Optics and Refraction Dr.

Arianne Rose Dumdum-Cambronero

Date: 09/21/2022
Time: 7:30-9:30 AM
2.4
VERGENCE OF LIGHT
I. GEOMETRIC OPTICS
A. Basic principles of geometric optics  The relationship of at least 2 light rays
a. Refraction of Light Rays striking or emanating from the eye.
b. Vergence of Light Negative vergence: light is
c. Prisms
d. Spherical Lenses
e. Cylindrical Lenses
F. Sphero-Cylindrical Lenses
II. ERRORS OF REFRACTION
A. Accommodation
B. Presbyopia
C. Myopia
D. Hyperopia
E. Astigmatism II. CATARACT SURGERY
III. CORRECTION OF REFRACTIVE ERRORS HISTORY
A. Spectacle lens for Myopic correction  During World War II fighter pilots had
B. Spectacle lens for Hyperopic correction
C. Refractive surgery: LASIK pieces of plexiglass shrapnels lodged in
IV. METHODS OF REFRACTION the eyes and the some would literally
get inside their eyes. This plastic did not
cause inflammation or infection. It did
not develop hypersensitivity; it did not
I. GEOMETRIC OPTICS react
 Consist of all the events that occur from  That makes the doctors wonder that
the moment light stimuli strikes the eye maybe the eye is capable of accepting
and gets focused on the retina. foreign materials without causing any
 The principal basis of geometric optics is reaction and that starts the beginning of
the transmission and bending of the modern lens implants.
direction of travel of light rays—this is  This was how it started, this was how
called refraction. they developed the idea that instead of
just pulling out the cataract/lens why not
 1. Refraction of Light Rays replace with an artificial lens.
 2. Vergence of Light  Principle of Cataract Surgery is removal
 3. Prisms of the affected lens and replacing it with
 4. Spherical Lenses a clear transparent lens
 5. Cylindrical Lenses
 6. Sphero-Cylindrical Lenses
EXTRACAPSULAR CATARACT
REFRACTION OF LIGHT RAYS EXTRACTION
 Light when passing through a liquid or  Requires a relatively large
solid transparent media is slightly circumferential incision 8-10mm to which
slowed in its speed depending on the the lens is extracted.
optical density of the medium.  Posterior capsule is left intact because it
 The relative unit of measurement for this will serve as a sort of hammock for the
property is called “index of refraction”. new lens
 An incision is made at the limbus or in
the peripheral cornea, either superiorly
or temporally. An opening is formed in
the anterior capsule (anterior
capsulorhexis), and the nucleus and
cortex of the lens are removed. An
Assessor: Mayo
Group 9 - Rivas, Dionisio, Marterio
P a g e 1|5
 intraocular lens can then be placed in
the empty “capsular bag,” supported by
the intact posterior capsule.
 After a ‘can opener’ capsulotomy was
performed with a bent needle or
cystitome the lens nucleus was
expressed.
 the incision was then sutured, A B
sometimes inducing considerable
corneal astigmatism which slowed
recovery as the stitches often required
removal at about 3 month
postoperatively.

PHACOEMULSIFICATION
 Aphakia a person who has no lens C D
 The principles have remained the same
but the technology has gotten better and
more expensive
 Phakos is Greek word for lens
 The principles have remained the same
but the technology has gotten better and
more expensive
 Phacoemulsification means
emulsification of liquefaction of the E F
natural lens of the eye Four quadrant phacoemulsification
 An instrument called the phaco A- Corneal incision
handpiece to carve up the lens nucleus. B- Capusolorrhexis
 This machine oscillates at ultrasonic C- Hydrodissection
speeds and allows us to groove ridges D- Nucleus is grooved
into the lens. E- Nucleus is cracked
 It emulsifies the cataract after which the F- Each nuclear quadrant is emulsified and
aspiration unit takes over and aspirates aspirated
the emulsified material

Assessor: Mayo
Group 9 - Rivas, Dionisio, Marterio
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  Can be done in an outpatient setting

