SISTIM PENGLIHATAN

Dr H SONNY PAMUJI LAKSONO. M Biomed

SUSUNAN OPTIK MATA

*MEMISAHKAN COP
& COA
*DI BLKG KORNEA
& DIDEPAN LENSA

ANATOMI MATA
CORNEA

TRANSPARANT

CHOROID

LAP PIGMENT,

>> PEMB DARAH

RETINA

SEL RESEPTOR

LENSA KRISTALINA
TRANPARANT,
DIFIKSASI OLEH
ZONULA ZINII
KE CILIARY
BODY
CILIARY BODY : TDD OTOT
SIRKULER & LONGITUDINAL
IRIS : OTOT SIRKULER
DILATASI PUPIL

*MENGISI SEBAGIAN BESAR BOLA MATA,

KONSISTENSI LUNAK
*PEMB DRH - , Bag luar : membran hyaloid, Bag tengah :
sal hyaloid. Nutrisi : dari khoroid, badan siliar&retina

STRUKTUR LAPISAN RETINA

RETINA :
BAG EQUATOR
These are the main cells in the
retina:
1.Photoreceptors (rods &
cones)
2.Horizontal cells (lateral
inhibition at the level of the
photoreceptors)
3.Bipolar cells ("on" and "off"
cells) connect photoreceptors
to retinal ganglion cells
4.Amacrine cells (lateral
inhibition at the level of the
retinal ganglion cells)
INTI (NUKLEUS)
5.Retinal ganglion cells (the
axons of which form the optic
KORTEKS
SEL KERUCUT:
nerve
There are about 6.5 to 7 million cones in each eye, and they are sensitive to bright light and
to color. The highest concentration of cones is in the macula. The fovea centralis, at the
center of the macula, contains only cones and no rods. There are 3 types of cone pigments,
each most sensitive to a certain wavelength of light: short (430-440 nm), medium (535540 nm) and long (560-565 nm). The wavelength of light perceived as brightest to the
human eye is 555 nm, a greenish-yellow. (A nanometernmis one billionth of a meter,
which is one millionth of a millimeter.) Once a cone pigment is bleached by light, it takes
about 6 minutes to regenerate

The Macula
The macula lutea is the small, yellowish central portion of the
retina, and it is the area providing the clearest, most distinct
vision. When one looks directly at something, the light from that
object forms an image on ones macula. A healthy macula
ordinarily is capable of achieving at least 20/20 (normal)
vision or visual acuity, even if this is with a correction in glasses
or contact lenses. Not uncommonly, an eyes best visual acuity is
20/15; in this case, that eye can perceive the same detail at 20
feet that a 20/20 eye must move up to 15 feet to see as distinctly.
Some people are even capable of 20/10 vision, which is twice as
good as 20/20. Vision this acute may be due to there being more
cones per square millimeter of the macula than in the average
eye, enabling that eye to distinguish much greater detail

fovea centralis
The very center of the macula is called the fovea centralis, an
area where all of the photoreceptors are cones; there are no rods
in the fovea. The fovea is the point of sharpest, most acute visual
acuity. (The center of the fovea is the foveola.) Because the
fovea has no rods, small dim objects in the dark cannot be seen if
one looks directly at them. For this reason, to detect faint stars
in the sky, one must look just to the side of them so that their
light falls on a retinal area, containing numerous rods, outside of
the macular zone.
There are about 110,000 to 115,000 cone cells in the fovea and
only about 25,000 cones in the tiny foveola. The macular/foveal
area is the main portion of the retina used for color
discrimination. Color vision deficiencies, which occur in less
than 8% of males and in less than 1% of females, are usually
hereditary, although they also can result from certain diseases,
injury, or as a side effect of some medications or toxins

BLIND SPOT ( BINTIK BUTA)

The beginning of the optic nerve in the retina is called the optic nerve head or optic disk. Since there are no
photoreceptors (cones and rods) in the optic nerve head, this area of the retina cannot respond to light stimulation. As
a result, it is known as the blind spot, and everybody has one in each eye. The reason we normally do not notice
our blind spots is because, when both eyes are open, the blind spot of one eye corresponds to seeing retina in the other
eye. Here is a way for you to see just how absolutely blind your blind spot is. Below, you will observe a dot and a
plus.
Follow these viewing instructions:
1.Sit about arms length away from your computer monitor/screen.
2.Completely cover your left eye (without closing or pressing on it), using your hand or other flat object.
3.With your right eye, stare directly at the
above. In your periphery, you will notice the
to the right.
4.Slowly move closer to the screen, continuing to stare at the .
5.At about 16-18 inches from the screen, the
should disappear completely, because it has been imaged onto
the blind spot of your right eye. (Resist the temptation to move your right eye while the
is gone, or else it
will reappear. Keep staring at the .)
6.As you continue to look at the , keep moving forward a few more inches, and the
will come back into
view.
7.There will be an interval where you will be able to move a few inches backward and forward, and the
will
be gone. This will demonstrate to you the extent of your blind spot.
8.You can try the same thing again, except this time with your right eye covered stare at the
with your left
eye, move in closer, and the
will disappear.
If you really want to be amazed at the total sightlessness of your blind spot, do a similar test outside at night when
there is a full moon. Cover your left eye, looking at the full moon with your right eye. Gradually move your right eye
to the left (and maybe slightly up or down). Before long, all you will be able to see is the large halo around the full
moon; the entire moon itself will seem to have disappeared.
Like any other ocular structure, certain pathologies can have an adverse affect on the optic disk and optic nerve.
Although there are too many to list completely, a few will be included here.

