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OPTICS
FEUNRMFBATCH2019-20233RDYR1ST SEM|ADASTRAPERASPERA

PROCESSES FOR VISION SNELL’S LAW

REFRCTION • Bending of light rays when passing from one
transparent medium to another of a different 1. Light travelling from a
density. medium of lower index of
It is also the eye examination done to determine refraction to a medium of higher
the required lens prescription you need to achieve index means the light is bent
normal vision (20/20) towards the normal line (white
line in the figure)
OPTICS • Branch of physics that studies the behavior and
properties of light 2. Light traveling from a medium
of higher index of refraction to a
medium of lower index, the light
FOUR PARTS OF OPTICS is bent away from the normal
Optical System
Physical Optics Deals with physical properties of light
OPTIC MEDIA
Geometric Optics Processes that occur in order that the light energy is
focused on the retina
Sense Organ
Physiologic Optics Retinal processes that transform light energy into
visual energy
Neuro-Optics The conduction of the visual energy to the visual
center to produce vision

ELECTROMAGNETIC SPECTRUM

Cornea 42 Diopters main refractive media of the eye

Aqueous Humor Minimal diopter
Crystalline Lens 19-35 Diopters main refractive media of the eye
but with variable diopters or refractive medium due
• Light is the stimulus for vision to accommodation
• Visible light is a portion of the electromagnetic spectrum. All other Vitreous Minimal diopter
radiations in the spectrum such as UV, X- rays, radio waves are not
seen by the eyes except for visible light
• The light has to traverse the parts of the optic media before it gets
• R,O,Y,G,B,V is the arrangement of visible light from lowest to highest into the macula
wavelength
• 40 D (from cornea) + 20 D (from lens) = 60 D
PHYSICAL OPTICS PHYSIOLOGIC OPTICS
VISIBLE LIGHT
• Portion of electromagnetic spectrum
• Light travels in the form of rays.
• When light rays strike the surface of an object, they may be reflected
or may pass through
• The light rays reflected from or pass through enter the eye
• Visible light is only 380 micra to 770 micra (round off to 400 to 800u)
• It is the basic stimulus for vision

CHARACTERISTICS OF VISIBLE LIGHT

❖ Velocity or speed
❖ Wavelength
❖ Frequency Light initiates a chain of reaction as the light is absorbed by the
photoreceptor at the outer segment layer isomerizing the 11 cis-retinal
bound to opsin into 11 trans-retinal which dissociates it from opsin. The
GEOMETRIC OPTICS trans-retinal may be metabolized to cis retinal and reattach to opsin.
• This explains how the light rays will behave before it reaches the retina
• As the light ray travels, it has to pass from one medium to another
(from the air to another medium) to reach its target which is the
retina

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• Photoreceptor outer segment (OS) contain visual pigments
• OS cell membrane allows Na entry and inner segment cell membrane STEPS IN DIAGNOSIS OF ERROR OF REFRACTION (EOR)
secretes the ion producing a resting current A. HISTORY
• Light causes the influx of Ca ions to affect a current disruption and
hyperpolarization Progressive blurring • Most common and sometimes the only
of vision complaint
Law of Conservation of Energy Photochemistry of vision
• Take note of the duration
Law of Specific Energy Sensory organ
• Note the laterality
CHARACTERISTICS OF VISUAL SENSES
AMBLYOPIA – AKA the Lazy eye where one eye is not
❖ Light sense
seeing well because of high EOR, the brain will now
❖ Form sense
have to rely on the better seeing eye such that if you
❖ Color sense
correct the EOR you can no longer attain a normal
vision
VISUAL RECEPTORS
Associated eye ADULT EYES
problem • Eye strain, headache (common symptom of
CONES RODS
EOR after using the eye for work), dizziness
• Daylight or photopic vision • No color perceptive ability
and nausea
• Color vision (scotopic)
• Contour resolution or visual • Faint light intensity CHILDREN EYES
acuity (center of vision) • Movement at the periphery • Blinking, itchiness, photosensitivity,
• Concentrated at the macula • Gross form sensitivity clumsiness, frowning, closing of 1 eye, head tilt
• Concentrated at the Prior consultation • Check for the use of glasses
periphery
Family history • Check for astigmatism and high myopia
Social history • People who read a lot and use gadgets
VISUAL ACUITY COLOR VISION
become more myopic because of
accommodation
Medical history • Diabetes and drugs (sulfonamides)

