Residen Pengayaan Maret 2016

Gullstrand (Sweddish Prof Ophthalmology)  Nobel

Prize 1911

“Reduced Schematic Eye”

 treat the eye as if it were a single refracting
element
 An ideal spherical surface separating 2 media
of different refractive indices: 1.000 for air and
1.333 for the eye
 “Reduced Schematic Eye”
 anterior corneal surface (P)
 simplified nodal point of
the eye (N), the fovea (F')
 The refractive power of this
reduced schematic eye is
60.0 D
 its principal plane at the
front surface of the cornea.
 Geometric principle :
Retinal Image Height = Nodal Point to Retina Distance
Snellen Letter Height Chart to Eye Distance

Ex: Nodal point to retina : 17mm

Chart to eye distance :20 ft (6000mm)
Height of Snellen chart : 60 mm
↓
Resulting image size on the retina : 0,17 mm.
Axis of The Eye
 Principal line of vision  the line passing through the fixation
target, perpendicular to the corneal plane
 Pupillary axis  is the imaginary line perpendicular to the
corneal surface and passing through the midpoint of the
entrance pupil.
 Visual axis  is the line connecting the fixation target and the
fovea
Axis of The Eye
 Optical axis is the line that best approximates the line
passing through the optical centers of the cornea, lens, and
center of the fovea.
 Angle alpha (a)  the angle between the visual axis and the
optical axis
 Angle kappa (K)  the angle between the pupillary axis and
the visual axis
 Blur Circles
 In myopia, the retinal image is in the composite of all
blur circles
• The size of each  proportional to diameter pupil
Visual Acuity
 The minimum legible threshold  point at which a patient's
visual ability cannot further distinguish progressively
smaller letters or forms from one another;
• The minimum visible threshold  the minimum brightness
of a target at which the patient can distinguish the target
from the background
 The minimum separable threshold  the smallest visual
angle formed by the eye and 2 separate objects at which a
patient can discriminate them individually
 Vernier acuity  the smallest detectable amount of
misalignment of 2 line segments
Snellen Visual Acuity
Bailey Lovie Charts
Contrast Sensitivity
 A measure of the ability of the visual system to distinguish
an object against its background
 Target :
 Sufficiently large to be seen
 High enough contrast with its background
 The higher the contrast  the easier the optotype is to
decipher
 I min : Ilumination of object
I max : Illumination of background
Control Sensitivity Function
 Contrast threshold
Minimum resolvable contrast
 Contrast sensitivity
Reciprocal of contrast threshold
 Changes of contrast sensitivity as a function of spatial
frequency of targets  Contrast Sensitivity Function (CSF)
 Luminance must be kept constant
 Mean luminance  shape of the normal CSF
 ↓ luminance  low spatial frequency falloff  shift to lower
frequencies
 Normal room illumination = 30-70 foot Lamberts
Condition Affect Contrast
Sensitivity
 Corneal Pathology  distortion/edema
 Lens Changes  incipient cataract
 Retinal Pathology  RP, central serous retinopathy,
macular degenerations
 Glaucoma  loss in midrange
 Retrobulbar Optic Neuritis  notch-type loss
 Amblyopia  generalized attenuation of the curve
 Pupil size
The Vistech contrast sensitivity test
The Pelli-Robson Letter Chart
Refractive States of The Eye
 The focal point concept
 The location of the image formed by an object at optical
infinity through a nonaccomodating eye
 The far point concept
 The far point is the point in space that is conjugate to
the fovea of the nonaccomodating eye
Refractive States of The Eye
 Emmetropia
Ametropia
• The axial length increases
axial (myopia) / decreases
(hyperopia)

• The refractive power of

optical elements
refractive increases (myopia) /
decreases (hyperopia)
Myopia
 Results from an eye having excessive refractive
power for its axial length and light rays focus in
front of the retina
 Similarly, the far point of the eye images in front
of the eye, between the cornea and optical
infinity
Hyperopia
 Results when the eye has insufficient refractive
power for its axial length and attempts to focus
light behind the retina
 The far point of the eye (virtual point) is located
behind the retina
Astigmatism
2 focal lines
 Variations in the curvature of the cornea or lens at
different meridians  light rays do not focus to a single
point
Simple myopic astigmatism
• 1 focal line lies in front of the
retina
• The other is on the retina