SEL BATANG
There are about 120 to 130 million rods in each eye, and they are
sensitive to dim light, to movement, and to shapes. The highest
concentration of rods is in the peripheral retina, decreasing in
density up to the macula. Rods do not detect color, which is the
main reason it is difficult to tell the color of an object at night or in
the dark. The rod pigment is most sensitive to the light wavelength
of 500 nm. Once a rod pigment is bleached by light, it takes about
30 minutes to regenerate. Defective or damaged cones results in
color deficiency; whereas, defective or damaged rods results in
problems seeing in the dark and at night.

COLOR VISION
To see any color, the retinal cone cells first must be stimulated by light. Redsensitive cones are most stimulated by light in the red to yellow range, greensensitive cones are maximally stimulated by light in the yellow to green range,
and blue-sensitive cones are maximally stimulated by light in the blue to violet
range. Accordingly, due to their respective sensitivities to long (L), medium (M),
and short (S) wavelengths, they also are referred to as L cones, M cones, and
S cones. Collectively, the photoreceptors in the human eye are most sensitive to
wavelengths between 530 and 555 nanometers, which is bright green tending
toward yellow.
Red-sensitive or L cones

Green-sensitive or M cones

Blue-sensitive or S cones

TRICOLOR THEORY YOUNG-HELMHOLTZ

* TEORI WARNA NYA TERDIRI DARI 3 MACAM SEL KERUCUT
* MASING MASING SEL KERUCUT TERDIRI DARI FOTOPIGMENT YANG
BERBEDA, DAN MASING MASING HANYA SENSITIF TERHADAP SALAH SATU
WARNA DASAR ( BIRU, HIJAU, MERAH)
*PIGMENT PERTAMA : BIRU
SENSITIVE THD WARNA BIRU ATAU
PIGMENT PANJANG GELOMBANG PENDEK
MENYERAP CHY MAX BIRUVIOLET
*PIGMENT KEDUA : HIJAU
SENSITIVE THD WARNA HIJAU ATAU
PIGMENT PANJANG GEL MENENGAH
MENYERAP CHY MAX
HIJAU
*PIGMENT KETIGA : MERAH
SENSITIVE THD WARNA MERAH
ATAU PIGMENT PANJANG GEL YANG PANJANG
MENYERAP CHY MAX
KUNING
*SEL KERUCUT YANG SENSITIF THD SPEKTRUM KUNING, CUKUP SENSITIF
THD MERAH SBG RESPON THD CHY MERAH PD AMBANG YG LEBIH RENDAH
DARI WARNA HIJAU

The brain must compare the input from the three

different kinds of cone cells, as well as make many other
comparisons. This comparison begins in the retina
(which is an extension of the brain), where signals from
red and green cones are compared by specialized
red-green opponent cells. These opponent cells
compute the balance between red and green light
coming from a particular part of the visual field. Other
opponent cells then compare signals from blue cones
with the combined signals from red and green
cones. When one type of cone does not work properly,
the proper color calculations cannot take place.

RECEPTOR CELLS
Rods are responsible for "scotopic" or low intensity vision. Cones are responsible for "photopic" or
high intensity vision. Both rods and cones contain a photopigment which absorbs the light. There are 4
photopigments, one in rods and one in each of 3 cones. The photopigment is called rhodopsin and
consists of two parts - a filter called an opsin and a light sensitive chromophore called retinal. Retinal is
common to all four photopigments. [See graph of distribution of cells across retina]

PHOTORECEPTION
In the dark the concentration of cGMP (cyclic guanosine monophosphate) in rods and cones is high.
This opens cyclic nucleotide gated (non-selective cation) channels (CNG channels). Sodium (Na +) and
calcium (Ca2+) enter the cell and this depolarizes, resulting in an increase in transmitter release.
In the light, a G-protein, transducin, is activated starting a cascade of biochemical events and resulting
in a fall in cGMP. The receptor operated channels close and the cells hyperpolarise (receptor potential),
resulting in a fall in transmitter release

MEKANISME PHOTORESEPTOR
POTENSIAL AKSI DIDALAM RETINA DITIMBULKAN
OLEH AKTIFITAS CAHAYA
PADA SENYAWA FOTOSENSITIF DIDALAM SEL
BATANG & KERUCUT.
* PADA SAAT CAHAYA DI ABSORBSI OLEH SENYAWA INI
, MAKA AKAN
MENIMBULKAN PERUBAHAN PERUBAHAN PADA
STRUKTUR SENYAWA TSB,
DAN HAL INI AKAN MEMULAI TIMBULNYA
AKTIFITAS DIDALAM SYARAF.
*

