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    Visual Acuity & Refractive Errors

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    Hidayad
    This document provides an overview of eye optics and refractive errors. It begins by describing three patient cases presenting with vision issues. It then covers objectives like understanding eye optics, visual acuity assessment, and common refractive errors. Specific refractive errors like myopia, hyperopia, presbyopia, and astigmatism are explained in terms of their etiology, clinical presentation, diagnosis, and treatment options. Additional topics covered include visual acuity testing, image reception through the eye, color vision and color blindness, and cataracts. The document uses diagrams to illustrate optical and refractive principles.

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    Visual Acuity & Refractive Errors

    Uploaded by

    Hidayad
    67 views43 pages
    This document provides an overview of eye optics and refractive errors. It begins by describing three patient cases presenting with vision issues. It then covers objectives like understanding eye optics, visual acuity assessment, and common refractive errors. Specific refractive errors like myopia, hyperopia, presbyopia, and astigmatism are explained in terms of their etiology, clinical presentation, diagnosis, and treatment options. Additional topics covered include visual acuity testing, image reception through the eye, color vision and color blindness, and cataracts. The document uses diagrams to illustrate optical and refractive principles.

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    This document provides an overview of eye optics and refractive errors. It begins by describing three patient cases presenting with vision issues. It then covers objectives like understanding eye optics, visual acuity assessment, and common refractive errors. Specific refractive errors like myopia, hyperopia, presbyopia, and astigmatism are explained in terms of their etiology, clinical presentation, diagnosis, and treatment options. Additional topics covered include visual acuity testing, image reception through the eye, color vision and color blindness, and cataracts. The document uses diagrams to illustrate optical and refractive principles.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    67 views43 pages

    Visual Acuity & Refractive Errors

    Uploaded by

    Hidayad
    This document provides an overview of eye optics and refractive errors. It begins by describing three patient cases presenting with vision issues. It then covers objectives like understanding eye optics, visual acuity assessment, and common refractive errors. Specific refractive errors like myopia, hyperopia, presbyopia, and astigmatism are explained in terms of their etiology, clinical presentation, diagnosis, and treatment options. Additional topics covered include visual acuity testing, image reception through the eye, color vision and color blindness, and cataracts. The document uses diagrams to illustrate optical and refractive principles.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 43

    1

    Eye Optics and


    Refractive Errors
    By: John J. Beneck MSPA, PA-C
    2
    Case 1
    14 year old boy comes to primary care
    office c/o inability to see the blackboard in
    school
    3
    Case 2
    51 year old man presents c/o difficulty
    reading the news paper: My arms are too
    short!
    4
    Case 3
    6 year old girl presents with mom who
    states she squints when looking at anything
    more than 2 feet away.
    5
    Objectives
    Understand the optics of the eye
    Understand visual acuity assessment
    Understand common refractive errors
    Understand color perception assessment

    6
    Objectives (Cont.)
    Understand common refractive errors in
    terms of:
    Etiology/pathology
    Clinical presentation
    Course and prognosis (when appropriate)
    Diagnosis
    Interventions/treatments

    7
    Abbreviations
    C/o complaining of or complains of
    8
    Visual Acuity
    Use Snellen chart
    Positioned 20 feet away

    Each Eye Alone, Then Together

    With Corrective Lenses (If indicated)
    9
    Snellen Charts
    http://store6.yimg.com/I/sightmart-eye-care-products_1753_2381891 accessed 9/5/03
    10
    Visual Acuity
    Visual acuity is expressed as two numbers
    The first indicates the distance of the patient
    from the chart
    The second indicates the distance at which a
    normal eye can read the line of letters
    Ex: 20/50
    Visual Acuity
    20/20
    ability to see letters of a given size at 20 feet
    20/40
    what a normal person can see at 40 feet, this
    person must be at 20 feet to see.
    20/200
    what a normal person can see at 200 feet, this
    person must be at 20 feet to see.
    12
    Further Acuity
    Assessment/Diagnosis
    Optometric examination
    Cornea
    Anterior chamber
    Posterior chamber
    Retinal examination and imaging
    13
    Image Reception
    Optics/Refraction
    Air anterior Cornea
    2/3 of the refractive power of the eye
    Posterior Cornea aqueous humor
    Iris / pupil
    Variable aperture
    Aqueous humor anterior lens
    Posterior lens vitreous humor
    14
    Image Reception
    Convex refraction
    Refractive index
    Convergence
    Image reversal
    Perception

    Blind spot
    Refractive Principles of a Lens
    Convex lens focuses light rays
    Figure 49-2; Guyton and Hall
    16
    The Refractive Principles of a Lens
    Figure 49-8; Guyton and Hall

    Refractive Principles of a Lens
    Concave lens diverges light rays.
    Figure 49-3; Guyton and Hall
    18
    Whats next?
    Emmetropia (normal vision)
    Myopia (near-sighted)
    Hyperopia (far-sighted)
    Inability of the lens to accommodate adequately
    for near vision
    Presbyopia
    Astigmatism
    19
    Myopia (Near-Sighted)
    The patient is able to focus on objects near but not far
    away
    Typical complaint is difficulty focusing on road signs or
    the black board
    The lens is unable to flatten enough to prevent conversion
    of images before reaching the retina
    The image comes into sharp focus in front of the retina
    Frequently squinting is compensatory mechanism

