SlideShare a Scribd company logo
Hyperopia and Presbyopia
Prof K N Jha, MS
Email: kirtinath.jha@gmail.com
Learning Aims
• Hyperopia: Definition, optics, clinical features,
diagnosis, treatment of hyperopia.
• Accommodation: Definition, mechanism,
measurement.
• Presbyopia ( Physiological failure of
accommodation)
• Treatment of presbyopia
Hyperopia
Hyperopia
Total hypermetropia comprises of
• Latent hypermetropia (portion of hypermetropia which
can be revealed only under cycloplegia)
• Manifest hypermetropia
Facultative hypermetropia , the portion which can be
overcome by accommodation.
Absolute hypermetropia , The part that cannot be
compensated by accommodation.
Clinical features
• In young:
-asymptomatic
-asthenopia, burning in the
eyes
-chronic conjunctival
congestion
- Esotropia( convergent
squint)
• In older patients:
Asymptomatic
Early presbyopic symptoms
Examination of the eye
• Small axial length
• Small corneal diameter
• Shallow anterior chamber
• Fundus: Normal, or may suggest features of
pseudopapillitis.
• Predisposition to angle closure glaucoma.
Diagnosis of Hyperopia in Young:
Cycloplegic Refraction
• Cycloplegia is the temporary paralysis of the ciliary
muscle with the use of pharmaceutic agent, to stabilize
refraction.
• Cycloplegic refraction is done in young hyperopes to
avoid overcorrection.
• Cycloplegic drugs: Atropine sulfate 1% ointment 3 times
a day for 3 days; cyclopentolate 1 % drop 2-3 times .
Treatment
• No treatment for low hyperopia in young.
• Spectacle correction with plus lenses in symptomatic adult.
• Correction of hyperopia plus addition for near in presbyopic
age.
• Contact lenses
• Hyperopic LASIK
• Phakic intraocular lens
• Holmium : YAG laser thermokeratoplasty
Correction of Hyperopia
Accommodation
• Accommodation is the mechanism by which
the eye changes refractive power by altering
the shape of its crystalline lens by mechanism
described by Helmholtz.
Mechanism of accommodation
• Contraction of ciliary muscle in response to
parasympathetic stimulation.
• Relaxation of the zonular fibres.
• Lens becomes more convex. The process involves
primarily the front surface of the lens.
• Accommodation occurs all round the circumference
and simultaneously in both the eyes.
• Near point: Nearest point where small objects
can be clearly distinguished is called the near
point.
• Near point varies with static refraction and age.
Amplitude of accommodation: diopters in the
change of lens power during accommodation.
Range of accommodation: distance between
the far point and the near point.
Average amplitude of accommodation
• Age in years In dioptres (D)
8 years 14 ± 2
20 years 11 ±2
40 years 6± 2
60 years 1.5±1
Amplitude of Accommodation and Age
Accommodation and convergence
• Accommodation convergence complex
• Accommodation / convergence ratio (AC/A
ratio)
• Accommodation convergence dissociation
Clinical accommodative problems
• Presbyopia
• Accommodative insufficiency
• Accommodative excess
Presbyopia
• Presbyopia is gradual loss of accommodative
response resulting from loss of elasticity of the
lens.
• It becomes a clinical problem when
accommodative amplitude becomes insufficient
for the patient for near work and reading.
Presbyopia
• Age : usually after 40 years
• Onset depends upon preexisting refractive
error, patients visual task and pupillary size.
Correction of presbyopia
• Convex lens for near work.
• The weakest convex lens is prescribed.
• May be prescribed as bifocal along with
distance correction.
Accommodative insufficiency
• Accommodative insufficiency is premature
loss of accommodation( premature
presbyopia)
• Clinical feature: blurring of near object or,
inability to sustain accommodative effort.
Premature presbyopia: Cause
• Concurrent or past debilitating illness
• Drugs : Parasympatholytic drugs ,tranquillizers
• Neurological disorders e.g. encephalitis
• Head trauma
• Glaucoma
• Diabetes mellitus
Presbyopia
• Treatment : Correction for near vision with
convex lenses.
Accommodative excess
• Spasm of Accommodation
• Mechanism: Ciliary muscle spasm
• Symptoms: Headache, brow ache, variable
blurring of distance vision, abnormally close
near point.
Accommodative excess
Etiology
• Iridocyclitis
• Use of anticholinesterases being used for
glaucoma
• Uncorrected refractive error, hyperopia,
astigmatism
• Prolonged and intense near work
Points to Remember
• Definition, optics, clinical features, diagnosis,
treatment of hyperopia.
• Definition, clinical features and correction of
presbyopia
• Accommodative excess

