OPTICS AND

REFRACTIVE
ERRORS
MSHANGILA MD, M.MED

AJUCO MD3
OPTICS
• Light
• Reflection of Light; Laws of Reflection of Light
• Refraction of Light; Laws of Refraction
• Types of Lenses;

- Spherical Lenses; Convex ; Concave

- Cylindrical Lenses
• Uses of Lenses
OPTICS
• LIGHT
• Light is the visible portion of the electromagnetic radiation spectrum. It lies between
ultraviolet and infrared portions, from 400 nm at the violet end of the spectrum to 700
nm at the red end.
• The white light consists of seven colours denoted by VIBGYOR (violet, indigo, blue,
green, yellow, orange and red).
• Reflection of light
• Reflection of light is a phenomenon of change in the path of light rays without any
change in the medium.
• The light rays falling on a reflecting surface are called incident rays and those reflected
by it are reflected rays. A line drawn at right angle to the surface is called the normal.
OPTICS
• Laws of reflection are:
• 1. The incident ray, the reflected ray
and the normal at the point of
incident, all lie in the same plane.
• 2. The angle of incidence is equal to
the angle of reflection.
OPTICS
• Refraction of light
• Refraction of light is the phenomenon of change in the path of light, when it goes from
one medium to another. The basic cause of refraction is change in the velocity of light
in going from one medium to the other.
OPTICS
• Laws of refraction are :

1. The incident and refracted rays are on

opposite sides of the normal and all the three
are in the same plane.

2. The ratio of sine of angle of incidence to the

sine of angle of refraction is constant for the
part of media in contact. This constant is
denoted by the letter n and is called ‘refractive
index’ of the medium 2 in which the refracted
ray lies with respect to medium 1 (in which the
incident ray lies), i.e., sin i/ sin r = n2. When
the medium 1 is air (or vaccum), then n is
called the refractive index of the medium 2.
Laws of refraction. N1 and N2 (normals); I
This law is also called Snell’s law of refraction.
(incident ray); i (angle of incidence); R (refracted
ray, bent towards normal); r (angle of refraction); E
(emergent ray, bent away from the normal).
OPTICS
• Lenses - A lens is a transparent refracting medium, bounded by two surfaces which form a part of
a sphere (spherical lens) or a cylinder (cylindrical or toric lens).
• Cardinal data of a lens

1. Centre of curvature (C) of the spherical lens is the centre of the sphere of which the refracting
lens surface is a part.

2. Radius of curvature of the spherical lens is the radius of the sphere of which the refracting surface
is a part.
OPTICS
3. The principal axis (AB) of the lens is the line joining the centres of curvatures of its
surfaces.

4. Optical centre (O) of the lens corresponds to the nodal point of a thick lens. It is a point
on the principal axis in the lens, the rays passing from where do not undergo deviation. In
meniscus lenses the optical centre lies outside the lens.

5. The principal focus (F) of a lens is that point on the principal axis where parallel rays
of light, after passing through the lens, converge (in convex lens) or appear to diverge (in
concave lens).
OPTICS
6. The focal length (f) of a lens is the distance between the optical centre and the principal focus.

7. Power of a lens (P) is defined as the ability of the lens to converge a beam of light falling on the
lens. For a converging (convex) lens the power is taken as positive and for a diverging (concave)
lens power is taken as negative. It is measured as reciprocal of the focal length in metres i.e. P =
1/f. The unit of power is dioptre (D). One dioptre is the power of a lens of focal length one metre.
OPTICS
Types of lenses
Lenses are of two types: the spherical and cylindrical (toric or astigmatic).

Basic forms of convex lenses Basic forms of concave lenses Cylindrical lenses
A- Convex
A- Biconvex A- Concave B- Concave
B- Plano-Convex B- Plano-Concave
C- Concavo-Convex C- Convexo-Concave
OPTICS OF THE EYE
• As an optical instrument, the eye is well compared to a camera with retina acting as a
unique kind of 'film'.

• The focusing system of eye is composed of several refracting structures which include
the cornea, the aqueous humour, the crystalline lens, and the vitreous humour.
These constitute a homocentric system of lenses, which when combined in action form
a very strong refracting system of a short focal length.

• The total dioptric power of the eye is about +60 D out of which about +44 D is
contributed by cornea and +16 D by the crystalline lens.
ERRORS OF REFRACTION
• Emmetropia (optically normal eye)

- a state of refraction, where in the parallel rays of light coming from infinity are focused
at the sensitive layer of retina with the accommodation being at rest
ERRORS OF REFRACTION(cont)
• Ametropia (a condition of refractive error)

- a state of refraction, when 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 meridians.
• The ametropia includes myopia, hypermetropia and astigmatism.
• The related conditions aphakia and pseudophakia.
ERRORS OF REFRACTION(cont)
• HYPERMETROPIA
• Hypermetropia (hyperopia) or long-sightedness is the refractive state of the eye wherein
parallel rays of light coming from infinity are focused behind the retina with
accommodation being at rest.
• Thus, the posterior focal point is behind the retina, which therefore receives a blurred
image.
ERRORS OF
REFRACTION(Hypermetropia cont)
• Etiology

• Hypermetropia may be axial, curvatural, index, positional and due to absence of lens.

