OPTOMETRY

VISION SCIENCE

Eyeball

Refractive system
the basic conditions of clear vision:

1. transparence

2. Imaging on fovea

3. Intact visual pathway

Refractive system
Refractive system
Cornea
Aqueous humor
Lens
Vitreous
Refraction the process of imaging on
retina that lights enter eye through
refractive system

Schematic eye

Gullstrand Schematic eye

refractive surfaces anterior/posterior surface of cornea,
anterior/posterior surface of lens cortex, anterior/posterior
surface of lens nucleus

Refractive system

Gullstrand Refractive system

Total refractive power of eye 58.64D
on maximum accommodation 70.57D
Refractive power of cornea 43.05D
Refractive power of lens 19.11D
Axis of eye 24mm

Reduced eye

Imaging of retina

reverse imaging

Emmetropia

Emmetropia the refractive condition in focus on fovea

that parallel lights enter eye through refractive system without
accommodation

Punctum remotum of emmetropia: infinite

Accommodation
Accommodation
the capability that eyes change refractive
condition in order to acquire clear
near sight

Accommodation
Helmhotz accommodation mechanism

See near

Ciliary muscle contract

Elastic deformation of lens

Lens zonule relax

accommodation

Schachar accommodation mechanism

See near

Ciliary muscle contract

Ante-&post-lens zonule relax

equatorial lens zonule tension

Peripheral lens flatten

Central lens project

accommodation

Accommodation

punctum remotum

Diopter 1 distance of punctum remotum

Static refraction

Dynamic refraction

Accommodation

Accommodation = diopter for far diopter

for near

Range of accommodation distance of far

point distance of near point

Accommodation & convergence

Triad Phenomena of eye
accommodation
convergence
Contraction of pupil

Ametropia

Ametropia the refractive condition out of

focus on fovea that parallel lights enter eye
through refractive system on static refraction

classification
myopia
hyperopia
astigmatism

Myopia

Myopia: the refractive condition that parallel lights enter

eye through refractive system and focus before fovea on
static refraction

Punctum remotum of myopia: a point before eye

Myopia classification
Function
Simple myopia
Pathologic myopia

Degree
mild < -3.00D
middle: -3.00D~-6.00D
severe: > -6.00D

Accommodation

Refractive factor
Axis myopia
Refractive myopia

Pseudomyopia
(accommodative myopia)
nonaccommodative myopia
Mixed myopia

Myopia

Clinical manifestation

vision far sight

Asthenopia

strabismus exophoria exotropia

Change of eyeball long eye axis exophthalmos

Change of fundus tessellation myopic conus

change of macula posterior scleral staphyloma
change of peripheral fundus

Myopia

Myopia

Myopia

Complications
Disorder of vitreous body
Retinal detachment
glaucoma
cataract

Myopia

Treatment
Spectacles: concave lens

principle the lowest diopter for BCVA

contact lens
Refractive operation
Treatment of complications

Myopia

Hyperopia

Hyperopia the refractive condition that parallel lights

enter eye through refractive system and focus after fovea
on static refraction

Punctum remotum of myopia: a point after eye

Hyperopia

Refractive factor

Axis hyperopia

Refractive hyperopia

Degree

mild < 3.00D

middle: 3.00D~ 6.00D

severe: > 6.00D

Hyperopia

Clinical manisfestation

sight

degree of hyperopia, accommodation, amblyopia

Asthenopia

Esotropia

Pathological change

Hyperopia

Correction: convex lens

Infant and adolescent dilation pupil to
examine eyesight
adult best sight comfort

Hyperopia

Myopia and correction

Hyperopia and correction

Astigmatism

Astigmatism the refractive status that parallel

lights cant focus through refractive system on static
refraction because refractive power of individual
meridian is different

Astigmatism
Regulation
Irregular astigmatism
Regular astigmatism

Regular astigmatism
astigmatism with rule
strong refractive-power meridian : 90 20
astigmatism against rule
strong refractive-power meridian : 18020
oblique astigmatism
axis: 45or 13520

Astigmatism

Classification on refraction
Simple hyperopic astigmatism SHA)
Compound hyperopic astigmatism CHA)
Simple myopic astigmatism SMA)
Compound myopic astigmatism CMA)
Mixed astigmatism MA)

