Refractive errors
Hyperopia
Myopia
Astigmatism
Aphakia
Presbyopia
Emmetropia (normal)
Myopia (short-sighted)
Myopia (short-sighted)
-ve lens
Symptoms and signs of myopia
Blurred distance vision
Near vision clear
Vision worse at twilight / night
Patients tend to “screw up “ eyes when
looking into the distance (pinhole effect)
Frontal headaches
Hyperopia (long-sighted)
Refractive Errors
Hyperopia (long-sighted) – eye accommodates
Refractive Errors
Hyperopia (long-sighted)
+ve lens
Symptoms of hyperopia
Symptoms of hyperopia depend on age
Young people can often accommodate to
overcome hyperopia
Older people cannot
Symptoms and signs of hyperopia
> +3.00 D < 25 years old
Transient blurring of distance vision when tired
Transient or continuous blurring of near vision
Eye strain, headaches, reduced span of
attention particularly for reading
Sometimes there may be Convergent
Strabismus
Symptoms and signs of hyperopia
25-35 years old
Insufficient accommodation to overcome
hyperopia
Blurring of distance vision particularly when
tired
Blurring of near vision
Eye strain, headaches, reduced span of
attention particularly for reading
Symptoms and signs of hyperopia
> 35 years old
Insufficient accommodation to overcome
hyperopia
Poor distance vision
Very blurred near vision
Astigmatism
Astigmatism
Astigmatism is usually caused by a regular
variation in the curvature of the cornea
A simplified image of this is the difference
between a football and a rugby ball (or
American Football)
The two principal curves are at right
angles (90 degrees) to each other
It can sometimes be caused by the
crystalline lens
Symptoms and signs of astigmatism
Blurred distance and near vision
Vertical lines may be clearer than horizontal
lines or vice versa
Patients tend to “screw up “ eyes when
looking at fine detail (pinhole effect)
Frontal headaches
Accommodation
Accommodation
A Presbyope cannot accommodate
adequately for near tasks
Symptoms and signs of presbyopia
Distance vision clear but blurred near vision
Occurs at 35+ years of age
Patient holds near object at arm’s length
Patient requires “good light” to see to read
Frontal headaches and eyestrain
Refractive Errors
Over 35 years - not enough accommodation
Presbyopia
Over 35 years - not enough accommodation
Presbyopia +ve lens
Aphakia
A patient who has had the crystalline lens
removed is “aphakic”
Require high positive lens to correct
>+10.00DS
Patient has very blurred vision at all distances
No accommodation
Unaided vision can give an estimate of
the size of refractive error
VISION Best SPHERE
6/5 Plano (zero)
6/6 0.25
6/9 0.50
6/12 0/75
6/18 1.00
6/24 1.50
6/36 2.00
6/60 2.50
<6/60 3.00 or over
Estimated Reading addition according
to age
Age(yrs) Addition
35-45 +1.50 DS
46-50 +2.00 DS
>51 +2.50 DS
Summary Chart
Ametropia Distance Near Vision Correcting
Vision lens
Myopia Poor Good Negative
Hyperopia
-Young Good Good (poss Positive
eyes strain)
-old Fair Poor
Presbyopia - Poor Positive
Aphakia Very poor Very very High
poor positive
