refractive errors (gangguan refraksi)

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REFRACTIVE ERRORS 11/3/2014 REFRACTIVE ERRORS Z A L D I 1 Z A L D I FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SUMATERA UTARA MEDAN 2014

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Page 1: Refractive Errors (gangguan refraksi)

REFRACTIVE ERRORS

11/3/2014REFRACTIVE ERRORS Z A L D I

1

Z A L D I

FAKULTAS KEDOKTERAN

UNIVERSITAS ISLAM SUMATERA UTARA

MEDAN

2014

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11/3/2014REFRACTIVE ERRORS Z A L D I2

Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.

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I. TUJUAN INSTRUKSIONAL UMUM

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa kelainan refraksi

dan dapat memberikan koreksi terbaik bagi pasien

dengan melakukan pemeriksaan sederhana yang

akan dipelajari selama masa perkuliahan secara

baik dan benar .

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II. TUJUAN INSTRUKSIONAL KHUSUS

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa dan memberikan

koreksi kacamata yang sesuai bagi pasien miopia ,

hipermetropia , astigmatisma dan presbiopia

dengan baik dan benar sesuai dengan

kompetensinya

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VISUAL EXAMINATION

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REFRACTIVE ERRORS Z A L D I

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VISUAL ACUITY

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SNELLEN CHART = 6/6 – 6/60

FINGER COUNTING ( FC ) = 5/60 – 0,5/60

HAND MOVEMENT ( HM ) = 1/300

LIGHT PERCEPTION ( LP ) = 1/∞

NO LIGHT PERCEPTION ( NLP ) = 0

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MAGNITUDE OF VISUAL

IMPAIRMENT

(Visual Acuity <6/18)

153 Million

Uncorrected

Refractive Errors

161 Million

Eye Diseases

= 314 Million

People severely visually impaired

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517million uncorrected presbyopes

In addition, recent studies indicate that there are:

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EMMETROPIA

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REFRACTIVE ERRORS

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= REFRACTIVE DISORDERS

= ANOMALI REFRAKSI

= KELAINAN REFRAKSI

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CLASSIFICATION

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REFRACTIVE ERRORS :

A. FAR VISION

1. MYOPIA

2. HYPERMETROPIA

3. ASTIGMATISM ( 5 )

B. NEAR VISION : PRESBYOPIA

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FOCUS NODE IN MACULA

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REFRACTIVE ERRORS Z A L D I

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THE ROLE OF OPTICAL DEFOCUS

Optically Imposed MyopiaTo compensate, the eye must

become more hyperopic.

Optically Imposed

HyperopiaTo compensate, the eye must

become more myopic.

Positive Treatment

Lens

Negative Treatment

Lens

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EMMETROPIA

Is the condition when the

parallel rays focused

exactly on the macula of

the eye in relax condition

---> the visual acuity is

maximum

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MYOPIA

Refractive condition in which, with accommodation completely relaxed, parallel rays are brought to a focus in front of the macula.

Myopic eye :refractive state overplus power

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ETIOLOGY

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Axial : The antero-posterior axis of the eye ball > normal

in this case, the refraction power of the cornea, lens and the lens position

are normal. The eye usually looks like proptosis

Curvature :

The size of the eye ball ---> normal, but there is a increasing of the

cornea/lens curvature

The change of the lens e.g. : intumescens cataract

Increasing of the refraction index

could occur on Diabetic patient

Changes of the lens location

changes of the lens position to the anterior after glaucoma surgery

lens subluxation

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SIGNS & SYMPTOMS

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Clinical findings :

Farsightedness are blurred, nearsightedness are normal

Asthenopia

On high myopia : hemeralopia occurred caused by periphery

retinal degeneration

Floating spots visualization caused by vitreous degeneration

screw up the eye lids together, in order to get a better vision

On high myopia -> proptosis simulation, deep Anterior Chamber

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COMPLICATIONS

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Commonly occurred on high myopia

1. Degenarated and liquefied vitreous

2. Retinal detachment

3. Pigmentation changes + Macular bleeding

4. Strabismus

5. Amblyopia

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CLASSIFICATION

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Myopia classification :

< 3.00 D = low myopia

3.00 - 6.00 D = moderate myopia

> 6.00 D = high myopia/gravis

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MANAGEMENT

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Treatment :

Low and moderate myopia : full correction with weakestspherical lens that give the best visual acuity

Example : VOD = 5/60 S -2.50 D = 6/7

S -2.75 D = 6/6

S -3.00 D = 6/6

S -3.25 D = 6/7

The glasses are ???

