YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ Refractive Errors Dr. Canan Aslı UTİNE.

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1 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ Refractive Errors Dr. Canan Aslı UTİNE

2 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20162 Aim  Learning the types of refractive errors and mechanisms of occurrence in the optical system of the eye  Learning the emetropisation and accommodation mechanisms Objective  To be able to completely classify the refractive errors and completely list the mechanism of occurence of each refractive error of the eye  To be able to completely list the concept, mechanism of occurrence and aim of emmetropisation process  To be able to completely list the elements of near vision reflex triad  To be able to completely list the changes in the eye when looking at distance and at near, according to vonHelmholtz theory

3 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20163

4 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20164

5 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20165

6 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20166 Refractive State of The Eye Corneal power (mean, 43 D) Anterior chamber depth (mean, 3.4 mm) Crystalline lens power (mean, 21 D) Axial length (mean, 24 mm)

7 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20167 Distribution of refraction components Sorsby et al. 1957

8 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20168 Refractive Error A mismatch between the refractive power and the focusing distance of the eye

9 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.20169 Refractive Error Clinically, it is the variation from perfect coincidence of the principal focus of the eye with the retina Parallel rays of light fail to converge to a sharp focus on the retina Affects all ages, sex, race, ethnic groups and religions but with variable prevalence and distribution

10 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201610 Refractive status Emmetropia Ametropia Hyperopia Myopia Astigmatizm Simple myopic Simple hyperopic Compound myopic Compound hyperopic Mixed

11 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201611 Etiology of Ammetropia Axial ammetropia Curvature ammetropia Index ammetropia

12 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201612 Accomodation Von Helmholtz theory Near objectsFar objects

13 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201613 Presbyopia

14 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201614

15 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201615 Hyperopia The refractive power of the eye is too weak so that light focuses behind the retina Total Manifest Latent

16 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201616 Myopia The refractive power of the eye is too much so that light focuses in front of the retina Physiologic (Simple) Pathologic (Degenerative)

17 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201617 Myopia Causes of myopia ?? Nature vs Nurture

18 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201618 Myopia Nature Genetic factors Interactive with environment

19 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201619 Myopia Nurture ? Visual task Eg. Reading, writing, computer, TV, etc. No definite conclusions yet

20 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201620 Astigmatism The refractive power is different in different meridians

21 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201621 Astigmatism

22 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201622 Correction By changing the eyeball length By changing the refractive power Changing the power of the existing structure Adding extra refractive medium

23 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201623 Pin - hole

24 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201624 Correction Myopia : Concave lenses Spectacles

25 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201625 Correction

26 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201626 Correction Spectacles Hyperopia : Convex lenses

27 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201627 Correction Contact lenses Commonly used types Hard lens Rigid gas-permeable lens (RGP) Soft lens Daily wear Extended wear

28 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201628 Contact lens - Complications Change ocular surface environment Hypoxia Allergy & Toxic Mechanical trauma Infection

29 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201629 Correction Refractive surgery Radial keratotomy Photorefractive keratectomy (PRK) Laser assisted subepithelial keratomileusis (LASEK) Laser in situ keratomileusis (LASIK)

30 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201630 Radial keratotomy

31 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201631 LASIK Refraction +6D to -8D Astigmatism <6D Corneal thickness and biomechanical properties Pupil size

32 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201632 LASEK

33 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ 20.09.201633 Refractive Surgery

34 YEDİTEPE ÜNİVERSİTESİ GÖZ HASTANESİ Any question ?