ERRORS OF REFRACTION-1 FOR BOPT 1 YEAR
EMMETROPIA
AMETROPIA
HYPERMETROPIA
MYOPIA
Ms. Khushi Kansal
Assistant Professor
Department of Paramedical Sciences
Swami Vivekanand Subharti University
EMMETROPIA
• Optically normal eye
• Defined as a state of refraction wherein the parallel rays of light
coming from infinity are focused at the sensitive layer of retina with
the accommodation being at rest.
Ametropia
• A condition of refractive error
• Defined as a state of refraction wherein the parallel rays of light
coming from infinity (with accommodation at rest) are focused either
in front or behind the sensitive layer of retina, in one or both the
meridian.
• Ametropia includes:
• Myopia
• Hypermetropia
• Astigmatism
Components of Ametropia
The overall refractive state of the eye is determined by four
components:
Corneal power (ranges from 40 to 45 D, mean 43.0 D)
Anterior chamber depth (mean 3.4mm)
Crystalline lens power (ranges from 15 to 20 D in its non accommodative
state)
Axial length (mean 24 mm)
HYPERMETROPIA
• Long-sightedness
• Refractive state of the eye wherein the parallel rays of light coming
from infinity are focused behind the retina with the accommodation
being at rest.
AETIOLOGICAL TYPES OF
HYPERMETROPIA
1. Axial hypermetropia: In this condition, the total refractive power of
the eye is normal, but there is an axial shortening of the eyeball.
• About 1mm shortening of the anteroposterior diameter of the eye results in
3D of hypermetropia.
2. Curvatural hypermetropia: in this, curvature of the cornea, lens or
both is flatter than the normal, resulting in a decrease in the
refractive power of eye.
• About 1mm increase in radius of curvature results in 6D of hypermetropia.
3. Index hypermetropia: occurs due to change in refractive index of
the lens in old age.
4. Positional hypermetropia: results from posteriorly placed
crystalline lens (congenitally or following trauma).
5. Absence of crystalline lens
6. Consecutive hypermetropia:
• Overcorrected myopia after refractive surgery
• Underpowered intraocular lens (IOL) in cataract surgery and refractive lens
exchange (RLE).
CLINICAL TYPES OF
HYPERMETROPIA
1. Simple hypermetropia: commonest form
• It results from normal biological variations in the development of the eyeball.
• May be hereditary
2. Pathological hypermetropia:
a) Congenital pathological hypermetropia: Microphthalmos, Microcornea,
Congenital posterior subluxation of the lens and congenital aphakia.
b) Acquired pathological hypermetropia : Senile hypermetropia, index,
positional (due to trauma), aphakia, consecutive.
3. Functional hypermetropia: results from paralysis of
accommodation.
Nomenclature of components of hypermetropia
depending upon the effect of accommodation
TOTAL HYPERMETROPIA
Total amount of refractive error which is estimated after complete
cycloplegia with atropine.
It consist of latent and manifest hypermetropia
1. Latent: the amount of hypermetropia (about 1D) which is corrected by the
inherent tone of ciliary muscle.
2. Manifest: is the remaining portion of total hypermetropia which is not
corrected by the ciliary tone.
• Facultative hypermetropia: which can be corrected by the patient’s accommodative
effort.
• Absolute hypermetropia: which can not be corrected
SYMPTOMS AND SIGNS OF
HYPERMETROPIA
SYMPTOMS:
Asthenopia symptoms
Defective vision
SIGNS:
Visual acuity (varies with the degree of hypermetropia)
Size of eyeball may be normal or may appear small
Cornea may be slightly smaller
Anterior chamber is comparatively shallow
TREATMENT OF HYPERMETROPIA
CONVEX LENS
• Spectacle (convex lens)
• Contact lens (convex lens)
• Surgical treatment (RLE, LASIK, PRK & ICL).
MYOPIA
• Short-sightedness
• Refractive state of the eye wherein the parallel rays of light coming
from infinity are focused in front of the retina with the
accommodation being at rest.
AETIOLOGICAL TYPES
1. Axial myopia: results from increase on anteroposterior length of
the eyeball. It is the commonest form.
2. Curvatural myopia: occurs due to increased curvature of the
cornea, lens or both.
3. Positional myopia: occurs due to anterior placement of crystalline
lens in the eye.
4. Index myopia: results from increase in refractive index of crystalline
lens associated with nuclear sclerosis.
5. Myopia due to excessive accommodation occurs in patients with
spasm of accommodation.
CLINICAL TYPES OF MYOPIA
1. Congenital myopia
2. Simple or development myopia
3. Pathological or degenerative myopia
4. Acquired myopia
1. Congenital myopia
• Associated with an increase in axial length and overall globe size.