More Related Content

What's hot

Refractive errors
Refractive errorsRefractive errors
Refractive errors
Muhammad Saim
 
Errors of refraction
Errors of refractionErrors of refraction
Errors of refraction
Dr Saurabh Kushwaha
 
Refractive Errors
Refractive ErrorsRefractive Errors
Refractive Errors
OphthalmicDocs Chiong
 
Myopia eye disease
Myopia eye diseaseMyopia eye disease
Myopia eye disease
dgbullet
 
Refraction and refractive errors
Refraction and refractive errorsRefraction and refractive errors
Refraction and refractive errors
Dr Mohd Najmussadiq Khan
 
Aphakia
AphakiaAphakia
Hypermetropia
HypermetropiaHypermetropia
Hypermetropia
SIDESH HENDAVITHARANA
 
Refraction in different refractive errors and their Management
Refraction in different refractive errors and their ManagementRefraction in different refractive errors and their Management
Refraction in different refractive errors and their Management
DrArvindMorya
 
Myopia
MyopiaMyopia
Aphakia by SURAJ CHHETRI
Aphakia  by SURAJ CHHETRIAphakia  by SURAJ CHHETRI
Aphakia by SURAJ CHHETRI
Suraj Chhetri
 
Retinoscopy and its principles
Retinoscopy and its principlesRetinoscopy and its principles
Retinoscopy and its principles
Laxmi Eye Institute
 
Refractive error
Refractive errorRefractive error
Refractive error
RAVI RAI DANGI
 
Aphakia and pseudophakia
Aphakia and pseudophakiaAphakia and pseudophakia
Aphakia and pseudophakia
shweta goyal
 
Optics of ametropia
Optics of ametropiaOptics of ametropia
Optics of ametropia
SSSIHMS-PG
 
Sau
SauSau
Presbyopia, Anisometropia & Aphakia
Presbyopia, Anisometropia & AphakiaPresbyopia, Anisometropia & Aphakia
Presbyopia, Anisometropia & Aphakia
Oussama Alserwy
 
Hypermetropia ppt
Hypermetropia pptHypermetropia ppt
Hypermetropia ppt
avinas
 
Aphakia
AphakiaAphakia
By pd aphakia & pseudophakia
By pd aphakia & pseudophakiaBy pd aphakia & pseudophakia
By pd aphakia & pseudophakia
Pushkar Dhir
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
Umesh Belbase
 

What's hot (20)

Refractive errors
Refractive errorsRefractive errors
Refractive errors
 
Errors of refraction
Errors of refractionErrors of refraction
Errors of refraction
 
Refractive Errors
Refractive ErrorsRefractive Errors
Refractive Errors
 
Myopia eye disease
Myopia eye diseaseMyopia eye disease
Myopia eye disease
 
Refraction and refractive errors
Refraction and refractive errorsRefraction and refractive errors
Refraction and refractive errors
 
Aphakia
AphakiaAphakia
Aphakia
 
Hypermetropia
HypermetropiaHypermetropia
Hypermetropia
 
Refraction in different refractive errors and their Management
Refraction in different refractive errors and their ManagementRefraction in different refractive errors and their Management
Refraction in different refractive errors and their Management
 
Myopia
MyopiaMyopia
Myopia
 
Aphakia by SURAJ CHHETRI
Aphakia  by SURAJ CHHETRIAphakia  by SURAJ CHHETRI
Aphakia by SURAJ CHHETRI
 
Retinoscopy and its principles
Retinoscopy and its principlesRetinoscopy and its principles
Retinoscopy and its principles
 
Refractive error
Refractive errorRefractive error
Refractive error
 
Aphakia and pseudophakia
Aphakia and pseudophakiaAphakia and pseudophakia
Aphakia and pseudophakia
 
Optics of ametropia
Optics of ametropiaOptics of ametropia
Optics of ametropia
 
Sau
SauSau
Sau
 
Presbyopia, Anisometropia & Aphakia
Presbyopia, Anisometropia & AphakiaPresbyopia, Anisometropia & Aphakia
Presbyopia, Anisometropia & Aphakia
 
Hypermetropia ppt
Hypermetropia pptHypermetropia ppt
Hypermetropia ppt
 
Aphakia
AphakiaAphakia
Aphakia
 
By pd aphakia & pseudophakia
By pd aphakia & pseudophakiaBy pd aphakia & pseudophakia
By pd aphakia & pseudophakia
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
 

