Astigmatism 1, Astigmatism 2 And Presbyopia Flashcards
First accurate description of astigmatism as such credited in 1800
Thomas young
Were reported in a period of nearly seventy years
11 cases
First one to produce a distance test chart for astigmatism
John Green
Defined as a refractive condition in which a variation of power exists in different meridians of the eye
ASTIGMATISM
The posterior principal foci of the same eye vary cause is almost always ba difference in curvature of the refractive surface of the ocular meridian
Causes of astigmatism
The major surface which can be proven to exhibit such a discrepancy is the anterior surface of the cornea unequal curvsture of the cornea
Corneal astigmatism
The major source of Astigmatism is held to be anterior surface of cornea,which usually exhibits
Direct or with the rule astigmatism
What is with the rule astigmatism
Different types of astigmatism are classified based on the shape of the cornea,lens and principal meridians. With the rule astigmatism is a common form of astigmatism that causes the cornea to be oblong shaped with high refractive power in the vertical meridian
Lens
The major astigmatic effect of the lens is not attributed to unequal curvature but not potentiality of the lens to be tilted in relation to the visual axis or shifted position within the eye
Other cause of astigmatism
Traction of the external ocular muscles upon the eyeball may force the sclera into a toroidal shape without altering the cornea
The eye may occupy an eccentric position in relation to the visual axis
Fovea
Changes may occur in the _____ with resultant variation index
Vitreous gel
_____ surface may exhubit some irregularity
Fundus
How is astigmatism diagnosed
Visual acuity
Keratometry
Refraction
Retinoscopy
-The sum resultant astigmatism of all factors of REFRACTIVE system due to normal variations in the surface of the different media
-also called physiological by duke elder
Total astigmatism
Total astigmatism
Anterior cornea + residual
Residual
Posterior corneal surface
Lenticular surface
Lenticular zonule
Complete anatomical data
A.C
ANTERIOR CORNEA
P.C
POSTERIOR CORNEA
F.C.P
FULL CORNEA PACHYMETRY
A.C.D
ANTERIOR CORNEA DEPTH
I
IRIS
L
LENS
In which the cornea exhibits a variation of curvature throughout different meridians
Corneal astigmatism
In which two principal meridians exist at right angle to each other one of the greatest and one of the least curvature
Regular
In which either the two principal axis are not at right angles to each other or the curvature of any one meridian is not uniform
Irregular
Referred to each cornea
With-the-rule (direct)
Against-the-rule (inverse or perverse)
Oblique
The meridian of greatest curvature lies between 30th to 60th or the 120th to 150th meridian
Oblique
Referred to each cornea
Wtr
With-the-rule (diect)
Against-the-rule (inverse or perverse)
Oblique
Referred to both cornea
Symmetric
Homologous
Heterologous
The total of the degrees representing the two weakest ( or two strongest) meridians for both eyes equals 180 degrees
Symmetric
Homologous
If with-the-rule
Heterologous
If against-the-rule
When two weakest or the two strongest meridians of both eyes do not total 180 degrees upon additin of their meridional locations
Asymmetric
Both eyes are with-the-rule or both are against-the-rule
Homonymous
One eye is with-the-rule and the others is against-the-rule
Heteronymous
In which the astigmatism is due to unequal curvature of the lens surface or layers
Lenticular
With accommodation relaxed, one meridian would focus on the retina while the other would tend to focus behind the retina
S.H.A
Simple hyperopic astigmatism
With the ACCOMMODATION completely relaxed the posterior principal foci of both meridians would tend to fall beyond the retina
C.h.a
Compound hyperopic astigmatism
With accomodation relaxed one meridian would focus on the retina and the other would focus in front of the retina
S.M.A
SIMPLE MYOPIC ASTIGMATISM
With accomodation relaxed,both principal meridians focus in front of the retina
C.M.A
COMPOUND MYOPIC ASTIGMATISM
With accomodation relaxed one meridian tends to focus behind the retina,while the other focuses in front of the retina
M.A
MIXED ASTIGMATISM
Something different from another of the same type
Variation
Change at near
In amount
According to
Mcdowell (1924)
Cox (1938)
Marton (1942)
Pascall (1944)
So called with the rule form of astigmatism according to
Beau seigneur (1946)
Causes of lenticular astigmatism
Such as tilt of the lens and the action extrinsic muscles maybe aggravated by accommodative action.
