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    HYPERMETROPIA and Myopia PDF

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    Drashti Chudasama
    Hypermetropia, also known as farsightedness or longsightedness, is a refractive error where parallel rays of light focus behind the retina when the eye is at rest. There are several types of hypermetropia including axial, curvatural, index, and positional. Symptoms vary depending on the degree of refractive error and can include tired eyes, headaches, watering, and blurred vision. Treatment options include optical correction with convex lenses, refractive surgery procedures, and contact lenses in some cases.

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    HYPERMETROPIA and Myopia PDF

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    Drashti Chudasama
    127 views55 pages
    Hypermetropia, also known as farsightedness or longsightedness, is a refractive error where parallel rays of light focus behind the retina when the eye is at rest. There are several types of hypermetropia including axial, curvatural, index, and positional. Symptoms vary depending on the degree of refractive error and can include tired eyes, headaches, watering, and blurred vision. Treatment options include optical correction with convex lenses, refractive surgery procedures, and contact lenses in some cases.

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    Hypermetropia, also known as farsightedness or longsightedness, is a refractive error where parallel rays of light focus behind the retina when the eye is at rest. There are several types of hypermetropia including axial, curvatural, index, and positional. Symptoms vary depending on the degree of refractive error and can include tired eyes, headaches, watering, and blurred vision. Treatment options include optical correction with convex lenses, refractive surgery procedures, and contact lenses in some cases.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    127 views55 pages

    HYPERMETROPIA and Myopia PDF

    Uploaded by

    Drashti Chudasama
    Hypermetropia, also known as farsightedness or longsightedness, is a refractive error where parallel rays of light focus behind the retina when the eye is at rest. There are several types of hypermetropia including axial, curvatural, index, and positional. Symptoms vary depending on the degree of refractive error and can include tired eyes, headaches, watering, and blurred vision. Treatment options include optical correction with convex lenses, refractive surgery procedures, and contact lenses in some cases.

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    of 55

    HYPERMETROPIA

    What is Hypermetropia?
    • Also known as hyperopia or long
    sightedness.
    • Parallel rays of light coming from infinity are
    focused behind the retina with
    accommodation being at rest.
    • There for posterior focal point is behind the
    retina which receives a blurred image.
    ETIOLOGICAL CLASSIFICATION

    ►Axial hypermetropia
    ►Curvatural hypermetropia
    ►Index hypermetropia
    ►Positional hypermetropia
    ►Absence of crystalline lens
    • 1. Axial HM:
    • short length of the eyeball
    • Ex. About 1mm of shortening of anteroposterior diameter of
    eye results in 3 Diopter of hypermetropia.
    • May be pathological / developmental.
    2. Curvatural HM:
    • Curvature of cornea and lens or both is flatter than normal.
    • Results in decreased in the refractive power of eye.
    • Ex. 1 mm increase in radius of curvature results in 6
    dioptre of Hypermetropia.
    • May be developmental /Rarely pathological
    3. Index HM:
    • Decrease in refractive index of the lens in old age
    • Due to Cortical Sclerosis.
    • May also occurs in Diabetics under treatment.

    4. Positional HM:
    • Posteriorly placed Crystalline lens.

    5. Absence of Crystalline Lens:


    • Congenitally / Acquired leads to aphakia ( a condition of High
    Hypermetropia)
    CLINICAL TYPES
    Age & HM :
    • At birth, eyeball is relatively short, having +2 to +3 hypermetropia
    • Which gradually reduced until by the age of 5-7 years, then the eye
    is emmetropic and remain till the age of about 50 yrs.
    • After this there is a tendency to develop hypermetropia again which
    gradually increases until the extreme of life by which the eye has
    same +2 to +3 with which it started. This senile hypermetropia is
    due to changes in the crystalline lens.
    CLINICAL PICTURES
    • Symptoms:
    It vary depending upon the age of patients and the degree of refractive
    error.
    1. Asymptomatic: No symptoms, usually <1 D, corrected with mild
    accommodation
    2. Asthenopic : Usually about 1-2 D refractive error is fully corrected
    by accommodative effort, thus vision is normal
    – Sustained accommodation produces asthenopic symptoms like:
    • Tiredness of eyes
    • Frontal / Frontotemporal headache
    • Watering
    • Mild photophobia
    3.Defective vision with asthenopic symptoms:
    • HM of about +2 to+4 D
    • Not fully corrected by accommodation
    • Thus, patient complains of defective vision more for near than
    distance associated with asthenopic symptoms

    4. Defective vision only:


    • When the amount of HM is more than +4D, the patient do not
    accommodate and there occurs marked defective vision for near
    and distance.
    Effect of aging on vision:
    • Patient with low hypermetropia have good vision in young
    age.
    • However, with the aging, due to decrease in
    accommodative power, the HM becomes manifest and
    patients complain of progressive decrease in vision.
    • To begin with blurring occurs for near vision and then for
    distance vision also
    Signs:
    • VA: Defective, varies with the degree of HM
    • Eye ball : Small/ Normal size
    • Cornea : Smaller
    May be cornea Plana
    • AC: shallower
    • Lens : could be dislocated Backwards
    • Retinoscopy & Autorefractometry reveals hypermetropia
    • Fundus examination:
    ✓ Optic Disc: Small may look more vascular with ill- defined
    margins
    ✓ May simulate papillitis(though there is no swelling of the disc,
    and so it is called pseudo papillitis)
    ✓ Retina as a whole may shine (shot silk appearance)
    • A- scan ultrasonography:
    short anterior-posterior diameter in axial HM.
    GRADING

    • Low HM : when error is <= 2D


    • Moderate HM: when error is +2 to +5D.
    • High HM: when error is >= +5D.
    COMPLICATIONS

    • Recurrent styes, blepharitis or chalazion may occur.


