Dr.

Mohamed Wassfi
Ophthalmology Consultant
Head of Ophthalmology Department
Thumbay University Hospital
 Refraction of Light

 Refraction is the bending of a wave when it enters a
medium where its speed is different. The refraction
of light when it passes from a fast medium to a slow
medium bends the light
ray towards the
normal to the
boundary between
the two media.
 Refraction of Light

 The amount of bending depends on the indices of
refraction of the two media.
 The index of refraction is defined as the speed of
light in vacuum divided by the speed of light in the
medium.
 Refractive Power

 The refractive power of any lens is expressed in
Diopters (D) and is equal to the reciprocal of the
focal length in meters ¨1/meters¨.

 Is ¨+¨ for converging (convex lens) and ¨-¨for

diverging (concave lenses)
Refractive Power

 Refraction in the Eye

 Refraction is the phenomenon which makes image
formation possible by the eye.
 Light should be correctly focused on the retina for
the eye to generate accurate visual information.
 Refraction in the Eye

 Most of the refraction in the eye (about 2/3: 43D)
takes place at the cornea, since the transition from
the air into the cornea is the largest change in index
of refraction that the light experiences. The
remaining 1/3 (17D) of refraction occurs at the
crystalline lens.
 While the crystalline lens is responsible for the
smaller portion of refraction, it is the total source of
the ability to accommodate the focus of the eye for
the viewing of close objects.
Accommodation

Mechanism of Accommodation

 Definitions

 Emmetropia:- when parallel rays of light from a
distant object are brought to focus on the retina with
the eye at rest “not accommodating “. There is an
adequate correlation between the axial length and
the refractive power of the eye.
 Definitions

 Ametropia:- when parallel rays of light are not
brought to a focus on the retina in an eye at rest.
There is a mismatch between axial length and
refractive power. It is simply called a “refractive
error”.

 Ametropia is divided into:

 Myopia: Near sightedness
 Hypermetropia: Far sightedness/Hyperopia
 Astigmatism
 Definitions

• Accommodation: Adjustment of the refractive power
of the lens inside the eye for seeing objects at various
distances. It is done by changing the curvature of the
lens.

• Presbyopia: Loss of accommodative ability of the

lens resulting in difficulties with near tasks.

• Astigmatism: the curvature of the cornea is not

spherical and therefore causes image blur on the
retina.

• Anisometropia: a refractive power difference

between the 2 eyes (usually > 2D).
 Myopia

 Parallel rays converge at a focal point in front of the
retina due to a longer than normal axial length (axial
myopia) or a highly curved cornea (refractive
myopia). This results in blurred distance vision with
good near vision.
 Hypermetropia

 Parallel rays converge at a focal point behind the
retina due to a shorter than normal axial length (axial
hypermetropia) or a very flat cornea (refractive
hypermetropia). This results in blurred near vision
and later on blurred distance vision as well.
 Astigmatism

 Parallel rays come to a focus at two rather than at a
single focal point due to an unequally curved cornea,
with one meridian more curved and the other more
flat in opposite directions. This causes distortion and
blurring of the images in both far and near vision.
 Presbyopia

 Is an age-related phenomena and not a refractive
error (above 40 years).
 It is due to weakness in the ciliary muscle, which
cannot contract as before.
 As a result, the lens cannot accommodate as well and
thus is not able to focus for near objects.
 It becomes worse with advancing age.
 Remember!!

 A refractive error simply means that the shape of the
eye does not bend light correctly, resulting in a
blurred image.

 A myope has too much plus in his eye whereas a

hypermetrope has too much minus.
Determination of Refractive Error

 Can be done with an auto-refractor or with a
retinoscope.
 Treatment

 Spectacles:
 Monofocal
 Spherical
 Cylindrical
 Sphero-cylindrical
 Bifocal
 Progressive
 Treatment

 Spectacles:
 Treatment

 Contact Lenses:
 Monofocal
 Spherical
 Toric (cylindrical)
 Bifocal
 Multifocal

Contact lenses can be either soft or rigid.

 Treatment

 Contact Lenses:
 Treatment

 Contact Lenses:
Up to 4D there is no
difference between the
spectacle prescription
and the contact lens
prescription.
 Treatment

 Refractive Surgery:
 Corneal Surgery
 LASIK
 PRK
 Phakic IOL
 Spherical
 Toric
 Refractive Lensectomy
 LASIK

 Stands for Laser-Assisted In Situ Keratomileusis.
 It is the most commonly used.
 The most accepted by patients.
 Used for:
 Myopia
 Hypermetropia
 Astigmatism
 Recently, presbyopia
LASIK

LASIK

LASIK

 PRK

 Stands for Photorefractive Keratectomy.
 Used for:
 Low to intermediate myopia
 Hypermetropia
 Astigmatism
 In patients with:
 Thin corneas
 Irregular corneas
PRK

 Phakic IOL

 The phakic intraocular lenses are used in:
 Patients with capacity of accommodation
 High ametropias
 Contraindications to corneal surgery (very thin or
irregular cornea)
Phakic IOL

 Refractive Lensectomy

 Clear Lens Extraction
 With IOL implantation (mono or multifocal/toric)
 High ametropias
 Patients with low or no accommodative capacity
 

Thank You