Dr. M. Yusran, SpM, M.

Sc
 Emmetropia
 Ametropia
 Emmetropia means no Refractive error
 It is the ideal condition in which the incident
parallel rays come to a perfect focus upon the
light sensitive layer of the retina, When
accommodation is at rest
 Ametropia means Refractive error Eye
 It is the opposite condition , wherein the
parallel rays of light are not focused exactly
upon the retina , When the accommodation is
at rest
 Myopia
 Hypermetropia
 Astigmatism
 Principal focus is formed in front of the
retina
 Axial Myopia
 Curvature Myopia
 Index Myopia
 Abnormal position of the lens
 Axial myopia results from increase in
anteroposterior length of the eye ball.
 Normal Axial length- 23mm to 24mm
 1mm increase in AL – 3Ds of Myopia
 Curvatural myopia occurs due to increased
curvature of the cornea and Lens or both.
 Anterior surface of the cornea- 7.8mm
 Posterior surface of the cornea- 6.5mm
 1mm increases in radius of curvature results
in – 6 Ds of Myopia
 Index myopia results from increase in the
refractive index of crystalline lens.
Refractive index of normal Lens - 1.42
 Positional myopia is produced by anterior
displacement of crystalline lens in the eye.

Accommodative Myopia:.
Myopia due to excessive
accommodation.
 Congenital myopia
 Simple Myopia (or) Developmental myopia
 Pathological Myopia (or) Degenerative myopia
 Congenital myopia is present since birth
however, it is usually diagnosed by the age of
2 – 3 years.
 Simple or developmental myopia is the
commonest variety. It is considered as a
physiological error not associated with any
disease of the eye.
 Power limit less than 6D
 Axial type of simple myopia
 Curvatural type of simple myopia
 Myopia associated with degenerative changes
in the eye.
 Myopia more than 6D to25D or More than
25D
 Axial growth
(i) Heredity
(ii) General growth process
 Poor vision for distance
 Asthenopic symptoms
 Exophoria
 Large eye ball
 deep Anterior chamber
 sluggish Pupil
 Large Disc
 Retinal tear – Vitreous haemorrhage
 Retinal detachment
 Degeneration of the vitreous
 Primary open angle Glaucoma
 Posterior cortical cataract
 Posterior staphyloma
 Optical
Spectacle Correction (Concave Lens)
Contact lens
 Surgical
PRK
Keratomileusis
Epikeratophakia
Redial Keratotomy
 Axial Hypermetropia
 Curvature Hypermetropia
 Index Hypermetropia
 Abnormal position of the lens
 Axial hypermetropia is by far the
commonest
 In fact, all the new- borns are almost
invariably hypermetropic (approx,+2.50D)
This is due to shortness of the globe, and is
physiological.
 Normal axial length – 23mm to 24mm
 1mm decrease in AL – 3Ds of
hypermetropia
 In which the curvature of cornea, Lens or
both is flatter than the normal resulting in a
decrease in the refractive power of the eye.
 Anterior surface of the cornea- 7.8mm
 Posterior surface of the cornea- 6.5mm
 1mm increase in radius of curvature results in
– 6Ds of hypermetropia
 Index hypermetropia occurs due to change in
refractive index of the lens in old age. It may
also occur in diabetics under treatment.
 Refractive index of Normal Lens - 1.42
 Total Hypermetropia may be divided into
 (a) Latent Hypermetropia
 (b) Manifest Hypermetropia
(i) Facultive Hypermetropia
(ii)Absolute Hypermetropia
 LH which is corrected physiologically by the
tone of ciliary muscle. As a rule latent
hypermetropia amounts to only one dioptre.
It can be revealed only after atropine
cycloplegia.
 Facultative hypermetropia is that
part of hypermetropia which can be corrected
by the effort of accommodation.

 Absolute hypermetropia which can

not be overcome by the effort of
accommodation.
 Simple hypermetropia
 Pathological hypermetropia
 Functional hypermetropia
 It results from normal biological variation in
the development of the eye ball. It includes
Axial and Curvatural HM. It may be
hereditary.
 PH results due to either congenital or
acquired conditions of the eye ball which are
out side the normal biological variations of
the development.
 At birth: 2D to 3 D Commonly Present
 At the age of 5 Yrs- 90% of Children’s are
Hypermetropic
 At Puberty:- Emmetropic
 Head ache
 Blurred vision particular near work
 Convergent squint
 Early onset of presbyopia
 Eye Strain
 Eyeappears to be small including
cornea and anterior chamber
becomes shallow
 Extreme cases – Microphthalmos
 Optical
Spectacle ( Convex Lens )
Contact lens