    • Accommodative convergent squint
    • Amblyopia
    • Predistortion to develop primary narrow angel glaucoma.
    TREATMENT
    • Optical Treatment –
    Appropriate convex lenses
    ➢ Method of prescription of convex lenses:
    1. Spectacles:
    Most comfortable, safe and easy
    1. Contact lenses :
    Indicated in unilateral HM
    cosmetic reason
    only prescribed when the prescription has stabilised
    • Surgical Treatment :
    • Thermal laser keratoplasty(TLK)
    • Photorefractive keratectomy(PRK)
    • Conductive keratoplasty(CK)
    • LASIK
    • IOL Implantation
    MYOPIA
    EMMETROPIA
    • When parallel rays of light coming from infinity are focused in
    sensitive layer of retina with accommodation being at rest.
    AMETROPIA
    • Condition of refractive error
    • It is a problem with focusing light accurately on the retina
    • Parralel rays of light coming from infinity are focused either infront
    or behind retina

    • Classified into:
    ▪ Myopia
    ▪ Hypermetropia
    ▪ astigmatism
    MYOPIA
    • Short sightedness
    • Parralel rays of light coming from infinity are focused infront of
    the retina
    ETIOLOGICAL CLASSIFICATION

    • Axial myopia
    • Curvatural myopia
    • Positional Myopia
    • Index Myopia
    • Myopia due to excessive accommodation
    CLINICAL TYPES
    • Congenital Myopia
    • Simple or Developmental Myopia
    • Pathological or Degenerative Myopia
    • Acquired Myopia: post traumatic
    post keratitic
    drug induced
    pseudomyopia
    space myopia
    night myopia
    consecutive myopia
    GRADING
    • By AOA
    ❑Mild - < -3D
    ❑Moderate -3D to -6D
    ❑High - >-6D
    CONGENITAL MYOPIA

    • Frequently seen in:


    ❑Premature babies
    ❑Increase in axial length
    ❑Increase in overall globe size
    ❑Since birth, diagnosed at age 2-3 year
    ❑Mostly unilateral
    ❑Usually 8-10 D, remains constant
    ❑May develop squint
    Cont.
    • May associated with:
    ❑Catract
    ❑Micropthalmus
    ❑Aniridia
    ❑Megalocornea
    ❑Congenital separation of retina

    ➢ Early correction is desirable


    SIMPLE MYOPIA
    • Commonest variety
    • Physiological error not associated with any disease of the eye
    • School myopia

    • Etiology:
    ▪ Normal biological variation in development of eye
    ▪ inheritance
    • Associated Factors:
    ▪ Axial type
    ▪ Curvatural type
    ▪ Role of diet
    ▪ Role of genetics
    ▪ Theory of excessive near work
    CLINICAL PICTURES

    • Symptoms:

    ▪ Poor vision for distance


    ▪ Asthenopic symptoms develop due to dissociation between
    accommodation and convergence
    ▪ Half shuting of the eye
    • Signs:
    ▪ Large and prominent eyeball
    ▪ Deep AC
    ▪ Large, sluggishly reacting pupil
    ▪ Normal fundus, rarely crescent
    ▪ Usually occur between 5-10 year age and keep increasing till
    18-20 year
    ▪ Usually dose not exceeds 6-8 D

    ➢ Diagnosis is confirmed by Retinoscopy


    PATHOLOGICAL MYOPIA
    • Rapidly progressive error associated with degenerative changes in eye

    • Etiology:
    ❑ Rapid axial growth of the eyeball outside the normal biological
    variations of development
    ❑ Role of heridetry- familial
    more common in female

    ❑ Role of general growth process: nutritional deficiency


    debilitating disorders
    ETIOLOGICAL HYPOTHESIS

    Genetic factors General growth process

    More growth of retina

    Streching of sclera

    Increased axial length

    Degenration of choroid

    Degeneration of retina

    Degeneration of vitreous
    CLINICAL PICTURE
    • Symptoms:
    ❑ Defective vision
    ❑ Muscae volitantes/floating black opacities
    ❑ Night blindness

    ➢Signs:
    ❑ Prominent eyeball
    ❑ Cornea large
    ❑ Deep AC
    ❑ Pupil slightly large and react sluggishly
    Cont…
    • Fundus examination:
    A. Optic Disc:
    ▪ Large and pale
    ▪ Myopic crescent on the temporal side of disc
    ▪ Sometimes peripapilary crescent
    ▪ Super traction crescent on nasal side

    B. Macula:
    ▪ White atrophic patches at the macula
    ▪ Foster Fuch’s spot
    ▪ Cystoid degeneration at periphery
    C. Posterior Staphyloma(sclera thining)
    D. Degenerative changes in vitreous:
    ▪ Vitreous liquification
    ▪ Vitreous degeneration
    ▪ PVD

    E. Visual fields contraction


    F. ERG reveals subnormal electroretinogram due to choreoretinal atrophy
    COMPLICATIONS

    • Retinal detachment
    • Complicated cataract
    • Vitreous haemmorhage
    • Choroidal haemmorhage
    TREATMENT
    • Optical Treatment –
    ❑ appropriate concave lenses

    • Surgical Treatment –
    ❑ epikeratophakia, RK, PRK, Phakik IOL’S ,LASIK

    • General measures -
    ❑ Balanced diet
    ❑ Early management of associated debilating disease
    Cont…..
    • Visual Hygiene
    ❑ To avoid asthenopic symptoms
    ❑ Adequate illumination during close work
    ❑ Clarity of print should begood to avoid undue ocular fatigue

    • Low vision Aids


    ❑ Indicated in patient of progressive myopia with advanced degenerative
    changes

    ❑ Prophylaxis
    ❑ Genetic counciling for people having pathological myopia

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