Astigmatism

Clinical manifestation
diminution of vision
asthenopia

correction
Preventing overcorrection

Anisometropia

Anisometropia the refractive status that refraction of

both eye is different

Clinical presentation

Eruption of binocular single vision

Fusion limitation
the difference of imagination on both retina 25
the difference of diopter on both eyes 3.0D

Asthenopia

alternative fixation

amblyopia

Presbyopia
Presbyopia the decrease of physiological
accommodation with aging
cause
Crystal sclerosis decreased elasticity
Decreased Ciliaris contraction
late enlargement of lens

Presbyopia
Clinical presentation
Difficulty in reading or working in a short distance
Read in bright light
asthenopia
Accommodation delay

Correction convex lens

Extraocular
muscles

Extraocular muscles

Extraocular muscles
Roles of Extraocular muscles
Main Action

Secondary Action

Medial rectus

Pronation

Lateral rectus

Extorsion

Superior rectus

Superior Turning

Pronation, Internal rotation

Inferior rectus

Inferior Turning

Pronation, External rotation

Superior obliquus Internal rotation

Inferior Turning , Extorsion

Inferior obliquus External rotation

Superior Turning , Extorsion

Extraocular muscles
Synergist the same eye
antagonist the same eye
Yoke muscles double eyes

Strabismus
Strabism: both eyes cant be fixed on the target
simultaneously and the optic axes are divergent.
one eye is fixing on the target and the other eye is
deviating from it.
Classification
Comitant strabismus
Non-concomitant strabismus
Special strabismus

Check of strabismus
History
Sight and refraction
mydriasis and refraction

Quantu determination
Corneal light reflection test
triangular prism and cover test

Divergence of eye
compensatory head position

Arc perimetry

ocular movement

synoptophore

triangular prism and Maddox

Check of strabismus

Comitant strabismus
Direction

accommodation

Concomitant esotropia

Accommodation esotropia

Concomitant exotropia

Part Accommodation esotropia

Non-accommodation esotropia

Period
Heterophoria
Heterotropia

Secondary

Constancy strabismus

Paralysis compensation

Alternating strabismus

Postoperation

intermittent strabismus

perception

Comitant strabismus
Therapeutics
Correction of refractive errors
Amblyopia discipline
Position discipline
operation

Non-concomitant strabismus
Etiological factor
congenital
aquired trauma,inflammation, vascular disease,
tumor, Metabolic disease
Physical eyeball motor disturbance

Non-concomitant strabismus
clinical situation
Diplopia and Vertigo
Compensatory head position
Divergence of eye position

Limitation of motion
2nd angle of strabismus >1st angle of strabismus

Non-concomitant strabismus
Therapeutics
etiological factor
Drug
triangular prism
operation

Difference between non- and

Comitant strabismus
Onset age
cause

Non-concomitant strabismus

Comitant strabismus

Any age

< 5 years

Congenital; aquired nervous system

disease, trauma,inflammation, vascular
disease, tumor, Metabolic disease

symptom Diplopia, Vertigo, Compensatory head position

unknown

No significant

ocular
movement

limited

normal

Strabism
angle

2nd angle >1st angle

Fixation to limited direction : angle increase

1st angle 2nd angle

Constant angle

Amblyopia

Amblyopia
Amblyopia
the visual development dysfunction of single/
double eye(s) because of insufficiency of
visual stimulation into eye(s) form
deprivation , and (or) difference between
double eyes vision import which causes
competition inhibition on the key period of
visual development .

BCVA 0.8

Amblyopia
Classification and causes

Degree

strabismic amblyopia

slight

Anisometropic amblyopia

middle

ametropic amblyopia
form deprivation amblyopia
Other causes

BCVA: 0.6 0.8

BCVA: 0.2 0.5

severe
BCVA: 0.1

Amblyopia
Clinical situation
Poor vision
Crowding phenomenon
Abnormal fixation
PVEP abnormality
Disfunction of binocular single vision
Elimination of other visual disfunction

Amblyopia
Therapeutics
correction of refractive errors
amblyopia exercise