B. ANCILLARY EXAMINATIONS
1. Visual acuity
2. Refraction - objective refraction is done either with the use of retinoscopy
NEURO-OPHTHALMOLOGIC OPTICS
or automated refractometer. This should always be refined with subjective
refraction.
3. Keratometry
4. Corneal tomography
5. Biometry or A scan ultrasonography

Biometry is a mathematical and statistical analysis of the anatomical

characteristics of the eye to determine the refractive power of the eye and
to determine the intraocular lens needed in cataract and refractive surgery.

1. TEST FOR VISUAL ACUITY

*This explains how visual energy at the retina will be transmitted and
Far Vision (Snellen’s • 20 ft or 6 meters away from the chart
interpreted by the brain as what we can see*
chart)
1. Monocular vision
Near Vision (Jaeger’s • 33 cm of 14 inches (arm’s length) away from
2. Binocular vision - Due to the crossing at the nasal half (refer to the figure)
chart) the chart
3. Stereopsis - Corresponding retinal points, Only possible if you have good
binocular vision (depth perception) Astigmatic Dial • Used for the determination of astigmatism
• Patience is asked which lines are straight, the
intensity of blackness and identify it by a
The human brain is very unique in such a way that even a monocular vision
clock hour
would still develop stereopsis by clues
Pinhole Test • Patient’s VA < 20/20 in either eye, to
*Review Visual field pathway and defects*
determine if the vision is due to error of
refraction
Primary Image Produced by the interconnection between the
photoreceptor axons and the cell processes of the
ACCOMODATION
bipolar cells start the process of analyzing the raw
• Process wherein the eye will have to focus from far to near vision
data at the photoreceptors
• Accommodation is the process by which the refractive power of the lens
Secondary Image Produced by bipolar cells that transmit the refined
increases to focus image of objects at different distances at the retina
information to horizontal cells where it is modified
• When the ciliary body contracts, the ciliary processes draw together,
Tertiary Image Produced in the ganglion cells, modified by the
allowing the lens zonules to relax making the elastic lens capsule force
amacrine cells and passes this reanalyzed information
the lens to assume a more spherical form
to the brain.
• As the anterior surface of the lens becomes more convex, the dioptric
power of the eye increases.

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• This is the main reason why the dioptric power of the lens
contributing to the dioptric power of the eye ranges from 19 – 35 D. REFRACTIVE STATE OF THE EYE
19 is unaccommodated while 35 is fully accommodated EMMETROPIA
• The image is exactly focused on
PRESBYOPIA the retina
• A physiologic condition wherein the power of accommodation is • When the image is not exactly at
diminished because of multifactorial causes- decreased elasticity the retina it is called ametropia or
of the lens, sclerosed muscles of accommodation and formation there is an error of refraction
of nucleus • It is the refractive state of the eye
• Occurs on people age 35 and above or around the age of 40 when the light rays coming from
(develops progressively with age) an object viewed from infinity (20
• This is manifested as a decreased ability to focus on near objects feet) come to a focus at the retina
as in reading while distance visual acuity remains the same without accommodation.
• This is corrected by reading glasses (plus lenses) with lower • Hence, the refractive state of the eye will depend on the axial length
segment of bifocal lenses, wherein the upper segment may of the eyeball and the refractive power or curvature of the cornea and
contain correction for distance visual acuity if needed. the lens
• Heredity plays a role in the refractive state of the eye.
SYNKINETIC NEAR TRIAD
• It is where the medial rectus, ciliary body and sphincter pupillae ERRORS OF REFRACTION (EOR)
all react during accommodation (not a reflex action) HYPEROPIA (FAR SIGHTED)
• Synkinetic action of the inferior division of oculomotor nerve

