Name: Shumaila Azam

Reg no: 70098213

Subject:Maimoona Rehmat

Topic:Accomodation
Section: B
Accomodation :-
The ability of the eye to change its focus from distant to near objects
(and vice versa). This process is achieved by the lens changing its shape.
Accommodation is the adjustment of the optics of the eye to keep an
object in focus on the retina as its distance from the eye varies.
 Far point: Position of an object when its image clearly falls on
retina with no accommodation.
 Near point: Nearest point clearly seen with maximum
accommodation.
 Range of accommodation: Distance between far point and near
point.

 Amplitude of accommodation: Dioptric power difference between

rest and fully accommodated eye.
 A=P-R (A: amplitude of accommodation: P:dioptric
value of near point; and R: dioptric value of far
point.
 What happens to the near point of accommodation as a person
age?
•During near accommodation, the lens equator moves outward causing
an increase in lens diameter.
•The near point of accommodation gradually recedes from about 7 cm
at the age of 10 years to about 20 cm at the age of 40 years and it
recedes further to about 40 cm at about the age of 50 years.
 What causes near point of accommodation?
•In order to fixate on a near object, the ciliary muscle contracts around
the lens to decrease its size.
•The suspensory zonules of Zinn relax and the radial tension around the
lens is released.
•This causes the lens to form a more spherical shape achieving a higher
level of refractive power.
 How to check near point of accommodation?
• Near point of accommodation “Push Up Test”:

•For this test, use relatively small letters (0.4M or 0.5M) to help better
control accommodation.
•Slowly move these letters closer to the eye until they become blurry.
•Measure the distance the letters became blurry. This is the near point
of accommodation.
 How do you calculate near point?

 Strategy:-The near point is 25 cm from the eye, so the object

distance is do=25 cm. We determine the image distance from the
lens equation.
 Solution:-
di=(1f−1do) −1. =(11.7cm−125cm) −1.
 Significance:-
From the magnification formula, we find m=−1.8cm25cm=−0.073.
 How is near point of accommodation affected by myopia?
• Because of myopia and hypermetropia image is not focused on
retina.
• In myopes image is focused in front of retina and hence near
point is more near to pt.
• While in hyperopes image focused behind retina, patient cannot
see near objects as near point further moves away from eye thus
decreasing amplitude of accommodation.
• Eye and amplitude of accommodation increases in uncorrected
myopes.
 Causes:-

 Decrease in accommodative power of lens with increasing age,

leads to presbyopia, occurs due to:
 Age-related changes in lens:

 Decrease in elasticity of lens capsule, and

 Progressive, increase in size and hardness (sclerosis) of lens

substance which is not easily moulded.
 Age related decline in ciliary muscle power.

 Symptoms:-

 Difficulty in near vision.

 Patients complaint of difficulty in reading small prints •

Asthenopic symptoms due to fatigue of the ciliary muscle are also
complained
 after reading or doing any near work.

 Optical treatment:-

 Prescription of appropriate convex glasses for near work.

 A rough guide for providing presbyopic glasses in an emmetrope

can be made from patient's age.
 About +1 DS is required at the age of 40-45 years,

 +1.5 DS at 45-50 years,

 + 2 DS at 50-55 years,

 +2.5 DS at 55-60 years.

 Surgical Treatment

 Corneal procedures
 Non ablative corneal procedure

 Monovision CK

 Laser based corneal procedure

 Laser thermal keratoplasty (LTK)

 Monovision LASIK.

 Presbyopic bifocal LASIK

 Presbyopic multifocal LASIK C

