REFRACTIVE ERRORS OF THE EYE

Refractive errors are abnormalities in the way light from a distant object is focused - via convergence of rays at the convex cornea and lens - onto the retina. Treatment of refractive errors is with spectacles or contact lenses. Note that binocular single vision is prevented where there is an image size difference between the eyes of 8% - corresponding to 3 or 4 dioptres difference in spectacles. Thus, eyes that are this different warrant contact lenses. Presbyopia: Presbyopia occurs as the lens becomes stiffer with age, with a consequent decrease in the range of focusing or accommodation. When the nearest point at which an object can be brought into focus is beyond the normal reading range then presbyopia has become apparent. This normally occurs at about the age of 45 years. Presbyopia can be compensated by the use of weak convex reading spectacles. As the degenerative stiffening of the lens gradually increases with age so there will be a need for gradual strengthening of the spectacles over the years. The changes associated with presbyopia are generally complete by the age of 60 years. Hypermetropia: In the hypermetrope, the point of focus of rays of light is behind the retina - the eyeball is too short. Vision is better for far objects than for near ones. It can be corrected using a convex spectacle lens. In young hypermetropes such focusing is usually done by accommodating the lens of the eye. However, this leaves less reserve for near-vision so that tiredness may develop on reading books etc. Also, as the process of presbyopia occurs with increasing age, there may be a reduction in the point in near-range vision - usually at about the age of 45. This may manifest itself when the patient needs to hold textual material away from him in order to read it. This problem can be overcome by the use of convex spectacle lenses for near work. Myopia: Myopia occurs where the image is focused at a point in front of the retina - the eyeball is too long. Vision is better for near objects than for far objects. This condition can be corrected by the use of a concave spectacle lens. Also surgical treatment may be possible with laser (photoreactive keratectomy). Myopia, like hypermetropia, is simply a physiological variant of length (the eyeball is longer than normal), and usually ceases to progress after adolescence. There may even be a slight reduction of myopia in late middle-age. Progressive myopia, in which the eyeball continues to lengthen throughout life, may lead to retinal degeneration or even retinal detachment. Astigmatism: Astigmatism is an ametropia caused by differences in curvature in different meridians of the refractive surfaces of the eye so that light rays are not sharply focused on the retina - they in fact result in an elliptical blur on the retina. Vision may be proportionately blurred both for near and far objects, irrespective of accommodation, and may result in visual fatigue - ocular headaches. Regular astigmatism can be compensated by spectacle lenses with an appropriately different curvature in two meridians.