1. Medial Rectus Convergence

2. Ciliary Body Accommodation
3. Sphincter pupillae M Constriction Left: Hyperopia. Right: Hyperopia Correction with Convex Lens
• The light rays are brought to a focus behind the retina
CYCLOPLEGIA
• Accommodation help bring to focus at the retina up to the limit of the
Condition where the ciliary body or accommodation is paralyze due to
power of accommodation
chemical injury; drugs that causes cycloplegia includes: atropine,
• Hyperopic complain of visual fatigue when performing visual task at
homatropine, cyclopentolate and tropicamide
near distance
• Most children are born hyperopic because of the shortness of the eye
partially compensated by the fact that the infant lens is more convex
2. MEASUREMENT OF REFRACTIVE OF ERROR (REFRACTION) than the adult lens
• Objective Refraction • Hyperopia is corrected by convex lenses designated as plus lens.
❖ Retinoscopy - look for the retinal reflex moving up and • Possible causes: very weak optical power of the cornea and the lens
down or side to side, changing the lenses to observe the or the axial length of the eye is small
retinal reflex
❖ Trial Lenses - for people who cannot stay put. Manual MYOPIA (NEARSIGHTED)
change in lenses is done. Used in children or in adults
❖ Autorefractometer
• Subjective Refraction

3. CORNEAL TOMOGRAPHY
• It is color-coded mapping of the surface curvature of the cornea. Left: Myopia. Right: Myopia Correction with Concave Lens
• It demonstrates irregularities in the curvature of cornea as in • The light rays are brought to a focus in front of the retina
keratoconus. • Children who are myopic are not expected to improve as they grow
• The brighter the colors mean more curve at the cornea older (unlike in hyperopia)
• The most common symptom is difficulty of distinguishing objects clearly
4. KERATOMETRY at a distance
• Done to measure the radius of curvature of the cornea. It helps • Myopia is corrected by concave lenses designated as minus lens.
determine the amount and type of astigmatism, for proper fitting • Possible causes: may be due to large eyeball (axial myopia) or increase
of contact lens and aid in biometry. in the power of the media (refractive myopia).
• For quantitative measurement of the curvature of the cornea
ASTIGMATISM
• Most of the autorefractometer has already programmed with
keratometer and refractometer so it is called
autorefractokeratometer

5. BIOMETRY
• Is a mathematical and statistical analysis of the anatomical • Light rays are not focused on the retina because of the variation of
characteristics of the eye to determine the refractive power of the refractive power along different meridian of the optic media
eye and to determine the intraocular lens needed in cataract and • For simplification, just get the strongest and the weakest focal point
refractive surgery
and try to shorten their distance or the Sturm interval
• Used for the determination of axial neck (how long is the eyeball) • This is corrected by cylindrical lens (different powers in different axis)
• Possible causes: irregularity mostly in the shape of the cornea or at
times the lens

