Topic: OPTICS AND REFRACTION
Lecturer: Franz Marie O. Cruz, MD
Legend: ** NOTES
Refraction
Definition
Physics: change in the direction of a wave due
to change in its transmission medium
Bending of a light wave as it enters a
medium where its speed is different
Medicine: clinical test in which a
phoropter/loose lenses may be used to
determine the eyes refractive error and the
best corrective lenses to be described
**The amount on bending depends on the indices
of refraction of the 2 media and is quantitatvely
described in Snells law
Optics of the human eye
Eye is analogous to a camera
Cornea = lens filter
Iris = adjustable diaphragm
Pupil = adjustable aperture
Crystalline lens = lens
Retina = film
Sclera = camera body
**Eye is analogous to a camera. Image-forming
light enters the eye through the cornea and is
refracted by both the cornea and the crystalline
lens. The diameter of the incoming beam of light is
controlled by the iris and is analogous to the
adjustable diaphragm in the camera. The opening
of the iris is called the pupil and is likened to the
adjustable aperture in the camera. The light rays
meet to form an image of the retina. The image is
inverted as it is in a camera. The sclera houses all
these structures much like the camera body.
2 Refracting Elements
1. Cornea
Acts like a converging lens
Accounts for 2/3 refractile power of the
eye
40 diopters
Focal length is constant/fixed
Corneal curvature
**The eye has to refracting elements. The cornea
and the crystalline lens. The cornea which forms a
part of the ocular surface acts like a converging lens
and accounts for 2/3 refractile power of the eye.
This is equal to 40 diopters. The focal length of the
cornea is fixed or constant and is dependent on the
corneal curvature.
2. Crystalline Lens
Thicker at the center than at the
edges
Converging lens
1/3 refractile power
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20 diopters
Focal length varies by changing the
shape of the lens allows eyes to
focus at different distances
Produces real, inverted image on
the retina
**The crystalline which is located in the anterior
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segment of the eye is a converging lens. It is thicker
at the center than at its edges. It accounts for 1/3 of
the refractile power of the eye and this is
approximately equal to 20 diopters. Unlike the
cornea, the focal length of the lens varies. This is
achieved by changing the shape of the lens and this
allows the eye to focus at different distances. A
person with no refractive error can see clearing at
distance and near. The 2 converging lens system of
the eye produces images that are real and inverted
on the retina.
Pupil
- Central opening of the iris
- Diameter of the pupil changes with ambient
light
- Bigger pupil diameter in the dark
- Smaller pupil diameter in bright
light
- Smaller pupil reduces spherical aberration
(causes image blur)
Accommodation
Process by which the eye changes in optical
power to maintain clear image of an object
as its distance varies
Part of the near reflex triad: convergence
and pupillary miosis
During accommodation, the ciliary body
contracts slackening of the zonule fibers
lens assumes a spherical shape lens
becomes more positive allows eye to
have a focused image of near object
Ciliary body is relaxed, lens zonules are taut,
Lens is flat
Ciliary body contracts, Lens zonules are relaxed,
Lens assumes a spherical shape
**This is a diagramatic explanation on how changes
in the shape of the lens allow for clear distance and
close vision. Light rays from a distance object are
parallel when they reach the eye, so you do not
need much refraction or converging power to bring
them to a focus on the retina. On the other hand,
light rays from a near object diverges and you need
more refraction to focus properly
Refraction by ICEMAN Bastinen
Emmetropia
When parallel light rays are focused sharply on the
retina
Ametropia
When the eye is unable to bring parallel light rays
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from a distant object into focus on the retina
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 **There are 4 types of refractive errors. Refractive
Errors affects an estimate of 2.3 billion worldwide.
Of this, 670 million have uncorrected or
inadequately corrected refractive errors. 90% reside
in rural areas and low-income countries. Because of
this, WHO has named errors of refraction as one of
its 5 priority diseases in its advocacy to eliminate
avoidable blindness globally by year 2020

Determinants of Refractive Errors:

1. Corneal curvature
2. Axial length length of the eyeball
3. Loss of accommodation

**There are 3 determinants of refractive errors: the

corneal curvature, axial length of the eye of the
length of the eyeball from the cornea to the retina
and age-related decline in accommodation.

1. Hyperopia Far-sightedness
Causes:
- Insufficient convergence power (lens or
cornea) to focus light rays on the retina
**An eye is emmetropic when its converging lens - Short eyeballs
system is able to focus parallel light rights on the Rays focus posterior to the retina
retina resulting to a clear image. On the other hand, Present in babies and young children;
ametropia is defined when the eye is . The focal outgrown as they get older and the eyeball
point may fall in front or behind the retina. This gets longer
results to a blurry image. Corrected by a plus (convergent) spherical
lens
Ametropia
Types of Refractive Errors:
1. Hyperopia
2. Myopia
3. Astigmatism
4. Presbyopia
Incidence of Refractive Errors:
2.3 billion people worldwide suffer
from poor vision due to refractive by ICEMAN Bastinen
errors
670 million have uncorrected or
inadequately corrected refractive
errors
90% reside in rural areas and low- **Hyperopia or farsightedness results from
income countries insufficient convergence power of the eye to focus
One of 5 priority eye diseases of the light rays on the retina. This occurs in people
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Vision 2020: Right to Sight with short eyeballs. The rays focus posterior to the
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program (WHO) retina. Hyperopia is normally present in babies and