Stenopaic effect
Lids when narrowed for near work and the diminution of the size of the pupil may also decrease the aberrations of the refractive system
To conclude the investigation by the different investigators
A. Spherical effect upon the astigmatism of the accommodations or spherical lens.
B.variations of effectivity of the correcting lens with changes in distance of fixation,power of the eye and incidence of the source
Revealed that the shift axis of the correcting cylinder which he believed to be due lenticular changes
Scobee (1947) reported 75%
The medical science of symptoms
The combined symptoms of a disease
Symptomatology
Symptoms that are observed only by the patients and that cannot objectively observed
Subjective
A symptom evident to the observer
Or a sign
Objective
This may be due to the requirement for constant accommodation in an attempt to place the circle of least confusion on the retina and to subsidiary wrinkling and furrowing of the brows the narrowing of the pupil aperture to reduce aberration and the assumption of unnatural ocular postures in cases of oblique astigmatism
ASTHENOPIA
For Astigmatism consists of the cylindrical power which equalizes the discrepancy between the two principal meridians
Basic correction
Following consideration
Effect upon image
Previous adaptation
Different amount of astigmatism at near point than existed at the far point
Cylinders apparently cannot be worn or where mixed astigmatism has been found and the patient shows no preference for the cylindrical correction.
Spherical equivalent
The asthenopia may be relieved by the relaxation of the accomodation which the patient has been using to place the circle of least confusion on the retina, which are 45 degrees from the principal meridians upon the retina every spherocylindrical combination which leaves those meridian upon the retina
Spherical equivalent
When parallel rays of light enter the eye with accommodation relaxed and do not come to a single point focus on or near the retina
ASTIGMATISM
Has an unequal curvature on its anterior surface
Cornea
Crystalline lens has an unequal curvature on its surface or in its layers
Lens
Equal to the difference in refracting power of the two principal meridians
Amount of astigmatism
Based on relative locations of principal meridians or axes when comparing the two eyes
Classifications
When the cornea has unequal curvature On the anterior surface
Corneal astigmatism
When the crystalline lens has an unequal curvature on the anterior surface
Corneal astigmatism
When the crystalline lens has an unequal curvature on the surface or in its layers
Lenticular astigmatism
The sum of corneal astigmatism and residual astigmatism
Total astigmatism
Total astigmatism
Corneal+ residual
Residual
PCS
POSTERIOR CORNEAL SURFACE
LS
LENTICULAR SURFACE
LZ
LENTICULAR ZONULE
When the two principal meridians are perpendicular to each other
Regular astigmatism
The three types of regular astigmatism
WTR
With-the-rule,
ATR
AGAINST-THE-RULE
AND OBL
OBLIQUE ASTIGMATISM
With-the-rule astigmatism
Minus cylinder axis around horizontal meridian
-When greatest refractive power is within 030 of the horizontal meridian (i.e between 0 and 30,150 and 180 meridians)
-the most common type of astigmatism based on the orientation of meridians
With-the-rule astigmatism
When the greatest refractive power is within 030 of the vertical meridian (i.e between 060 to 120 meridians)
Against-the-rule astigmatism (Atr)
Minus cylinder axis around vertical meridian
When the greatest refractive power is within 030 of the oblique meridians (i.e between 030 and 060 or 120 and 150)
Oblique astigmatism
-When the two principal meridians are not perpendicular to each other.
-curvature of any one meridian is not uniform
-associated with trauma disease or degeneration.
