 Reading material must be held further
away to see (for some)
 Fatigue and eyestrain when reading

Detection and Diagnosis
 Presbyopia is detected with vision
testing and a refraction.
《 Treatmrnt 》
 The treatment for presbyopia is very
simple, but is entirely dependent on the
individual’s age, lifestyle, occupation,
and hobbies. If the patient has good
distance vision and only has difficulty
seeing up close, reading glasses are
usually the easiest solution. Presbyopia
needs convex lens to compensate the
deficiency of accommodation,making its
near point in normal scope.
 For others, bifocals (glasses with
reading and distance correction) or
separate pairs of reading and distance
glasses are necessary. Another
option is monovision: adjusting one
eye for distance vision, and the fellow
eye for reading vision. This can be
done with contact lenses or
permanently with refractive surgery.