A B

C D

E F
Completion of Phacoemulsification
A- Cortical lens matter is pulled centrally
and aspirated
B- Viscoelastic is injected into the capsular Small Incision Manual Cataract Surgery
bag A- Anterior chambered is entered
C- Incision is enlarged B- Capsuloohexis
D- Intraocular lens (IOL) is inserted C- Prolapse of nucleus into anterior
E- IOL dilated chamber
F- Sidepports are hydrated D- Expression of nucleus
E- Cortical cleanup
SMALL INCISION CATARACT SURGERY F- IOL in place
 Manual sutureless small incision
cataract surgery (MSICS) is based on POSTOPERATIVE CARE
the traditional nuclear expression form  Mature cataract in place
of extracapsular cataract extraction, in  No ROR
which the nucleus is removed intact, but  After the operation you have a very nice
utilizing a small incision. The cortex is red orange reflex
removed by manual aspiration. MSICS  Intraocular lens is in place and is at the
may be indicated for dense cataracts back with the posterior capsule is intact
unsuitable for phacoemulsification.  Inject the miotic so the pupil will constrict
 Advantage of small-incision surgery;  So makakita na ang patient
 more controlled operating conditions  Before the surgery hand movement lang
 avoidance of suturing ang makita sng patient
 rapid wound healing  After operation 20/20 or 20/25 an ang
 lesser degrees of corneal distortion patient.
 reduced postoperative intraocular  When doing separate operations for
inflammation both eyes, as short as 2 weeks you can

Assessor: Mayo
Group 9 - Rivas, Dionisio, Marterio
P a g e 3|5
 already operate on other eye, unless the posterior capsule at the site of
cataract in other eye is immature and apposition between the remnants of
not yet affecting the vision the anterior capsule and posterior
capsule; impart a vacuolated
appearance to the capsule
 Capsular Fibrosis - due to fibrous
metaplasia of epithelial cells, less
common and usually appears earlier
than Elsching pearls.
 Treatment: involves creation of an
opening in posterior capsule, with the
Nd;YAG laser

POSTERIOR CAPSULE OPACIFICATION

 Remember in modern cataract surgery, Posterior Capsular Opacification
we leave behind the posterior capsule A- Elsching Pearls
intact that will support the intraocular B- Capsular fibrosis
lens C- Appearance following laser capsulotomy
D- Laser pitting of the IOL
 If magisi mo ang PC or torn and vitreous
escapes, you have so many
complications
CONGENITAL CATARACT AND
 Sometimes patients PCO, cataract no
DEVELOPMENTAL CATARACT
longer there but the posterior capsule
 Congenital cataract is present at birth
that you left intact will develop
opacification itself  Developmental cataract is diagnosed
after one year pa
 Most common late complication of
uncomplicated cataract surgery  Isolated hereditary cataract in 25% of
cases (rare)
 Intraocular lenses are lifetime asta na na
mapatay ka  Cataract is usually not hereditary but
due to aging
 Signs of PCO:
 Congenital rubella syndrome associated
 Elsching Pearls - bladder cells or
with uni or bilateral cataract 15% -
Wedl Cells. Are caused by the
mother acquired congenital rubella
proliferation and migration of residual
during 1st trimester (organogenesis)
equatorial epithelial cells along the

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Group 9 - Rivas, Dionisio, Marterio
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 TIMING OF SURGERY
 If you have bilateral dense cataract early
surgery by 6 weeks to prevent stimulus
deprivation or myopia
 Because there is cataract, the retina
cannot be stimulated by light
 Retina and optic nerve will develop
Lazy eye syndrome
 To prevent this, you ave to remove
dense cataract by 6 weeks beyond
this there will be deprivation already
 In bilateral partial cataract it can be
operated later
 Unilateral dense cataract urgent surgery
within days followed by aggressive anti-
lazy eye therapy because one eye, will
already be developing myopia
 Partial Unilateral observe further
 Lens Coloboma
 May ara area sa lens that was not
fully developed
 Segmental Agenesis
 Hemispherical deformity of the lens
 All this will affect vision


Assessor: Mayo
Group 9 - Rivas, Dionisio, Marterio
P a g e 5|5