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The Lens
Jason Ryan, MD, MPH
The Lens

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Petr Novák, Wikipedia

Wikipedia/Public Domain
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How Lenses Work

Refraction

Light

Focal
Point

Object Lens

Most refraction performed by cornea (fixed)

Some performed by lens (adjustable)
The Lens
• Surrounded by a capsule with type IV collagen
• Avascular
• Nutrients via diffusion
• Contains elongated fiber cells
• Anaerobic metabolism AfraTafreeh.com

• Principle source of energy production

• Glucose → lactic acid
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Accommodation
• Lens modifies shape to focus on near objects
• Lens changes optical power of eye

Jmarchn/Wikipedia
Accommodation
• Ciliary muscle: Smooth muscle within ciliary body
• Changes shape of lens
• Circular muscle – surrounds lens
• Connected to lens by ligaments (zonules)
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Jmarchn/Wikipedia
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Accommodation

Rest State Accommodation

Ciliary muscles relaxed Ciliary muscles contract
Zonules pulled tight Zonules relax
Lens flattens Lens rounds
Focus on far objects Focus on near objects
Lens of the Eye
• Far objects
• Ciliary relax
• Lens flatter
• Near objects
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• Ciliary contract
• Lens rounder
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Presbyopia
• Lens stiffens with age
• Can’t focus on near objects (reading)

Eric Chan/Flikr
Accommodation Reflex
• 3 reflex responses as object moves closer to eye
• #1 Convergence:
• Eyes move medially to track object
• #2 Miosis
• Pupil constricts AfraTafreeh.com
• Block entry of divergent light rays from near object
• #3 Accommodation
• Shape of lens changes
• Focal point maintained on retina
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Refractive Errors
• Impaired vision due to abnormal focal point of eye
• Improved with glasses or contact lenses

PublicDomainImages
Refractive Errors
• Corneal curvature must match eye size
• Failure to match = refractive error

Eye
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Cornea
Light
Object

Lens
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Myopia
Nearsightedness
Eye

Cornea
Object Light

Lens

Focal point is in front of retina

Eye too long or cornea has too much curvature
Can’t focus on far objects (nearsighted)
Myopia
Nearsightedness

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Wikipedia/Public Domain
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Myopia
Nearsightedness
Eye

Cornea
Light
Object

Lens

Corrected with a negative lens

Example: -1.75
Myopia
Nearsightedness

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Gumenyuk I.S./Wikipedia
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Hyperopia
Farsightedness
Eye

Cornea
Object Light

Lens

Focal point is behind retina

Eye too short or cornea has too little curvature
Can’t focus on near objects (farsighted)
Hyperopia
Farsightedness

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Wikipedia/Public Domain
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Hyperopia
Farsightedness
Eye

Cornea
Light
Object

Lens

Corrected with a positive lens

Example: +1.50
Hyperopia
Farsightedness

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Гуменюк И.С. /Wikipedia

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Astigmatism
Eye

Cornea
Light
Object

Lens

Uneven curvature of cornea

Multiple focal points
Objects blurry
Astigmatism

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Normal Cornea Astigmatism

Corrected with lenses or surgery

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Ectopia Lentis
• Dislocation of lens
• Commonly due to trauma
• Rarely associated with systemic disease
• Can occur as ocular manifestation of systemic disease
Ectopia Lentis

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Retina Gallery
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Ectopia Lentis
• Marfan Syndrome
• Most commonly associated systemic condition
• Autosomal dominant disorder; fibrillin defect
• Tall, long wing span
• 50-80% of cases have lens dislocation
• Classically upward/outward lens dislocation
• Homocystinuria
• Cystathionine β synthase deficiency
• Markedly elevated homocysteine levels
• Marfanoid body habitus
• Classically downward/inward lens dislocation
Cataracts

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Image courtesy of Rakesh Ahuja, MD

Wikipedia/Public Domain
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Cataracts
• Opacification of lens
• Painless
• Lead to ↓ vision
• Treated with surgery

Image courtesy of Rakesh Ahuja, MD

Cataracts
Risk Factors

• Older age
• Smoking
• Alcohol
• Excessive sunlight
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• Corticosteroids
• Trauma, infection
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Aldose Reductase
Polyol Pathway

NADPH NADP+

Glucose Sorbitol

Cataracts
Aldose
Accumulation
Reductase
↑ lens osmolarity

Galactose Galactitol
Diabetes
Cataract Risk Factor

• Glucose can be metabolized to sorbitol in lens

NADPH NADP+
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Glucose Sorbitol Fructose

Aldose Sorbitol
Reductase Dehydrogenase
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Galactose Disorders
• Classic Galactosemia
• Presents in infancy
• Live failure
• Cataracts
• Galactokinase deficiency
Wikipedia/Public Domain
• Milder form of galactosemia
• Main problem: cataracts as child/young adult

Aldose
Reductase
Galactose Galactitol
TORCH Infections
• Can lead to cataracts
• Classically part of congenital rubella syndrome
• Deafness
• Cardiac malformations
• “Blueberry muffin” skinAfraTafreeh.com
(extramedullary hematopoiesis)