    20
    Errors of Refraction
    Figure 49-12; Guyton and Hall

    Normal vision
    Far sightedness
    Near sightedness
    21
    Myopia Correction
    Corrective concave lens use
    Glasses
    Contact lenses
    Surgical
    LASIK (greatest range of correction for myopia)
    Laser-Assisted In Situ Keratomileusis
    Epithelial flap cut and lifted
    Laser applied to deep layers of cornea
    Flap repositioned
    Squinting?

    22
    Correction of Myopic Vision
    Figure 49-13; Guyton and Hall

    Myopia corrected with
    concave lens
    23
    Depth of Focus
    Effect of pupil size on focus in myopic patients
    Note the difference in divergence of rays as
    they reach the retinal surface
    24
    Hyperopia (Far-Sighted)
    The patient is able to focus on objects far away
    but not close up
    Typical complaint is difficulty reading
    The image comes into sharp focus behind the
    retina
    25
    Errors of Refraction
    Figure 49-12; Guyton and Hall

    Normal vision
    Far sightedness
    Near sightedness
    26
    Hyperopia Correction
    Corrective convex lens use
    Glasses
    Contact lenses
    Surgical
    LASIK
    Laser-Assisted In Situ Keratomileusis
    Epithelial flap cut and lifted
    Laser applied to deep layers of cornea
    Flap repositioned

    27
    Correction of Hyperopic Vision
    Figure 49-13; Guyton and Hall

    Hyperopia corrected
    with convex lens
    Presbyopia; The Inability to
    Accommodate
    Caused by progressive denaturation of the proteins of the
    lens.
    Makes the lens less elastic.
    Begins about 40-50 years of age.
    Near point of focus recedes beyond 22 cm (9 inches).

    29
    Astigmatism

    Unequal focusing of light rays due to an oblong
    shape of the cornea
    Presents with relatively stable blurry vision
    Patient unable to focus on objects near or far
    Near vision is typically better
    30
    Astigmatism
    Vertical focal point different from Horizontal
    focal point
    Cornea lacks discoid continuity
    More curved in one plane than another
    Unable to correct with a single concavity or
    convexity index
    31
    Exaggerated Astigmatic Corneal Shape
    Notice the difference in
    the degree of curve of the
    cornea in 2 planes
    Cornea: face-on
    32
    Astigmatism Correction
    Cylindrical optical refractive correction
    Glasses
    Contact lenses
    Surgery
    LASIK
    Laser-assisted in situ keratomileusis

    Cataracts
    Cataracts
    cloudy or opaque area of the lens
    caused by coagulation of lens proteins
    More to come
    34
    Cataract
    35
    Cataract Correction
    Surgical
    The lens is replaced
    Induces presbyopia
    Frequently dramatically improves far vision
    Pigment Layer of Retina
    Pigment layer of the retina is very important
    Contains the black pigment melanin
    Prevents light reflection in the globe of the eye
    Without the pigment there is diffuse scattering of
    light rather than the normal contrast between dark
    and light.
    This is what happens in albinos
    poor visual acuity because of the scattering of
    light
    Best corrected vision is 20/100-20/200
    Color Vision
    Color vision is the result of activation of cones.
    3 types of cones:
    blue cone
    green cone
    red cone
    The pigment portion of the photosensitive
    molecule is the same as in the rods, the protein
    portion is different for the pigment molecule in
    each of the cones.
    Makes each cone receptive to a particular
    wavelength of light
    38
    Each Cone is Receptive to a
    Particular Wavelength of Light
    Figure 50-7; Guyton & Hall
    Color Blindness
    lack of a particular type of cone
    genetic disorder passed along on the X
    chromosome
    occurs almost exclusively in males
    about 8% of women are color blindness carriers
    most color blindness results from lack of the red
    or green cones
    lack of a red cone, protanope.
    lack of a green cone, deuteranope.
    40
    Eyes & Visual Pathways
    Ishihara Test for Color Blindness

    The individual with normal color vision will see a 5 revealed in the
    dot pattern.
    An individual with Red/Green (the most common) color blindness
    will see a 2 revealed in the dots.
    http://www.toledo-bend.com/colorblind/Ishihara.html, 2001
    41
    Color Vision

    Colorblind individuals should see the yellow square.
    Color normal individuals should see the yellow
    square and a "faint" brown circle.
    42
    How about those cases
    Case 1
    14 year old boy comes to primary care office c/o
    inability to see the blackboard in school
    Case 2
    51 year old man presents c/o difficulty reading the news
    paper: My arms are too short!
    Case 3
    6 year old girl presents with mom who states she
    squints when looking at anything more than 2 feet
    away.
    43
    Now, Do You See Things More
    Clearly???

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