young children but they as a rule outgrow them as
they get older and the eyeball gets longer. In
hyperopia, you would a plus or convergent spherical
lens to bring the focal point to the retina.
2. Myopia Near-sightedness
Causes:
- Excessive convergence power (lens or
cornea) to focus light rays on the retina
- Long eyeballs
Rays focus anterior to the retina
Genetically-inherited
Develops in children between the ages 8-
12, progresses during teenage years,
stabilizes by age 20
Corrected by a minus (divergent) spherical
lens
4. Presbyopia
Progressive loss of accommodative
ability of the crystalline lens caused by
the natural process of aging (beginning
at the age of 40 y/o)
Progressive hardening of the lens, loss
of ability to change its shape
Difficulty with near visual work such as
reading, eye strain
Occurs in the presence of myopia,
hyperopia and astigmatism
Remedied optically with plus spherical
lens
**Patients complain that theyre arms are not long
enough

Well-lighted
chart
Appropriate
distance
One eye at a
time
Uncorrected/c
orrected/
pinhole VA
Proper labeling
3. Astigmatism
Cornea and crystalline lens may not
have the same radius of curvature Well-lighted
in all meridians room
More than 1 focal points Appropriate
Results in distortion of vision at all distance
distances Wear reading
Corrected by a cylindrical lens glasses
Proper labeling
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**When we measure visual acuity, we take visual

acuity at distance and visual acuity at near. These
are just reminders when taking the visual acuity.
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One eye at a time, the other eye, non-tested eye

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has to be fully occluded. Uncorrected/corrected VA

the pinhole, Jaeger chart held 14 inches away, wear 2. Contact Lenses: spherical vs toric
reading glasses

Refractive Errors
Prescription of Lenses

**Corrective glasses can be monofocal, bifocal or

**Corrective eye surgeries
Correction of Refractive Errors
1. Spectacle correction: monofocal vs bifocal vs
trifocal
2. Contact Lenses
3. Refractive Surgeries
A. Corrective corneal surgeries
i. Corneal incisions
a. Radial keratotomy
b.Limbal relaxing incisions
ii. Corneal ablative surgeries
a. Photorefractive keratectomy (PRK)
b. Laser-in-situ-keratomileusis (LASIK)
c. Femtosecond LASIK (Intralase)
B. Lens surgeries
i. Cataract surgery
ii Clear Lens extraction
iii. Phakic intraocular lens implantation
trifocal. Monofocal glasses corrects for one distance
only, and its usually for far. Most if not all of you
who wears glasses will have monofocal correction.
Bifocal means there are 2 segments for correction
at 2 distances. Toric contact lenses has a treated or
ballasted are such that it lies at a certain way or
angle on the cornea and doesnt rotate allowing it
to correct the astigmatism.
3. Refractive Surgeries
Corrective corneal surgeries
A. Corneal incisions
i. Radial Keratotomy
ii. Limbal relaxing incisions
iii. Partial thickness peripheral incisions

**There are several ways to correct refractive

errors. The simplest and cheapest ways are thru the

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prescription of spectacles or glasses or contact
lenses.

1. Spectacle correction: monofocal vs bifocal

vs trifocal/multifocal
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b. Corneal ablative surgeries
i. PRK-Photorefractive Keratectomy
ii. LASIK
iii. Femtosecond LASIK
Intraocular Lenses
i. Monofocal
Monofocals are set to provide best corrected
vision at near, intermediate or far distances.
Most people who choose monofocals have their
IOLs set for distance vision and use reading
glasses for near activities. On the other hand, a
person whose IOLs were set to correct near
vision would need glasses to see distant objects
clearly.

ii. Toric
This is a monofocal IOL with astigmatism
correction built into the lens.

Lens Surgeries
i. Cataract Surgery with implantation of
intraocular
lens
ii. Clear Lens Surgery + IOL implantation
iii. Phakic IOL

iii. Multifocal
These newer IOL types reduce or eliminate the

by ICEMAN Bastinen
need for glasses or contact lenses.
In the multifocal type, a series of focal
zones or rings is designed into the IOL.
Depending on where incoming light
focuses through the zones, the person may
be able to see both near and distant
objects clearly.
The design of the accommodative lens
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allows certain eye muscles to move the IOL

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forward and backward, changing the focus

 much as it would with a natural lens,
allowing near and distance vision.
The ability to read and perform other tasks
without glasses varies from person to
person but is generally best when
multifocal or accommodative IOLs are
placed in both eyes.
It usually takes 6 to 12 weeks after surgery
on the second eye for the brain to adapt
and vision improvement to be complete
with either of these IOL types.

iv. Multifocal +Toric

v. Phakic IOL
a special kind of intraocular lens that is
implanted surgically into the eye to correct
myopia (nearsightedness). They are called
"phakic" because the eye's natural lens is left
untouched. This is in contrast to intraocular
lenses that are implanted into eyes after the
eye's natural lens has been removed during
cataract surgery.
Phakic intraocular lenses are indicated for
patients with high refractive errors when the
usual laser options for surgical correction (LASIK
and PRK) are contraindicated

by ICEMAN Bastinen
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