• 1. Axial hypermetropia- commonest form. In this condition the total refractive power of eye is normal but
there is an axial shortening of eyeball. 1–mm shortening of the anteroposterior diameter of the eye results in 3
dioptres of hypermetropia.

• 2. Curvatural hypermetropia- the curvature of cornea, lens or both is flatter than the normal resulting in a
decrease in the refractive power of the eye. About 1 mm increase in radius of curvature results in 6 dioptres of
hypermetropia.

• 3. Index hypermetropia occurs due to decrease in refractive index of the lens in old age. It may also occur in
diabetics under treatment.

• 4. Positional hypermetropia results from posteriorly placed crystalline lens.

• 5. Absence of crystalline lens either congenitally or acquired (following surgical removal or posterior
dislocation) leads to aphakia — a condition of high hypermetropia.
ERRORS OF
REFRACTION(Hypermetropia cont)
• Clinical picture

• Symptoms

• Vary depending upon the age of patient and the degree of refractive error.

1. Asymptomatic.

2. Asthenopic symptoms. These include: tiredness of eyes, frontal or fronto-temporal headache, watering and
mild photophobia. Especially associated with near work and increase towards evening.

3. Defective vision with asthenopic symptoms.

• When the amount of hypermetropia is such that it is not fully corrected by the voluntary accommodative efforts,
then the patients complain of defective vision which is more for near than distance and is associated with
asthenopic symptoms due to sustained accommodative efforts.

• 4. Defective vision only. When the amount of hypermetropia is very high, the patients usually do not
accommodate (especially adults) and there occurs marked defective vision for near and distance.
ERRORS OF REFRACTION(cont)
• Treatment
• A. Optical treatment. Basic principle of treatment is to prescribe convex (plus) lenses,
so that the light rays are brought to focus on the retina

• Modes of prescription of convex lenses

- Spectacles
- Contact lenses; unilateral hypermetropia (anisometropia). For cosmetic reasons
ERRORS OF REFRACTION(Myopia
cont)
• MYOPIA
• Myopia or short-sightedness is a type of refractive error in which parallel rays of light
coming from infinity are focused in front of the retina when accommodation is at rest.
ERRORS OF REFRACTION(Myopia
cont)
• Etiological classification

1. Axial myopia results from increase in 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 is produced by anterior placement of crystalline lens in the eye.

4. Index myopia results from increase in the refractive index of crystalline lens associated
with nuclear sclerosis.

5. Myopia due to excessive accommodation occurs in patients with spasm of

accommodation.
ERRORS OF REFRACTION(Myopia
cont)
• Clinical varieties of myopia
• 1. Congenital myopia
• 2. Simple or developmental myopia
• 3. Pathological or degenerative myopia
• 4. Acquired myopia which may be: (i) post-traumatic;
• (ii) post-keratitic; (iii) drug-induced, (iv)
• pseudomyopia; (v) space myopia; (vii) night
• myopia; and (viii) consecutive myopia.
ERRORS OF REFRACTION(Myopia
cont)
• Clinical picture

• Symptoms

• Poor vision for distance (short-sightedness) - main symptom.

• Asthenopic symptoms may occur in patients with small degree of myopia.

• Signs

• Prominent eyeballs. The myopic eyes typically are large and somewhat prominent.

• Fundus is normal; rarely temporal myopic crescent may be seen.

• Diagnosis is confirmed by performing retinoscopy

ERRORS OF REFRACTION(Myopia
cont)
• Treatment of myopia
• 1. Optical treatment of myopia constitutes prescription of appropriate concave lenses, so
that clear image is formed on the retina
ERRORS OF REFRACTION(cont)
• ASTIGMATISM
• Astigmatism is a type of refractive error wherein the refraction varies in the different
meridia.
• Consequently, the rays of light entering in the eye cannot converge to a point focus but
form focal lines.
ERRORS OF
REFRACTION( Astigmatism cont)
Types of astigmatism :

simple myopic (A);

simple
hypermetropic (B);

compound myopic (C);

compound
hypermetropic (D);

and mixed (E).

ERRORS OF
REFRACTION( Astigmatism cont)
• Treatment

1. Optical treatment of regular astigmatism comprises the prescribing appropriate cylindrical lens, discovered
after accurate refraction.

i. Spectacles with full correction of cylindrical power and appropriate axis should be used for distance and near
vision.

ii. Contact lenses.

2. Surgical correction of astigmatism is quite effective

ERRORS OF REFRACTION(cont)
• PRESBYOPIA

• Pathophysiology and causes

• Presbyopia (eye sight of old age) is not an error of refraction but a condition of physiological insufficiency of
accommodation leading to a progressive fall in near vision.

• ANISOMETROPIA

• The optical state with equal refraction in the two eyes is termed isometropia. When the total refraction of the
two eyes is unequal the condition is called anisometropia.

• 2 percent difference in the size of the two retinal images. A difference up to 5 percent in retinal images of two
eyes is well tolerated. In other words, an

• anisometropia up to 2.5 is well tolerated

• However, if it is more than 4 D, it is not tolerated and is a matter of concern.