Errors of refraction- presbyopia,

astigmatism
Lucija Franušić
Refraction
 eye =optical system
 focuses light entering through cornea
 passing via the pupil
 formation of an image on the retina
 optical process of vision = light passing from one
transparent medium to another of different optical density
changes its speed and direction of movement =refraction
 refraction = ability of the eye to visualize a distant object
by formation of a clear image on the retina
Errors of refraction
 emmetropia  state when the lens of the eye is relaxed
and an object at least at a distance >6m is sharply focused
on the retina and clearly visualized
 ametropia state when the images of distant objects are
not clearly focused upon the retina (too far forward, too
far back etc.)
Presbyopia/ the Ageing eye
 accommodation enables the eye to
have flexibility of focus (ability to see
both distant and near objects clearly)
 the amplitude of accommodation
gradually diminishes throughout life

 first becomes troublesome when the

near point of the eye has receded so far
that it is beyond comfortable reading or
working distance = hypermetropia
Presbyopia- diagnosis
 refractometry /optometry- objective method of finding
out the error of refraction using refractometer or
optometer
Presbyopia- treatement
1. convex lenses
2. bifocal, multifocal progressive or
variable focus lenses
3. progressive addition lenses
(clarity at all distances)
4. surgical correction- bifocal or
multifocal IOLs are implanted
after lens extraction
Astigmatism
 variation of refraction in different meridians
 caused by cornea not being spherical (e.g. keratoconus)
 regular astigmatism  cornea has its direction of
greatest and least curvature at right angles to one another
 irregular astigmatism  surface of the cornea is
irregular  rays of light are refracted irregularly without
any symmetry (e.g. ulceration, trauma)
Astigmatism- diagnosis
 keratometry /ophthalmometry - objective method of
estimating corneal astigmatism by measuring curvature of
central cornea
Astigmatism- treatement
1. cylindrical lenses
(affecting one set of rays
more than the other)

2. irregular astigmatismit
cannot be corrected- can
only be improved by rigid
contact lenses
 Michaella Lynn, M.D

 board certified in Pediatric Ocular Diseases

 medical degree - State University of New York Downstate Medical
Center,Brooklyn, N.Y.
 residency in pediatrics- Kings County Hospital, Brooklyn
 fellowship training in ocular disease- University of Maryland
Hospital,Baltimore
 Chair of the Department of Pediatrics at the University of
Wisconsin School of Medicine and Public Health
 Pediatrician-in-Chief of the American Family Children's Hospital
 published numerous articles in refereed journals such as the New
England Jounal of Medicine and Pediatrics Journal
The Infant Aphakia Treatment Study Contact
Lens Experience to Age 5 Years
Buddy Russell, M.D., Lindreth DuBois, M.D.,
Michaella Lynn, M.D., Michael A. Ward, M.D.,
Scott R. Lambert, M.D.

N Engl J Med 2017; 43(6):352–357

Introduction
 aphakia is the absence of the lens of the eye
 it is a rare congenital condition and is usually caused by
surgical removal (pseudoaphakia)
 1:10 000 infants
 aim: to describe our experience treating a cohort of
unilateral aphakic infants with contact lenses in the Infant
Aphakia Treatment Study (IATS)
Methods
1. sample
 114 infants with aphakia (56 male, 58 female)
 57 infants were randomized to contact lens wear

1. methods
 examination under anesthesia, including keratometry,
was performed at the time of enrollment and at
approximately 1 year of age and again at 5 years of age
 followed until age 5 years
Results
 24 treated eyes (46%) wore silicone elastomer (SE)
contact lenses,11 eyes (19%) rigid gas permeable (GP)
contact lenses,17 eyes (29%) wore both lens types at
various points of time
 the mean rate of decrease in keratometric power was less
in eyes that wore GP lenses (0.10 D/mo.) compared to
eyes wearing SE lenses (0.22 D/mo.)
 thirteen contact lens-related adverse events occurred
among 7 patients after age 1 year
Conclusion
 cohort of infants with unilateral aphakia successfully wore
contact lenses with relatively few adverse events
 the GP lens prevents the cornea from flattening and has a
better effect than SE lens
 contact lenses provide a safe and effective treatment for
infantile unilateral aphakia and are the recommended
method of correction during the first six months of life
based on equal visual outcomes with primary intraocular
lens implantation