Viewers also liked

Presbyopia
PresbyopiaPresbyopia
NETRA on SIGGRAPH 2010
NETRA on SIGGRAPH 2010NETRA on SIGGRAPH 2010
NETRA on SIGGRAPH 2010
Vitor Pamplona
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
Aparna Badri
 
Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...
Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...
Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...
TONY SCARIA
 
Astigmatism - Common Eye Condition
Astigmatism - Common Eye ConditionAstigmatism - Common Eye Condition
Astigmatism - Common Eye Condition
rickjohn283
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
noel herrera
 
Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...
Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...
Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...
presmedaustralia
 
Corneal surgery
Corneal surgeryCorneal surgery
Corneal surgery
shree sagar
 
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
parkavenuelasek
 
Retinoscopy
RetinoscopyRetinoscopy
Retinoscopy
Ankush Weginwar
 
Astigmatism correction
Astigmatism correctionAstigmatism correction
Astigmatism correction
Farhana Islam
 
Astigmatism, anisometropia, anisekonia.
Astigmatism, anisometropia, anisekonia.Astigmatism, anisometropia, anisekonia.
Astigmatism, anisometropia, anisekonia.
Vishy Srivastava
 
Global Blindness: Managing presbyopia
Global Blindness: Managing presbyopiaGlobal Blindness: Managing presbyopia
Presbyopia
PresbyopiaPresbyopia
Presbyopia
bizalum
 
Correcting presbyopia - Modern Options
Correcting presbyopia - Modern OptionsCorrecting presbyopia - Modern Options
Correcting presbyopia - Modern Options
Jason Higginbotham
 
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)
Bikash Sapkota
 
Laser Blended Vision for Presbyopia:
Laser Blended Vision for Presbyopia: Laser Blended Vision for Presbyopia:
Laser Blended Vision for Presbyopia:
London Vision Clinic
 
Presbiopia by stanley ogochukwu okerulu
Presbiopia by stanley ogochukwu okeruluPresbiopia by stanley ogochukwu okerulu
Presbiopia by stanley ogochukwu okerulu
Stanley Ogochukwu Okerulu
 
Advances in presbyopia treatment
Advances in presbyopia treatmentAdvances in presbyopia treatment
Advances in presbyopia treatment
perfectvision
 
refractive surgeries
refractive surgeriesrefractive surgeries
refractive surgeries
nehapathak88
 

Viewers also liked (20)

Presbyopia
PresbyopiaPresbyopia
Presbyopia
 
NETRA on SIGGRAPH 2010
NETRA on SIGGRAPH 2010NETRA on SIGGRAPH 2010
NETRA on SIGGRAPH 2010
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
 
Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...
Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...
Refractive errors of eye ophthalmology astigmatism hypermetropia myopia medic...
 
Astigmatism - Common Eye Condition
Astigmatism - Common Eye ConditionAstigmatism - Common Eye Condition
Astigmatism - Common Eye Condition
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
 
Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...
Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...
Laser Vision Clinic Central Coast results for 2013 and Presbyopia management ...
 
Corneal surgery
Corneal surgeryCorneal surgery
Corneal surgery
 
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
 
Retinoscopy
RetinoscopyRetinoscopy
Retinoscopy
 
Astigmatism correction
Astigmatism correctionAstigmatism correction
Astigmatism correction
 
Astigmatism, anisometropia, anisekonia.
Astigmatism, anisometropia, anisekonia.Astigmatism, anisometropia, anisekonia.
Astigmatism, anisometropia, anisekonia.
 
Global Blindness: Managing presbyopia
Global Blindness: Managing presbyopiaGlobal Blindness: Managing presbyopia
Global Blindness: Managing presbyopia
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
 
Correcting presbyopia - Modern Options
Correcting presbyopia - Modern OptionsCorrecting presbyopia - Modern Options
Correcting presbyopia - Modern Options
 
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)
 
Laser Blended Vision for Presbyopia:
Laser Blended Vision for Presbyopia: Laser Blended Vision for Presbyopia:
Laser Blended Vision for Presbyopia:
 
Presbiopia by stanley ogochukwu okerulu
Presbiopia by stanley ogochukwu okeruluPresbiopia by stanley ogochukwu okerulu
Presbiopia by stanley ogochukwu okerulu
 
Advances in presbyopia treatment
Advances in presbyopia treatmentAdvances in presbyopia treatment
Advances in presbyopia treatment
 
refractive surgeries
refractive surgeriesrefractive surgeries
refractive surgeries
 

Similar to Refraction 2 k n jha 25.08.16

Refractive errors correction
Refractive  errors correctionRefractive  errors correction
Refractive errors correction
Desta Genete
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
Ahmed Almumtin
 