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The different refractive powers can be reduced into 2 principal meridians Advantages Disadvantages
• If the 2 medians are at right angle to each other, it is called Safe Restricted visual field because of the frame
regular astigmatism Easy adjustment Aniseikonia if there is a very great EOR
• If not, it is irregular astigmatism Distortion of image especially at the periphery
When you see a prescription with a “degrees” at the end, this is Cosmetic and psychological impact
astigmatism
2. CONTACT LENSES
DIVISIONS OF ASTIGMATISM
• Can be either Hard or Soft
MOTION PARALLAX – When • UV Protection
a person is at constant speed, • Gas permeable
objects that are seen closer
to the depth of vision tend to Cornea gets its oxygen supply in the atmosphere; contact lenses that are
move faster and the direction not gas permeable may deprive the cornea to oxygen; allow the cornea to
is towards the back while get the oxygen supply before applying the non-gas permeable contact
objects from farther depth lenses
moves with the motion and
direction of the person Advantages Disadvantages
Better visual field Psychological trauma
Compound Myopia both focal points are in front of the retina Less aniseikonia Frequency of lens loss
Compound Hyperopic both focal points are behind the retina Good for aphakia Corneal complications especially if unsterile
Simple Myopia one of the focal points is on the retina, the other Less retinal image
is in front of the retina difference
Simple Hyperopia one of the focal points is on the retina, the other
is behind the retina 3. REFRACTIVE SURGERY
Mixed Astigmatism one focal point is in front of the retina, the other
is behind the retina RADIAL • It is incision (4-8 incisions) on the cornea and the lens
KERATOTOMY because they are the refractive media
Regular astigmatism 2 medians are at right angle to each other or
perpendicular to each other • Work on the cornea first because it is external
Irregular astigmatism principal meridians are separated by any angle • The is the first refractive surgery done by making
other than 90° and are not perpendicular to each radial incisions and you will have a different corneal
other curvature
PHOTO- • Burns the corneal surface and then make the corneal
ANISOMETROPIA REFRACTIVE epithelium regenerate itself
• Refractive error of each eye is different KERATECTOMY • After PRK, usually there is a lot of pain but if you
• 2D to 3D difference of both eyes in EOR is considered tolerable (PRK) – patched the eye or used a bandage contact lens, pain
• Aniseikonia - difference in retina image EXCIMER will be reduced
❖ 0.5D for every 1% difference in retinal image size LASER • After 24 to 48 hours, the cornea has already
❖ Brain allows up to 5% difference regenerated
❖ In diopters, 2.5D difference is tolerable LASER IN-SITU • Combination of PRK and ALK
KERATO- • It is the improvement of PRK and till uses the excimer
GOAL OF TREATMENT MILEUSIS laser
1. Improve visual acuity 3. Ocular discomfort (LASIK) • Pain is not felt but bandage contact lens may be used
2. Muscle balance 4. Headache to keep the cornea in place
• Corneal epithelium removed and a portion is left
behind (like a door) using a keratome
If you don’t use your glasses, will your EOR progress? No, it doesn’t get • Apply the excimer laser and remove the necrosed
worse, it’s the same. If you use the wrong glasses it will also not progress tissue and put back the epithelium
However, treatment is required to improve the ocular discomfort, headache, • Epithelium is still intact with less pain involvement
etc. FLEX (ReFLEX) • Uses a femtosecond laser
LENTICULE • Improved LASIK
TREATMENT MODALITIES EXTRACTION • Less and tiny incision, no need for keratome
1. CORRECTIVE LENSES (SMILE) (2011) • Small incision lenticular extraction
• Further enhances FLEX
Spherical
INTACS • Temporizing procedure for the people who cannot
Convex (plus lens) treats hyperopia
undergo refractive surgery yet
Concave (minus lens treats myopia
• Like for young people or those whose refractive state
Cylindrical is not stable (sometimes it’s -2 then all of a suddenly
Astigmatism (minus or plus) need to have an axis it’s -4)
• Stabilizes the refractive index first by placing a silicon
OPTICAL DEVICES tube around the cornea
Spectacles • With this, the curvature of the cornea will be molded
❖ Impact-resistant ❖ Phorosensitive/transition/photogray in different curvature. However, if you remove the
❖ Antireflective lenses (gray color at the sun, otherwise it is clear) Intacs, it may slowly go back
❖ Mirrored surfaces ❖ Tinted-yellow, blue, neutral gray
❖ Polaroid

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SUMMARY
CORRECTION OF REFRACTIVE ERRORS
• Spectacle lenses
• Contact lenses
• Keratorefractive surgery

❖ Radial keratotomy – rarely used nowadays

❖ Photorefractive keratectomy (PRK)
❖ Laser in situ keratomileusis (LASIK)
❖ Small incision lenticular extraction (SMILE) – Started at 2007
❖ Lenticule extraction with femtosecond laser -FLEX- (ReFLEX)- Started at
2011
❖ Intrastromal corneal implants (INTACS)
❖ Arcuate keratotomy – Usually done for astigmatism

• Intraocular lenses
• Clear lens extraction
• Refractive lens exchange

RADIAL KERATECTOMY PRK

LASIK INTACS