Scribd
Upload
96 views30 pages

Hyperopia & Presbyopia

The document discusses various refractive errors including hyperopia, presbyopia, and anisometropia. It defines hyperopia as a refractive error where parallel rays of light focus behind the retina, causing blurred distant vision. Presbyopia is defined as the age-related loss of accommodation in the lens, causing difficulties with near tasks. Anisometropia is described as unequal refractive error between the two eyes, which can cause issues like diplopia if not properly corrected.

Uploaded by

Talha UR Rehman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
96 views30 pages

Hyperopia & Presbyopia

The document discusses various refractive errors including hyperopia, presbyopia, and anisometropia. It defines hyperopia as a refractive error where parallel rays of light focus behind the retina, causing blurred distant vision. Presbyopia is defined as the age-related loss of accommodation in the lens, causing difficulties with near tasks. Anisometropia is described as unequal refractive error between the two eyes, which can cause issues like diplopia if not properly corrected.

Uploaded by

Talha UR Rehman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 30

ERRORS OF REFRACTION

HYPEROPIA & PRESBYOPIA


Dr. M. Usman Sadiq
Refraction
Lenses
 POSITIVE or CONVERGING (CONVEX)

 NEGATIVE or DIVERGING (CONCAVE)


Eye as a Camera

Eyelids- Shutter

Cornea- Focusing System


Lens- Focusing System

Iris- Diaphragm

Choroid- Dark Chamber

Retina-Light Sensitive Film


Emmetropia

43 diopters

AXL = 24-25mm

15 diopters

Accomodation at Rest
Ametropia
 A refractive error is present

Myopia • Near Sightedness

Hypermetropia • Far Sightedness

Astigmatism • the curvature of the cornea and/or lens is not spherical


and therefore causes image blur on the retina.

Presbyopia • Loss of accommodative ability of the lens resulting in


difficulties with near tasks
SCENARIO 1
 A 16 year old female presented with gradual
decrease of distant vision in both eyes. On
examination Visual Acuity is 6/12 in right eye and
6/36 in left eye which improved with pinhole test.
What is the diagnosis?
Hypermetropia
Hypermetropia
 Parallel rays of light coming from infinity are
focused behind the retina and image is blurred.
Etiology
 Axial - Decreased AP diameter of Eyeball
 Curvature - Flattening of Cornea, Lens or both
 Index - old age, diabetics under treatment
 Positional - Posteriorly placed lens
 Absence of lens - Aphakia
Total Hypermetropia
 It is the total amount of refractive error, estimated
after complete cycloplegia with Atropine/Cyclopen.

Latent Manifest
Hypermetropia Hypermetropia
Latent Hypermetropia
 Corrected by inherent tone of ciliary muscle
 Usually about 1D
 High in children
 Decreases with age
 Revealed after abolishing tone of ciliary muscle
with atropine/cyclopen.
Manifest Hypermetropia
 Remaining part of total hypermetropia.

FACULTATIVE HYPERMETROPIA
 Corrected by patients accommodative effort

ABSOLUTE HYPERMETROPIA
 Residual part not corrected by patients
accommodative effort
Total
Hypermetropia

Manifest Latent
Hypermetropia Hypermetropia

Facultative Absolute
Hypermetropia Hypermetropia
Symptoms
 Principal symptom is blurring of vision for close work
 Symptoms vary depending upon age of patient &
degree of refractive error
 Asymptomatic
 Asthenopic symptoms
 Defective vision with asthenopia
 Defective vision only
 Convergent Squint
Signs
 VISUAL ACUITY : Defective
 EYEBALL: Small or Normal in size
 CORNEA : may be smaller than normal. There can
be CORNEA PLANA.
 ANTERIOR CHAMBER : may be shallow
 LENS: could be dislocated backwards
 A Scan Ultrasonography (Biometry) will reveal short
axial length
Normal Age Variation
 At birth +2D to +3D Hypermetropia is present.
 Gradually diminished by the age 5-10 years.

COMPLICATIONS
 Amblyopia (LAZY EYE)
 High Hypermetropia
 Unilateral Hypermetropia
Treatment
NONSURGICAL
 Spectacles – Convex Lens (Plus Lens)

 Contact Lens

SURGICAL
 Photorefractive Keratectomy (PRK)

 Laser insitu Keratomileusis (LASIK) Cornea


 Conductive Keratoplasty
PRK v LASIK

PRK LASIK
Young Children (<6 Years)
 Some degree of hypermetropia is physiological so
no correction needed.

 Treatment required if error is high or strabismus is


present.

 In children error tends normally to diminish with


growth so refraction should be carried out every
six month and if necessary the correction should
be reduced, otherwise a lens which is
overcorrecting their error may induce an artificial
myopia.
SCENARIO 2
 A 42 year old male patient comes with complaints
of gradual painless visual loss which is for near.
What is the most probable diagnosis?

PRESBYOPIA
Presbyopia
Presbyopia
 The physiologic loss of accommodation in the eyes in
advancing age.
 Depositition of insoluble proteins in lens in advancing
age leads to decrease in elasticity of lens which
ultimately decreases accommodation.

 Around 45 years of age , accommodation become


less than 3D

 Reading is possible at 40-50 cm

 Difficultly reading fine print , headache , visual fatigue


Increasing Near Point of Accommodation
with Age
Age (years) Distance (cm)

10 7

20 10

30 14

40 20

50 40
Symptoms
 The need to hold reading material at arm's length.
 Blurred near vision
 Headache
 Fatigue
 Symptoms worse in dim light
Treatment
 Spectacles – Covex (Plus) Lens
 Only for Near Work
Anisometropia
 The optic state of eye where both eyes have equal
refraction is known as Isometropia.

 If both eyes have unequal refraction, this condition


is called Anisometropia.
 Refractive correction often leads to different image
sizes on the 2 retinas (aniseikonia) which may lead
to diplopia.

 Aniseikonia depend on degree of refractive anomaly


and type of correction.

 Treatment is done with spectacles (Aniseikonic


Glasses) & Contact Lens.

You might also like