Scribd
Upload
19 views21 pages

Accommodation

Uploaded by

70143099
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
19 views21 pages

Accommodation

Uploaded by

70143099
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 21

ACCOMMODATION

Accommodation

• A mechanism by which we can focus the


diverging rays coming from a near object
on the retina in bit to see clearly. In it
there is increase in the power of the lens
• Contraction of ciliary muscle
Ocular structures involve in
accommodation
• Change in the form of lens brought by
contraction of ciliary muscle.
• Zonule fibers relaxed
• Lens in globular form
at rest, radius of curvature
of lens is 11mm and post-
6mm . In accommodation
Front becomes 6 – 3 mm
From periphery to central
Posterior remains same
Ocular changes in
accommodation
• Slackening of zonules.
• Changes in lens curvature
• Anterior pole of the lens moves forward
• The lens sinks down
• Pupillary constriction and convergence of
the eyes
• The choroid stretched forward by the
ciliary muscle contraction.
Near point(punctum
proximum)
• Near point of accommodation.
The nearest point at which small objects
can be seen clearly is called near point or
punctum proximum
• Far point
The distant point is called far point or
punctum remotum
Range of accommodation
• Distance between near point and far point
is called range of accommodation
• Amplitude of accommodation
• The difference between dioptric power
needed to focus at near point (P) and to
focus at far point (R) is called amplitude
of accommodation (A) so A=P-R
In emmetropic eye far point is at infinity
and near point varies with age
• 7cm_at age of 10 years
• 25cm _at 40 years of age
• 33cm _ at 45 years of age
Measurement of NPA
• RAF rule
• Measured in cm
• One side of bar gives in D values shows
amplitude of accommodation e.g. pt
reports the point appears blurred at 25cm
the dioptric marking will show +4D and
the age 40 years
Anomalies of accommodation
1. Deficient accommodation
a- Physiological (presbyopia)
b- Pharmacological (cycloplegia)
c- Pathological
2. Increased accommodation
a- Excessive accommodation
b- Spasm of accommodation
PRESBYOPIA
It is not an error of refraction but a
condition of physiological
insufficiency of accommodation due
to reduced amplitude, leading to
progressive fall in near vision
Cause
Power of lens decrease with age due to
i. Decrease in elasticity of lens capsule
ii. Increase in size and hardness of lens
iii. Ciliary muscle power decrease
Causes of premature presbyopia
• Uncorrected hypermetropia
• Premature sclerosis of lens
• Prsenile weakness of ciliary muscles
• Chronic simple glaucoma
Symptoms
• Difficulty in near vision
• Asthenopic symptoms due to fatigue of
muscles
• Intermittent diplopia at near
Signs

• Reduced amplitude of accommodation in


order to work comfortably at the habitual
reading distance.
• Increase in near point of accommodation
Treatment
Optical correction of presbyopia by convex
lens
Rough estimate for presbyopic add
according to age
• 45 years : +1 to +1.25D
• 50 years : +1.50 to +1.75D
• 55 years : +2.00 to +2.25
• 60 years : +2.50 to +3.00
Basic principles for correction of
presbyopia
• Always correct refractive error for
distance
• Find out presbyopic correction needed in
each eye and add it to distance correction
• Near point should be according to the
profession of the pt
• Weakest convex lens with which an
individual can see clearly and comfortably
with both eyes
• Additional correction for intermediate
Spectacles
▫Single vision reading glasses
▫Multifocal lenses containing near Add
 Bifocal lenses
 Trifocal lenses
 Progressive addition lenses
Contact lenses

▫ Single vision contact lenses with glasses


▫ Monovision contact lenses
▫ Bifocal and multifocal contact lenses
Amplitude of Accommodation and
Age (Donder’s Table)
Age (years) Amplitude (D) Age (years) Amplitude (D)
10 14 45 3.5
15 12 50 2.5
20 10 55 1.75
25 8.5 60 1
30 7 65 0.5
35 5.5 70 0.25
40 5 75 00

You might also like