CLINICAL FEATURES
• Present since birth
• High degree of error
• Anisometropia
• Associations: congenital convergent squint, cataract, microphthalmos,
aniridia, megalocornea and congenital separation of retina.
TREATMENT
• Full cycloplegic refractive error including any astigmatic correction should be
prescribed.
II. SIMPLE MYOPIA
• Also known as physiological or developmental myopia.
• Not associated with any disease of the eye.
• Occurs at school going age (usually between 8 to 12 years of age).
• Also called school myopia.
• Magnitude of error: usually the error does not exceed 6-8D.
AETIOLOGY
• Results from normal biological variation in the development of eye.
• Factors associated with simple myopia are as follows:
Axial type of simple myopia
Curvatural type of simple myopia (due to underdevelopment of the eyeball)
Role of genetics
Role of diet
Theory of excessive near work
SYMPTOMS
• Poor vision for distance
• Half shutting of the eyes
• Asthenopic symptoms
• Change in physiological outlook (more indoor activities, become introvert and
develop little interest in outdoor activities).
SIGNS
• Predominant eyeballs
• Anterior chamber is slightly deeper than normal
• Pupils are large
• Fundus is normal; rarely temporal myopic crescent may be seen
• Magnitude of error: usually the error does not exceed 6-8D.
III. PATHOLOGICAL MYOPIA
• Degenerative/progressive myopia
AETIOLOGY
• Rapid axial growth of the eyeball which is outside the normal biological
variations of development.
• Heredity
• General growth process
SYMPTOMS
• Defective vision
• Floaters
• Night blindness
SIGNS
• Prominent eyeballs
• Anterior chamber is deep
• Pupils are large
• Magnitude of error: increases by as much as 4 D yearly and usually stabilizes
at about the age of 20, or may progress until mid-30s and results in 10-20d,
which may even progress to 30-40 D.
SIGNS
• Fundus examination:
Optics disc appears large and pale, myopic crescent is present.
Degenerative changes in retina and choroid.
Posterior staphyloma
Degenerative changes in vitreous
IV. ACQUIRED MYOPIA
1. Index myopia: nuclear sclerosis, diabetic myopia
2. Curvatural myopia: increase in corneal (keratoconus) and lenticular
curvature.
3. Positional myopia: due to anterior subluxation of lens.
4. Consecutive myopia: overcorrecting IOL, surgical overcorrection of
hypermetropia.
5. Drug-induced myopia: cholinergic drugs, steroid-induced,
sulphonamides
6. Pseudo myopia: produced in condition such as excessive
accommodation and spasm of accommodation.
TREATMENT OF MYOPIA
• Optical treatment: concave spectacles and contact lenses
• Surgical treatment
• Preventive measures:
Atropine
Pirenzepine
Balanced diet
Genetic counselling
• Visual hygiene
• Low-vision aids
ASTIGMATISM
• It is a type of refractive error in which the rays of light entering the
eye can not converge to a point focus but form focal lines.
• There are two types of astigmatism : Regular and irregular
REGULAR ASTIGMATISM
• The astigmatism is regular when the refractive power changes
uniformly from one meridian to another (there are two principal
meridian).
TYPES OF REGULAR ASTIGMATISM
WITH-THE-RULE ASTIGMATISM
The two principal meridian are placed at right angles to one another,
but the vertical meridian is more curved than the horizontal.
Correction require the concave cylinders at 180 +- 20 or convex
cylindrical lens at 90 +-20
AGAINST THE RULE ASTIGMATISM
Horizontal meridian is more curved than the vertical meridian.
Correction of this astigmatism will require the prescription of convex
cylindrical lens t 180+-20 or concave cylindrical lens 90 +- 20 axis
OBLIQUE ASTIGMATISM
where the two principal meridians are not the horizontal and vertical,
though these are at right angles to one another (e.g. 45 and 135
degree).
Oblique astigmatism found to be symmetrical (e.g. cylindrical lens
required at 30 degree in both eyes) or complementary (e.g. cylindrical
lens required at 30 in one eye and at 150 in the other eye).
BI-OBLIQUE ASTIGMATISM
The two principal meridian are not at right angle to each other, e.g. one
may be at 30 degree and the other at 100 degree.
CLINICAL FEATURES
• Blurring of vision
• Asthenopia symptoms
• Tilting of the head
• Half-closure of the lids
• Burning and itching
IRREGULAR ASTIGMATISM
• It is characterized by an irregular change of refractive power in different
meridian. There are multiple meridian which admit no geometrical analysis
CLINICAL FEATURES
Defective vision
Distortion of objects
Polyopia
TREATMENT
Optical treatment: contact lens
Surgical treatment
TREATMENT
• Optical treatment
• Cylindrical spectacle
• Contact lens or Toric contact lens
• Surgical treatment