Contact Lens

Laser ( LASIK , PRK )

Clear Lens Extraction

Phakic IOL

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HYPERMETROPIA

Is a refraction anomaly that

without accommodation parallel

rays will be focused behind the

retina

Divergent rays from near

object, will be focused farther

behind the retina

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ETIOLOGY

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Axial ---> eye ball diameter < N

Deminished convexity of cornea/lens curvature

Decreasing Refractive index

Changed lens position

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CLINICAL MANIFESTASION

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H. Manifest ---> is detected without paralazing

accommodation and is represented by the strongest

convex glass needed , the patient sees most distinctly.

It correspons to the amount of accommodation which he

relaxes when a convex lens is placed before the eye.

Devided into two types :

Facultative : Can be overcome by an effort of accommodation

Absolute : Can not be overcome

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CLINICAL MANIFESTATION

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Total Hipermetrop : detected after the accommodation

has been paralyzed with cylcopegic agents

Latent Hypermetrop : is the diference of the total

hypermetrop with the manifest hypermetrop

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Latent Hypermetropia

Manifest Hypermetropia

Hypermetropia

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CLINICAL MANIFESTATION

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CLINICAL FINDING

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Nearsightness are blurred

High hypermetropia at old age : farsightedness also

blurred

Astenophia accommodative (eye strain)

Children : high hypermetropia usually occurring

convergent strabismus (convergent squint)

* Treatment : Glasses !!!!!

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ASTIGMATISM

Refractive condition ofthe eye in which there isa difference in degree ofrefraction in differentmeridian, each willfocused parallel rays ata different point.

The shape of theimages : Line, oval, circle, never

a point

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ETIOLOGY

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Etiology of Astigmatism :

Corneal curvature disturbances ---> 90%

Lens curvature disturbances ---> 10%

0

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CLINICAL FINDING

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Nearsightness or farsightedness are blurred

Astenophia (eye strain)

Headache

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TYPE OF ASTIGMATISM

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Ast. M. Simplex C-2.00 X 90

Ast. H. Simplex C+2.00 X 45

Ast. M Compositium S-1.50 C-1.00 X 60

Ast. H Compositium S+3.00 C+2.00 X 30

Ast. Mixtus S+2.00 C-5.00 X 180

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Ast. M. Simplex Ast. H. Simplex

Ast. M Compositium Ast. H Compositium

Ast. Mixtus

CLINICAL MANIFESTATIONS

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MANAGEMENT

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Glasses

Contact Lens

LASIK

Refractive Surgery ( Keratotomi Radial )

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PRESBYOPIA

Physiological changes because accommodation

capability is lowering at old age

Accommodation

Age

16

10

6

2

10 20 40 50 60

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PRESBYOPIA CORRECTION

Presbiopia additions :

40 years old S + 1.00 D

45 years old S + 1.50 D

50 years old S + 2.00 D

55 years old S + 2.50 D

60 years old S + 3.00 D

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GLASSES PRESCRIPTION

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FAR CORRECTION PLUS ADDITION

EXAMPLE ; MALE , 50 YEARS

RE : S -1,50 D AND LE : S +1,00 D

ADDITION : S +2,00 D

R/ RE : S -1,50 AND LE : S +1,00 D

NEAR CORRECTION : RE : S +0,50 D

AND LE : S +3,00 d

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REFERENCES

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American Academy of Ophthalmology, Clinical

Refraction , 2011-2012

Khurana AK, Comprehensive Ophthalmology, Fourth

Edition , New Delhi, New Age Internasional (p) Limited

Publisher, 2007.

Vaughan & Asbury's : General Ophthalmology

17th Edition , Mc Graw- Hill’s Companies , May 2007

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Segala puji bagi Allah, Tuhan semesta alam.