MYOPIA.pptx
MYOPIA.pptxMYOPIA.pptx
MYOPIA.pptx
udayasree30
 
Errors 1
Errors 1Errors 1
Visual acuity and its disturbances (asik)
Visual acuity and its disturbances (asik)Visual acuity and its disturbances (asik)
Visual acuity and its disturbances (asik)
Asik Pradhan
 
Hypermetropia
HypermetropiaHypermetropia
Hypermetropia
adityarana242502
 
Hypermetropia
HypermetropiaHypermetropia
Hypermetropia
Hossein Mirzaie
 
Accomodation and its anomalies
Accomodation and its anomaliesAccomodation and its anomalies
Accomodation and its anomalies
Sahibzada H. Anjum Nadeem
 
Refractiveerrors 130309052054-phpapp01
Refractiveerrors 130309052054-phpapp01Refractiveerrors 130309052054-phpapp01
Refractiveerrors 130309052054-phpapp01
Amarjeet Sinha
 
Accommodation and convergence
Accommodation and convergenceAccommodation and convergence
Accommodation and convergence
SAMEEKSHA AGRAWAL
 
Hypermetropia/Hyperopia
Hypermetropia/HyperopiaHypermetropia/Hyperopia
Hypermetropia/Hyperopia
Suraj Shil
 
Accomodation and its anomalies
Accomodation and its anomaliesAccomodation and its anomalies
Accomodation and its anomalies
AyushiPatel59
 
Accommodation optics, theory and anomalies of Accommodation Dr. Anand Trivedi
Accommodation optics, theory and anomalies of Accommodation Dr. Anand TrivediAccommodation optics, theory and anomalies of Accommodation Dr. Anand Trivedi
Accommodation optics, theory and anomalies of Accommodation Dr. Anand Trivedi
AnandTrivedi24
 
Presbyopia by Juned ppt.
 Presbyopia by Juned ppt.  Presbyopia by Juned ppt.
Presbyopia by Juned ppt.
Juned Choudhary
 
Prescription of glasses in children
Prescription of glasses in childrenPrescription of glasses in children
Prescription of glasses in children
Eranda Wannigama
 
Reffraction myopia by Dr Abdul Basir safi eye surgeon from Afghanistan
Reffraction myopia by Dr Abdul Basir safi eye surgeon from AfghanistanReffraction myopia by Dr Abdul Basir safi eye surgeon from Afghanistan
Reffraction myopia by Dr Abdul Basir safi eye surgeon from Afghanistan
Dr Abdul Basir Safi
 
OPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIA
OPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIAOPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIA
OPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIA
kadayathsandeep
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
SSSIHMS-PG
 
Myopia lecture By Sumayya Naseem
Myopia lecture By Sumayya NaseemMyopia lecture By Sumayya Naseem
Myopia lecture By Sumayya Naseem
Sumayya Naseem
 
Esotropia
EsotropiaEsotropia
Esotropia
PRAKRITIYAGNAM
 

Similar to Refraction 2 k n jha 25.08.16 (20)

Refractive errors correction
Refractive  errors correctionRefractive  errors correction
Refractive errors correction
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
 
MYOPIA.pptx
MYOPIA.pptxMYOPIA.pptx
MYOPIA.pptx
 
Errors 1
Errors 1Errors 1
Errors 1
 
Visual acuity and its disturbances (asik)
Visual acuity and its disturbances (asik)Visual acuity and its disturbances (asik)
Visual acuity and its disturbances (asik)
 
Hypermetropia
HypermetropiaHypermetropia
Hypermetropia
 
Hypermetropia
HypermetropiaHypermetropia
Hypermetropia
 
Accomodation and its anomalies
Accomodation and its anomaliesAccomodation and its anomalies
Accomodation and its anomalies
 
Refractiveerrors 130309052054-phpapp01
Refractiveerrors 130309052054-phpapp01Refractiveerrors 130309052054-phpapp01
Refractiveerrors 130309052054-phpapp01
 
Accommodation and convergence
Accommodation and convergenceAccommodation and convergence
Accommodation and convergence
 
Hypermetropia/Hyperopia
Hypermetropia/HyperopiaHypermetropia/Hyperopia
Hypermetropia/Hyperopia
 
Accomodation and its anomalies
Accomodation and its anomaliesAccomodation and its anomalies
Accomodation and its anomalies
 
Accommodation optics, theory and anomalies of Accommodation Dr. Anand Trivedi
Accommodation optics, theory and anomalies of Accommodation Dr. Anand TrivediAccommodation optics, theory and anomalies of Accommodation Dr. Anand Trivedi
Accommodation optics, theory and anomalies of Accommodation Dr. Anand Trivedi
 
Presbyopia by Juned ppt.
 Presbyopia by Juned ppt.  Presbyopia by Juned ppt.
Presbyopia by Juned ppt.
 