 Surgical
Thermokeratoplasty
 Curvature
Ex: Keratoconus, Lenticonus etc..
 Centering error
Ex: Sub location of the lens
 Refractive index
Ex: Cataract
 Retinal
Oblique placement of macula
 Regular
 Irregular
 Refractive types
 Physiological types
 Simple astigmatism
 Compound astigmatism
 Mixed astigmatism
 With rule astigmatism
 Against rule astigmatism
 Oblique astigmatism
 Head ache
 Blurring of vision
 Eye tired
 Eye ache
 Head Tilt
 Optical Treatment
* Cylindrical lens
* Under correction
* Contact lens (RGP, Toric)
 Refractive surgery
* Astigmatic Keratotomy
* PRK, LASIK
 Percentage of astigmatism
* 0.25-0.50D 50%
* 0.75-1.00D 25%
* 1.00-4.00D 24%
*>4.00D 1%
 Percentage of Types
* with rule 38%
* Against rule 30%
* Oblique 32%
 This is a
physiological aging
process, In which
the near point
gradually recedes
beyond the normal
reading or working
distance
 Lens matrix is harder and less easily moulded
 Lens capsule is less elastic
 Progressive increase in size of the lens
 Weakening of the ciliary muscle
 Patient holds the book at arms length
 Patient prefers to read in bright light
 Eye strain
 Head ache
 Eyes feels tired and ache
Methods of prescription
* Occupation
* Working distance
* Age
Surgical
* Anterior ciliary sclerotomy
* Laser thermal keratoplasty
* Small diameter corneal inlays
 Aphakia means
absence of the
Crystalline lens
from the Eye ball
 Congenital
 Surgery
 Traumatic
 Anterior chamber – Deep
 Iris
(i) Iridodonesis (or) Tremulousness
(ii) Peripheral button-hole iridectomy mark
 Image magnification of about 25-30%
 Spherical aberration, Peripheral and
Pincushion
 Roving ring scotoma (The scotoma extents
from 50°- 65° from central fixation)
 Jack in the box
 Spectacle ( Convex lens )
 Contact lens
 Secondary IOL
 Epikeratophakia
 Keratophakia
 Pseudophakia
means False lens
 Image magnification is only 0- 2%
 No spherical and prismatic aberrations
 Minimum (or) No Anisokonia with rapid
return of binocularity
 Normal Peripheral field of vision and
eccentric vision
 Freedom from handling of the optical
devices
 Cosmetically it is well accepted
 Risks and complications may be more
 Initially, the cost is more
 PCO
 CME
 IOL related complications
 Pemeriksaan untuk mengetahui refraction
correction  tajam penglihatan terbaik
 Bergantung pada respon pasien
 Sarana
◦ Chart
◦ Trial lens
◦ Ruang 5/6 meter
Prinsip refraksi subyektif
1.Accomodation– dalam keadaan relaksasi
2.Maximum PLUS, minimum minus
1. Tentukan visus masing masing mata
2. Jika belum 6/6, gunakan pinhole  maju? ~
kelainan refraksi
3. Tambahkan S +0.25
Lanjutkan
Terang dengan lensa
+
+ 0.25

Kabur Ganti dengan

lensa -

Lanjutkan sampai 6/6 atau visus maksimal terbaik

4. Visus maksimal  pinhole  maju 
ingat ASTIGMAT!
5. Setelah astigmat terkoreksi, tambahkan
lensa S(+) 0.25 (Duke Elder test)
6. Cek binocular balance
 Bentuk Astigmatism
◦ Regular
 With the rule
 Against the rule
◦ Irregular

 Tehnik pemeriksaan
◦ Stenopeic Slit
◦ Astigmatic Dial
◦ Jackson Cross Cylinder
• Tempatkan stenoipeic slit pada trial
frame

• Rotasikan pada posisi dimana huruf

tampak paling jelas (principal
meridian)

• Tempatkan sferis (+) atau (-) hingga

tajam penglihatan terbaik diperoleh

•Rotasikan 90°, tempatkan sferis (+)

atau (-) hingga tajam penglihatan
terbaik
+
 - +

- +

less plus
cyl
sphere
1. Tentukan tajam penglihatan terbaik dengan
menggunakan lensa sferis
2. Lakukan fogging dengan menambah lensa sferis
(+) hingga visus sekitar 20/50
3. Pasien diminta menilai garis terhitam dan
tertajam
4. Tambahkan lensa silinder (-) dengan axis tegak
lurus dengan garis terhitam dan tertajam hingga
seluruh garis tampak sama
5. Kurangi lensa sferis (+) atau tambahkan lensa
sferis (-) hingga visus terbaik didapatkan
 Umumnya digunakan
untuk refine axis
silinder dan
kekuatan refraksi
yang telah diperoleh

 Garis merah
menandakan axis
dari minus power
 Garis hitam
menandakan axis
dari plus power
1. Tentukan tajam penglihatan terbaik dengan
menggunakan lensa sferis
2. Gunakan 1 atau 2 baris lebih besar dari
baris terakhir yang bisa dilihat pasien
3. Letakkan handle cross cylinder pada axis
correcting cylinder