ANISOMETROPIA

dr. Ameria Paramita, SpM, MARS

BW Luxury Hotel, 21 September 2019
Jambi
 ANISOMETROPIA ≠ ANISEIKONIA

Anisometropia Aniseikonia

Unequal total Unequal size or

refraction shape of image
between the two between the two
eyes eyes
DEFINITION

 Derived from Greek, made up of four parts:

 An- (not)
 iso- (equal)
 metr-(measure)
 opia (vision)
 Total refraction of the two eyes is unequal
 Difference of 1 D in two eyes cause a 2 % difference in the
size of the two retinal images
 Tolerated until 5 % difference
 2.5 D - well tolerated
 2.5 – 4 D – individual sensitivity
 > 4 D – not tolerated
 Alternate vision when one of the two eyes is used
at a time
 Occurs when one eye is emmetropic or moderately
 hypermetropic and the other myopic
 Patient uses former eye for distant vision and later
for near vision
 Anisometropia leads to development of squint
Etiology

 Congenital and developmental

 Acquired
 Uniocular aphakia
 Wrong power IOL
 Trauma
 Post Keratoplasty
Classification

 Absolute anisometropia : It is that condition in

which the refractive power of two eyes is unequal.
 Relative anisometropia : The total refraction of the
two eyes can be equal, but the axial length may be
different  This will lead to clear retinal image but
a difference in the size of the retinal images.
 Simple
 One eye normal, other myopic / hypermetropic
 Compound
 Both eyes either myopic / hypermetropic
 Mixed
 One eye myopic, other eye hypermetropic
Signs and symptoms

 Amblyopia
 Strabismus
 Diplopia
 Headaches
 Eye Strain
 Light Sensitivity
 Difficulty Reading
 Impaired Depth Perception.
 If fellow eye is close to emmetropic, there may be
asymptomatic.
 Tend to close or rub one eye.
 For very young, parents should note :
 Any preferential looking
 Headache
 Failure to reach developmental milestones specially with
mobility.
 Status of vision :
 Binocular Single Vision : present in small degree of
anisometropia.
 Uniocular Vision : When refractive error in one eye is of
high degree.
 Alternating Vision : occurs when one eye is hyperopic
and other myopic , then hyperopic eye is used for distant
vision and myopic for near.
Diagnosis

 Visual Acuity
 Dry & Wet (Cycloplegic) Refraction
 Subjective (snellen chart) or objective (retinometry)
 Biometry (Keratometry/Topography & A-scan)
 Axial Length
 Corneal curvature
 Measurement of Deviations.
 Binocular Vision :
 “FRIEND” Test
 Worth’s Four Dot Test (WFDT)
 “TNO” Test to assess stereopsis.
“FRIEND” test

 F, I, N - GREEN
 R,E,D - RED
1. The patient wears red green F R I EN D
goggles and is seated at a
distance of 6m from the chart
2. Binocular single vision- will
read FRIEND at once
3. Uniocular vision – will read
either FIN or RED
4. Alternate vision– will read FIN
at one time and RED at other
time
Worth’s Four Dot Test
 Sees all four lights in absence of
manifest squint normal binocular
vision
 ARC- sees four lights in presence
of manifest squint
 Sees 2 red lights- LE
suppression
 Sees 3 green lights- RE
suppression
 Sees 2 red and 3 green
alternately- alternate suppression
 Sees 5 lights (2red, 3 green)-
diplopia
“TNO” test

 To determine depth
perceptions especially in
young age
 It graded to provide
retinal disparities from
15 to 480 sec of arc
 Consist of a booklet
containing 7 plates
 Each plates contain two
type of figures which can
be perceived when
viewed binocularly with
red green spectacles
Management / Therapy

 Glasses
 Contact Lenses
 Refractive Surgeries
 Some Specific Modalities
 GLASSES
 In children  prescribe full refractive difference
regardless of age, presence of strabismus or not, degree
of anisometropia
 The corrective spectacles can be tolerated up to a
maximum difference of 4D,after that diplopia occurs.
 So in children where best corrected visual acuity is
required in both eyes, contact lenses are preferred
 In adults, the more ametropic eye is under corrected
 In adults with alternating vision the condition is usually
left alone
 CONTACT LENSES
 Advised for :
 Higher degrees of anisometropia
 Children
 High degrees of astigmatism
 Soft lenses or Rigid Gas Permeable (RGP) lenses
 OTHER MODALITIES
 Intraocular lens implantation for uniocular aphakia
 Refractive corneal surgery for unilateral
myopia,astigmatism,hypermetropia
 Phakic refractive lenses(PRL) - for 4 to 10D
 Refractive lens exchange(RLE) - for more than 10D
 LASIK : Laser Assisted in Situ Keratomileusis