Prescription of glasses in children
Prescription of glasses in childrenPrescription of glasses in children
Prescription of glasses in children
 
Reffraction myopia by Dr Abdul Basir safi eye surgeon from Afghanistan
Reffraction myopia by Dr Abdul Basir safi eye surgeon from AfghanistanReffraction myopia by Dr Abdul Basir safi eye surgeon from Afghanistan
Reffraction myopia by Dr Abdul Basir safi eye surgeon from Afghanistan
 
OPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIA
OPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIAOPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIA
OPHTHALMOLOGY PRESENTATION, TOPIC ON MYOPIA
 
Presbyopia
PresbyopiaPresbyopia
Presbyopia
 
Myopia lecture By Sumayya Naseem
Myopia lecture By Sumayya NaseemMyopia lecture By Sumayya Naseem
Myopia lecture By Sumayya Naseem
 
Esotropia
EsotropiaEsotropia
Esotropia
 

More from ophthalmgmcri

Csom aa, 10.04.17, s.s.bakshi
Csom aa, 10.04.17,  s.s.bakshiCsom aa, 10.04.17,  s.s.bakshi
Csom aa, 10.04.17, s.s.bakshi
ophthalmgmcri
 
Csom.dr.bini,03.04.17
Csom.dr.bini,03.04.17Csom.dr.bini,03.04.17
Csom.dr.bini,03.04.17
ophthalmgmcri
 
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm, 20.03.17
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm,   20.03.17Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm,   20.03.17
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm, 20.03.17
ophthalmgmcri
 
Lens iii 13.04.17 - dr.n.swathi
Lens iii 13.04.17 - dr.n.swathiLens iii 13.04.17 - dr.n.swathi
Lens iii 13.04.17 - dr.n.swathi
ophthalmgmcri
 
Lens ii 12.04.17,n.swathi.n
Lens ii 12.04.17,n.swathi.nLens ii 12.04.17,n.swathi.n
Lens ii 12.04.17,n.swathi.n
ophthalmgmcri
 
Lens i 06.04.17,dr.n.swathi
Lens i 06.04.17,dr.n.swathiLens i 06.04.17,dr.n.swathi
Lens i 06.04.17,dr.n.swathi
ophthalmgmcri
 
Uvea 3,22.03.17
Uvea 3,22.03.17Uvea 3,22.03.17
Uvea 3,22.03.17
ophthalmgmcri
 
Uvea 2,16.03.17
Uvea 2,16.03.17Uvea 2,16.03.17
Uvea 2,16.03.17
ophthalmgmcri
 
Uvea 1,15.03.17
Uvea 1,15.03.17Uvea 1,15.03.17
Uvea 1,15.03.17
ophthalmgmcri
 
Ocular pharmacology ii, dr.kurinchi, 22.06.17
Ocular pharmacology ii, dr.kurinchi, 22.06.17Ocular pharmacology ii, dr.kurinchi, 22.06.17
Ocular pharmacology ii, dr.kurinchi, 22.06.17
ophthalmgmcri
 
Ocular pharmacology i,dr.kuricnchi,16.03.17
Ocular pharmacology i,dr.kuricnchi,16.03.17Ocular pharmacology i,dr.kuricnchi,16.03.17
Ocular pharmacology i,dr.kuricnchi,16.03.17
ophthalmgmcri
 
Dr.A.R.Rajalakshmi, 8.2.17 chronic conjunctivitis ii
Dr.A.R.Rajalakshmi,  8.2.17 chronic conjunctivitis iiDr.A.R.Rajalakshmi,  8.2.17 chronic conjunctivitis ii
Dr.A.R.Rajalakshmi, 8.2.17 chronic conjunctivitis ii
ophthalmgmcri
 
Dr.A.R.Rajalakshmi, 02.2.17 intro, acute conj - i
Dr.A.R.Rajalakshmi, 02.2.17   intro, acute conj  - iDr.A.R.Rajalakshmi, 02.2.17   intro, acute conj  - i
Dr.A.R.Rajalakshmi, 02.2.17 intro, acute conj - i
ophthalmgmcri
 
Dr.r.subramaniyan, 09 3-17,Aqueous Humour Dynamics
Dr.r.subramaniyan, 09 3-17,Aqueous Humour DynamicsDr.r.subramaniyan, 09 3-17,Aqueous Humour Dynamics
Dr.r.subramaniyan, 09 3-17,Aqueous Humour Dynamics
ophthalmgmcri
 