-VA is often not correctable to 20/20
IRREGULAR ASTIGMATISM
When one of the principal meridians is focused on the retina and the other is not focused on the retina (with accommodation relaxed)
Simple astigmatism
When one of the principal meridians is focused in front of the retina and the other is focused on the retina (with accommodation relaxed)
Simple myopic astigmatism
When one of the principal meridians is focused behind the retina and the other is focused in front on the retina (with accommodation relaxed)
Simple hyperopic astigmatism
When both principal meridians are focused either front or behind the retina (with accommodation relaxed)
Compound astigmatism
When both principal meridians are focused in front of the retina (with accommodation relaxed)
Compound myopic astigmatism
When both principal meridians are focused behind the retina (with accommodation relaxed)
Compound hyperopic astigmatism
When one of the principal meridians is focused in front of the retina and the other is focused behind the retina (with accommodation relaxed)
Mixed astigmatism
-The principal meridians or axes of the two eyes are symmetrical (e.g both eyes are WTR OR ATR)
-the sum of two axes of the two eyes equals approximately 180
Symmetrical astigmatism
-The principal meridians or axes of the two eyes are not symmetrical (e.g one eye is wtr while the other eye is ATR)
-THE SUM of the two axes of the two eyes does not equal approximately 180
Asymmetrical astigmatism
-infants are born with atr astigmatism where the cornea is the source of the astigmatism
- preschool children have little or no astigmatism
-teenage children demonstrate a shift towards wtr astigmatism
- older adults show a shift towards atr astigmatism
Age
In general there are no significant differences between males and females
Gender
-higher prevalence in north Americans,latinos
-asian infants tend to be WTR astigmatism
-caucasian infants tend to be ATR astigmatism
Ethnicity
For older adults the average rate of change towards atr astigmatism is less than or equal to 0.25D every 10 yrs
General trend
-Theoretically at no distance does an uncorrected astigmat have a sharp retinal image.
-clinically if astigmatism is small (less than 0.50DC) the patient may not notice blur
VISUAL ACUITY
Accommodation may make the retinal image even more blurry
Simple or compound myopic astigmatism
Accommodation may improve VA ti some extent
Simple or compound hyperopic astigmatism
-Va is relatively good
-may not need much accommodations
Mixed astigmatism
-myopia or absolute hyperopia
-when multiplied by a factor of two it equals astigmatism (D)
Spherical refractive error (D)
Decreased visual acuities at distance or near
Signs
-clinical test
-Distance and near
Visual acuity test
-autorefraction
-keratometry
-retinoscopy
Most reliable source of information for cylinder power or axis
Retinoscopy
Single vision glasses with cylinder
Spectacles
-toric soft
-toric rigid gas permeable contact lenses
Contact lenses
-photorefractive keratometry (prk)
-laser assisted in situ keratomileusis (Lasik)
Refractive surgery
Another term of presbyopia
Short arm syndrome
The inability of the human eye to focus on objects up close that result with aging.
PRESBYOPIA
Presbyopia age start
40-50
A condition whereby the amplitude of accomodation diminishes when increase in age where clear and comfortable vision at near point is not achievable. Recession of near point with increase in age
Presbys-old
Ops-eye
Lens based
Attributes all of the loss in acc to biomechanical changes in the lens capsule and lens and none to the ciliary muscle the amount of ciliary muscle contraction (or effort/innervation) required to produce a unit change in acc. Remains contact with age
H-H-G THEORY
HELMHOLTZ- HESS-GULLSTRAND THEORY
Muscle based
The amount of ciliary muscle contraction
D-D-F
Donder’ s-Duane-Fincham theory
Muscle based
The amount of ciliary muscle contraction needed to produce a unit change in acc progressively increases with age thus as one ages the reduced amplitude is due to progressive weakening of the ciliary muscle itself
D-D-F
Donder’ s-Duane-fincham theory
Muscles based
Causes of sclerosis
Nutritional changes
Action uv rays
Exposure to intense infrared radiation