EMMETROPIA
& AMETROPIA
MOPB 021
R MOSOLOLI
EMMETROPIA & AMETROPIA
Balanced state of refractive power of the cornea, lens and the axial length of
the eyeball. Parallel rays of light are brought to a focus on the fovea when the
eye is not accommodating
The state of the eye when parallel rays of light are not focused on the fovea
with the accommodation relaxed
MYOPIA
– Parallel rays coming from infinity focus in front of the retina with
accommodation at rest short sightedness
This can come about d2 different mechanisms:
– Axial: increased axial length of the eye ball (commonest)
– Curvatural: increased curvature of cornea or lens or both
– Index: increased refractive index of lens (NS)
– Excessive accommodation: in spasm of accommodation
MYOPIA
HYPERMETROPIA
– Parallel rays coming from infinity focus behind the retina far sightedness
This can come about d2 different mechanisms:
– Axial: shortened axial length of the eye ball
– Curvatural: decreased curvature of cornea or lens or both
– Index: change in refractive index of lens in old age and diabetics
– Positional: posteriorly placed lens
– Absence of crystalline lens (Aphakia)
HYPERMETROPIA
HYPERMETROPIA
Clinical
Classifications
Biological variation
in size/shape of eye
ball
PATHOLOGICAL
SIMPLE
Aphakia, Post Senile, Positional, D2 paralysis of
sublaxation of lens, Aphakia, accommodation (3rd
micro cornea, Consecutive, Orbital N. Palsy)
microphthalmos Mass
CONGENITAL ACQUIRED FUNCTIONAL
HYPERMETROPIA
Facultative
Manifest
Total Absolute
Latent
HYPERMETROPIA
– Total: total amount of refractive error, estimated after complete cycloplegia with
atropine
– Latent: remainder of the hypermetropia which is masked by ciliary tone and
involuntary accommodation. It is the difference between manifest hyperopia and
total hyperopia with cycloplegia
– Manifest: without cycloplegia, corrected by accommodation and plus lens,
Measured by strongest plus lens correction accepted for clear distance vision.
– Facultative: corrected by accommodative effort
– Absolute: Residual part not corrected by patients accommodative effort, measured
by weakest plus lens which give max vision
HYPERMETROPIA
• Small error
• Asymptomatic
No Treatment
• Normal VA
• No muscular imbalance
• Correct if strabismus is presence
Children <6/7yrs
• Correct if error is high
• Marked symptoms- Correct as much total
hyperopia as possible & relieve accomm
Adults • Correct whole of error where there is accomm
spasm
• Undercorrect exophoria, intolerant patients
ASTIGMATISM
– Parallel rays coming from infinity refract
differently in different meridian and
image is formed as a Sturm’s conoid
– Three-dimensional envelope of light
rays formed by an astigmatic lens acting
upon the rays of light from a point
object
– Instead of a single focal point, there’re
two, separated by focal interval. The
distance between the two focal points is
called the Interval of Sturm
ASTIGMATISM
This can come about d2 different mechanisms:
– Corneal: d2 abnormalities in the curvature of cornea
– Lenticular:
• Curvatural: d2 abnormal curvature of the lens
• Positional: d2 oblique placement or tilting of the lens
• Index: d2 difference of refractive index of the lens in different meridia
– Retinal: d2 oblique placement of macula
ASTIGMATISM
Regular Astigmatism: Principle meridians
are perpendicular
With-the-rule: vertical meridian is
steepest
Against-the-rule: horizontal meridian is
steepest
Oblique: steepest curve lies in between
120-150 degrees, and 30-60 degrees
Irregular Astigmatism: Principle meridians
are not perpendicular
ASTIGMATISM
– Simple astigmatism: one focal
line focussed on the retina, the
other infront/behind
– Compound astigmatism: both
focal lines are focussed either
infront or behind
– Mixed astigmatism: focal lines
straddle the retina
ANISOMETROPIA
– Refraction of the two eyes is different
– Small degrees of anisometropia do occur however Larger degrees Amblyopia
– Hyperopic eye is more likely to develop amblyopia
– Accommodation is a binocular function=> the hyperopic eye as a result remains
blurred as the eyes cant accommodate by different amounts
– Myopic patients are less likely to develop amblyopia as both eyes have clear vision,
exception is when one eye is highly myopic
– Anisometropic myopes who have been anisometropic all their lives may tolerate
higher degrees of anisometropia and achieve binocular vision (with more than 2D
difference)