Dr. r.subramaniyan, 08 3-17 tear film
Dr. r.subramaniyan, 08 3-17 tear filmDr. r.subramaniyan, 08 3-17 tear film
Dr. r.subramaniyan, 08 3-17 tear film
ophthalmgmcri
 
Disease of middle ear,dr.s.s.bakshi,27.03.17
Disease of middle ear,dr.s.s.bakshi,27.03.17Disease of middle ear,dr.s.s.bakshi,27.03.17
Disease of middle ear,dr.s.s.bakshi,27.03.17
ophthalmgmcri
 
Diseases of external ear,dr.s.gopalakrishnan, 13.03.17
Diseases of external ear,dr.s.gopalakrishnan, 13.03.17Diseases of external ear,dr.s.gopalakrishnan, 13.03.17
Diseases of external ear,dr.s.gopalakrishnan, 13.03.17
ophthalmgmcri
 
Dis of mid ear,dr.s.s.bakshi,27.03.17
Dis of mid ear,dr.s.s.bakshi,27.03.17Dis of mid ear,dr.s.s.bakshi,27.03.17
Dis of mid ear,dr.s.s.bakshi,27.03.17
ophthalmgmcri
 
Diseases of external ear,dr.s.gopalakrishnan, 13.06.17
Diseases of external ear,dr.s.gopalakrishnan, 13.06.17Diseases of external ear,dr.s.gopalakrishnan, 13.06.17
Diseases of external ear,dr.s.gopalakrishnan, 13.06.17
ophthalmgmcri
 
Dr. reema thomas aqueous dynamics 18 1-17
Dr. reema thomas aqueous dynamics 18 1-17Dr. reema thomas aqueous dynamics 18 1-17
Dr. reema thomas aqueous dynamics 18 1-17
ophthalmgmcri
 

More from ophthalmgmcri (20)

Csom aa, 10.04.17, s.s.bakshi
Csom aa, 10.04.17,  s.s.bakshiCsom aa, 10.04.17,  s.s.bakshi
Csom aa, 10.04.17, s.s.bakshi
 
Csom.dr.bini,03.04.17
Csom.dr.bini,03.04.17Csom.dr.bini,03.04.17
Csom.dr.bini,03.04.17
 
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm, 20.03.17
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm,   20.03.17Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm,   20.03.17
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm, 20.03.17
 
Lens iii 13.04.17 - dr.n.swathi
Lens iii 13.04.17 - dr.n.swathiLens iii 13.04.17 - dr.n.swathi
Lens iii 13.04.17 - dr.n.swathi
 
Lens ii 12.04.17,n.swathi.n
Lens ii 12.04.17,n.swathi.nLens ii 12.04.17,n.swathi.n
Lens ii 12.04.17,n.swathi.n
 
Lens i 06.04.17,dr.n.swathi
Lens i 06.04.17,dr.n.swathiLens i 06.04.17,dr.n.swathi
Lens i 06.04.17,dr.n.swathi
 
Uvea 3,22.03.17
Uvea 3,22.03.17Uvea 3,22.03.17
Uvea 3,22.03.17
 
Uvea 2,16.03.17
Uvea 2,16.03.17Uvea 2,16.03.17
Uvea 2,16.03.17
 
Uvea 1,15.03.17
Uvea 1,15.03.17Uvea 1,15.03.17
Uvea 1,15.03.17
 
Ocular pharmacology ii, dr.kurinchi, 22.06.17
Ocular pharmacology ii, dr.kurinchi, 22.06.17Ocular pharmacology ii, dr.kurinchi, 22.06.17
Ocular pharmacology ii, dr.kurinchi, 22.06.17
 
Ocular pharmacology i,dr.kuricnchi,16.03.17
Ocular pharmacology i,dr.kuricnchi,16.03.17Ocular pharmacology i,dr.kuricnchi,16.03.17
Ocular pharmacology i,dr.kuricnchi,16.03.17
 
Dr.A.R.Rajalakshmi, 8.2.17 chronic conjunctivitis ii
Dr.A.R.Rajalakshmi,  8.2.17 chronic conjunctivitis iiDr.A.R.Rajalakshmi,  8.2.17 chronic conjunctivitis ii
Dr.A.R.Rajalakshmi, 8.2.17 chronic conjunctivitis ii
 
Dr.A.R.Rajalakshmi, 02.2.17 intro, acute conj - i
Dr.A.R.Rajalakshmi, 02.2.17   intro, acute conj  - iDr.A.R.Rajalakshmi, 02.2.17   intro, acute conj  - i
Dr.A.R.Rajalakshmi, 02.2.17 intro, acute conj - i
 