Compound myopic
astigmatism
• Both focal lines lie in front of the
retina
Astigmatism..
Simple hyperopic astigmatism
• 1 focal line lies behind the retina
• The other is on the retina

Compound hyperopic astigmatism

• Both focal lines lie behind the retina

Mixed astigmatism
• 1 focal line lies in front of retina
• The other lies behind the retina
Regular Astigmatism
- The principle meridians (or axes) of astigmatism have
constant orientation at every point across the pupil
- The amount of astigmatism is the same at every point

Correctable with cylindrical spectacle lenses

Regular Astigmatism
With-the-rule astigmatism

• The vertical meridian is steepest

• Children >>
• A correcting plus cylinder should be used at or near axis 90o

Against-the-rule astigmatism

• The horizontal meridian is the steepest

• Older adults >>
• A correcting plus cylinder should be used at or near axis 180o

Oblique astigmatism

• The principal meridians lie near 45o and 135o

Irregular Astigmatism
 The orientation of the principal meridians or the
amount of astigmatism changes from point to point
across the pupil.
Binocular state of the eye
 Single vision is the ability to focus the eye on one thing
and then combine the two shadows into one

 Binocular vision disorders:

- Anisometropia refers to any difference in the
spherical
equivalents between the 2 eyes
- Aniseikonia unequal image size, can be due to a
difference in the shape of the images formed in the 2 eyes
- Unilateral afakia extreme example of hyperopic
anisometropia arising from refractive ametropia
Accomodation
Mechanism by which the eye change
refractive power by altering the shape of its
crystalline lens
Parasympathetic stimulates ciliary muscle
to contracts

Zonular fibers relax

Tension on lens capsule ↓ & lens become

more convex
Changes With Accomodation
With Accomodation Without Accomodation
Ciliary muscle action Contraction Relaxation
Ciliary ring diameter Decreases Increases
Zonular tension Decreases Increases
Lens shape More spherical Flatter
Lens equatorial diameter Decreases Increases
Axial lens thickness Increases Decreases
Central anterior lens Steepens Flattens
capsule curvature
Central posterior lens Minimal change Minimal change
capsule curvature
Lens dioptric power Increases Decreases
Presbyopia
Crystalline lens
becomes more sclerotic
Loss of accomodation
and resists deformation
due to aging
when the ciliary muscle
contracts.

Measurement of lens
Increasing lens rigidity
position & curvature in
&sclerosis with age
the intact eye
 • Birth to 6th years

• Axial length grows ± 5 mm

• High prevalence of myopia in infants

 Most children actually emmetropic

 2% incidence of myopia at 6 years
 Emmetropization mechanism
 Lens power

Determines
Corneal individual’s Axial
power refractive length
status

Change Anterior
continuously as chamber
depth
the eye grows
 1st few
Born with 3.0 D of
month→increase
hyperopia
slightly

End of 2nd
year→anterior 1 year old→declines to
segment attains adult 1.0 D of hyperopia
proportion

Age 3-14 years →

Curvatures of corneal power
refracting surface decreased 0.1-0.2 D +
continue to change lens power decreased
1.8 D
 Complexities and "imperfections" - compared with
mathematical ideals-
 Simplifications and approximations  make models
easier to understand
 Ex. anterior surface of the cornea is assumed to be
spherical, but the actual anterior surface tends to
flatten toward the limbus
 the center of the crystalline lens is usually de centered
with respect to the cornea and the visual axis of the
eye.
Modulation Transfer Function
(MTF)
 Spatial frequency
 the number of light bands per unit length or per unit
angle

 Snellen acuity 100% contrast = 30 cycle per degree

Near acuity test
LEA CHART