Dr.r.subramaniyan, 09 3-17,Aqueous Humour Dynamics
Dr.r.subramaniyan, 09 3-17,Aqueous Humour DynamicsDr.r.subramaniyan, 09 3-17,Aqueous Humour Dynamics
Dr.r.subramaniyan, 09 3-17,Aqueous Humour Dynamics
 
Dr. r.subramaniyan, 08 3-17 tear film
Dr. r.subramaniyan, 08 3-17 tear filmDr. r.subramaniyan, 08 3-17 tear film
Dr. r.subramaniyan, 08 3-17 tear film
 
Disease of middle ear,dr.s.s.bakshi,27.03.17
Disease of middle ear,dr.s.s.bakshi,27.03.17Disease of middle ear,dr.s.s.bakshi,27.03.17
Disease of middle ear,dr.s.s.bakshi,27.03.17
 
Diseases of external ear,dr.s.gopalakrishnan, 13.03.17
Diseases of external ear,dr.s.gopalakrishnan, 13.03.17Diseases of external ear,dr.s.gopalakrishnan, 13.03.17
Diseases of external ear,dr.s.gopalakrishnan, 13.03.17
 
Dis of mid ear,dr.s.s.bakshi,27.03.17
Dis of mid ear,dr.s.s.bakshi,27.03.17Dis of mid ear,dr.s.s.bakshi,27.03.17
Dis of mid ear,dr.s.s.bakshi,27.03.17
 
Diseases of external ear,dr.s.gopalakrishnan, 13.06.17
Diseases of external ear,dr.s.gopalakrishnan, 13.06.17Diseases of external ear,dr.s.gopalakrishnan, 13.06.17
Diseases of external ear,dr.s.gopalakrishnan, 13.06.17
 
Dr. reema thomas aqueous dynamics 18 1-17
Dr. reema thomas aqueous dynamics 18 1-17Dr. reema thomas aqueous dynamics 18 1-17
Dr. reema thomas aqueous dynamics 18 1-17
 

Recently uploaded

contraindications in asana movement - during yoga practice
contraindications in asana movement - during yoga practicecontraindications in asana movement - during yoga practice
contraindications in asana movement - during yoga practice
Karuna Yoga Vidya Peetham
 
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.pptASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
Rommel Luis III Israel
 
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
The Lifesciences Magazine
 
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
Santhosh Raj
 
About CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdfAbout CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdf
CentiUP
 
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptxGORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
Rommel Luis III Israel
 
Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...
SGRT Community
 
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
 Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F... Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F...
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
aadeshkumar4448
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
CentiUP
 
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
aadeshkumar4448
 
CSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.pptCSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.ppt
vattakandyrahoof8
 
Nursing management of the patient with Tonsillitis PPT
Nursing management of the patient with Tonsillitis PPTNursing management of the patient with Tonsillitis PPT
Nursing management of the patient with Tonsillitis PPT
blessyjannu21
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
HEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptx
HEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptxHEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptx
HEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptx
Rommel Luis III Israel
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
Gokul Rangarajan
 
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdfPsychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
Healthcare Improvement Support
 
The Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-TechThe Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-Tech
Gokul Rangarajan
 
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCWPRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
dnee1
 
Bashundhara Toiletries Logo Guideline 2024
Bashundhara Toiletries Logo Guideline 2024Bashundhara Toiletries Logo Guideline 2024
Bashundhara Toiletries Logo Guideline 2024
khabri85
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
Rommel Luis III Israel
 

Recently uploaded (20)

contraindications in asana movement - during yoga practice
contraindications in asana movement - during yoga practicecontraindications in asana movement - during yoga practice
contraindications in asana movement - during yoga practice
 
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.pptASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
 
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
 
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
 
About CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdfAbout CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdf
 
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptxGORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
 
Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...
 
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
 Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F... Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F...
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
 
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
 
CSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.pptCSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.ppt
 
Nursing management of the patient with Tonsillitis PPT
Nursing management of the patient with Tonsillitis PPTNursing management of the patient with Tonsillitis PPT
Nursing management of the patient with Tonsillitis PPT
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
 
HEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptx
HEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptxHEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptx
HEALTH ASSESSMENT IN NURSING USING THE NURSING PROCESSpptx
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
 
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdfPsychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
 
The Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-TechThe Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-Tech
 
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCWPRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
 
Bashundhara Toiletries Logo Guideline 2024
Bashundhara Toiletries Logo Guideline 2024Bashundhara Toiletries Logo Guideline 2024
Bashundhara Toiletries Logo Guideline 2024
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
 

Refraction 2 k n jha 25.08.16

  • 1. Hyperopia and Presbyopia Prof K N Jha, MS Email: kirtinath.jha@gmail.com
  • 2. Learning Aims • Hyperopia: Definition, optics, clinical features, diagnosis, treatment of hyperopia. • Accommodation: Definition, mechanism, measurement. • Presbyopia ( Physiological failure of accommodation) • Treatment of presbyopia
  • 4. Hyperopia Total hypermetropia comprises of • Latent hypermetropia (portion of hypermetropia which can be revealed only under cycloplegia) • Manifest hypermetropia Facultative hypermetropia , the portion which can be overcome by accommodation. Absolute hypermetropia , The part that cannot be compensated by accommodation.
  • 5. Clinical features • In young: -asymptomatic -asthenopia, burning in the eyes -chronic conjunctival congestion - Esotropia( convergent squint) • In older patients: Asymptomatic Early presbyopic symptoms
  • 6. Examination of the eye • Small axial length • Small corneal diameter • Shallow anterior chamber • Fundus: Normal, or may suggest features of pseudopapillitis. • Predisposition to angle closure glaucoma.
  • 7. Diagnosis of Hyperopia in Young: Cycloplegic Refraction • Cycloplegia is the temporary paralysis of the ciliary muscle with the use of pharmaceutic agent, to stabilize refraction. • Cycloplegic refraction is done in young hyperopes to avoid overcorrection. • Cycloplegic drugs: Atropine sulfate 1% ointment 3 times a day for 3 days; cyclopentolate 1 % drop 2-3 times .
  • 8. Treatment • No treatment for low hyperopia in young. • Spectacle correction with plus lenses in symptomatic adult. • Correction of hyperopia plus addition for near in presbyopic age. • Contact lenses • Hyperopic LASIK • Phakic intraocular lens • Holmium : YAG laser thermokeratoplasty
  • 10. Accommodation • Accommodation is the mechanism by which the eye changes refractive power by altering the shape of its crystalline lens by mechanism described by Helmholtz.
  • 11. Mechanism of accommodation • Contraction of ciliary muscle in response to parasympathetic stimulation. • Relaxation of the zonular fibres. • Lens becomes more convex. The process involves primarily the front surface of the lens. • Accommodation occurs all round the circumference and simultaneously in both the eyes.
  • 12. • Near point: Nearest point where small objects can be clearly distinguished is called the near point. • Near point varies with static refraction and age.
  • 13. Amplitude of accommodation: diopters in the change of lens power during accommodation. Range of accommodation: distance between the far point and the near point.
  • 14. Average amplitude of accommodation • Age in years In dioptres (D) 8 years 14 ± 2 20 years 11 ±2 40 years 6± 2 60 years 1.5±1
  • 16. Accommodation and convergence • Accommodation convergence complex • Accommodation / convergence ratio (AC/A ratio) • Accommodation convergence dissociation
  • 17. Clinical accommodative problems • Presbyopia • Accommodative insufficiency • Accommodative excess
  • 18. Presbyopia • Presbyopia is gradual loss of accommodative response resulting from loss of elasticity of the lens. • It becomes a clinical problem when accommodative amplitude becomes insufficient for the patient for near work and reading.
  • 19. Presbyopia • Age : usually after 40 years • Onset depends upon preexisting refractive error, patients visual task and pupillary size.
  • 20. Correction of presbyopia • Convex lens for near work. • The weakest convex lens is prescribed. • May be prescribed as bifocal along with distance correction.
  • 21. Accommodative insufficiency • Accommodative insufficiency is premature loss of accommodation( premature presbyopia) • Clinical feature: blurring of near object or, inability to sustain accommodative effort.
  • 22. Premature presbyopia: Cause • Concurrent or past debilitating illness • Drugs : Parasympatholytic drugs ,tranquillizers • Neurological disorders e.g. encephalitis • Head trauma • Glaucoma • Diabetes mellitus
  • 23. Presbyopia • Treatment : Correction for near vision with convex lenses.
  • 24. Accommodative excess • Spasm of Accommodation • Mechanism: Ciliary muscle spasm • Symptoms: Headache, brow ache, variable blurring of distance vision, abnormally close near point.
  • 25. Accommodative excess Etiology • Iridocyclitis • Use of anticholinesterases being used for glaucoma • Uncorrected refractive error, hyperopia, astigmatism • Prolonged and intense near work
  • 26. Points to Remember • Definition, optics, clinical features, diagnosis, treatment of hyperopia. • Definition, clinical features and correction of presbyopia • Accommodative excess