RESPON LISTRIK SEL-SEL

DIRETINA
* RESPON SEL BATANG, KERUCUT DAN
SEL HORIZONTAL : HIPERPOLARISASI
* RESPON SEL BIPOLAR : HIPERPOLARISASI
ATAU DEPOLARISASI
*AMACRINE SEL : POTENSIAL DEPOLARISASI
( SEBAGAI GENERATOR POTENSIAL)

DASAR-DASAR IONIK POTENSIAL

FOTORESEPTOR
* CHANNEL ION NATRIUM PADA SEGMENT
LUAR SEL BATANG SEL KERUCUT
TERBUKA PADA KEADAAN GELAP
SEHINGGA TERJADI ALIRAN LISTRIK
DARI DALAM KE LUAR
* POMPA Na+-K+ PADA SEGMENT BAG
DALAM BERPERAN MEMPERTAHANKAN
KESEIMBANGAN ION
* PADA SAAT ADA CAHAYA PADA BAG
LUAR SEGMENT, MAKA BEBERAPA
CHANNEL NATRIUM TERTUTUP
HIPERPOLARISASI POTENSIAL RESEPTOR
ME < KAN PELEPASAN NEUROTRANSMITER DI
SINAPS

POTENSIAL AKSI DI SEL GANGLION>

IMPULS KE OTAK

SENYAWA-SENYAWA FOTOSENSITIF

* SENYAWA-SENYAWA FOTOSENSITIF

PROTEIN( OPSIN & RETINENE 1)

* RETINENE 1 MERUPAKAN ALDEHIDA DARI VIT A

RETINAL

RHODOPSIN
* PIGMEN FOTOSENSITIF DIDALAM SEL BATANG : RHODOPSIN ( VISUAL
PURPLE)
* OPSIN NYA DISBT : SCOTOPSIN
* SENSITIF TERHADAP CAHAYA DGN PANJANG
GELOMBANG 505 nm
* BM : 41,00, BANYAK TERDAPAT DI BAGIAN

P
E
M
B
T
K

DISK SEL BATANG

* PADA KEAD GELAP : RETINENE 1 DLM
RHODOPSIN BER BTK: 11 CIS

CAHAYA

METARHODOPSIN II
CHANNEL ION NATRIUM
* PEMISAHAN RETINENE 1 DARI
OPSIN (SCOTOPSIN)

ALL TRANS
PENUTUPAN

L
G
S

HUBUNGAN RHODOPSIN DAN CHANNEL ION NATRIUM

* RHODOPSIN AKAN MENGAKTIVASI TRANSDUCIN(= G PROTEIN)
BERIKATAN DGN GTP
AKTIVASI PHOSPODIESTERASE
KATALISIS( cGMP
5 GMP), c GMP BERPERAN UNT MEMPERTAHANKAN
AGAR CHANNEL ION NATRIUM TERBUKA, PE<< c GMP MENYEBABKAN
CHANNEL ION NATRIUM TERTUTUP
HYPERPOLARISASI

SETIAP 1 MOL
RODOPSIN
TDD 7
CROMOFOR

STRUKTUR RHODOPSIN

MEKANISME PENGAKTIFAN RODOPSIN

Pada saat ada cahaya

Dalam keadaan malam

Perubahan GTP
menjadi cGMP
O/ guanilate
cyclase

CHANEL Na
terbuka & ion
masuk

Pengaktifan rodopsin oleh

cahaya
transducin

Perubahan GDP
phospodiesterase

Channel tertutup

Na tidak bisa masuk

GTP
cGMP

EFEK DEFISIENSI VITAMIN A TERHADAP PENGLIHATAN

* VITAMIN A

SINTHESIS RETINENE / RETINAL

* DEFISIENSI VIT A

RABUN SENJA / NIGHTBLINDNESS /NYCTALOPIA

* FUNGSI SEL BATANG & KERUCUT TERGGG

* DEFISIENSI KRONIS

DEGENERASI

STRUKTUR LAPISAN SEL RETINA.

* TERAPI DGN VIT A

HANYA BER

MANFAAT BILA BELUM TERJADI PERUBAHAN STRUKTUR ANATOMI SEL

PADA LAPISAN RETINA/ RESEPTOR
PADA RETINA RUSAK

BIPOLAR CELLS

The release of transmitter either inhibits

"depolarising" or (+) bipolar or stimulates
"hyperpolarizing" or (-) bipolar cells which
then relay the receptor potential to the retinal
ganglion cells which increase/decrease their
firing rate as appropriate. [Therefore, (+)
bipolars lose their transmitter inhibition and
depolarize in light, whereas (-) bipolars lose
their stimulus and hyperpolarize in light. Nb.
light causes photoreceptors to hyperpolarize
and transmitter release, at synapses with
bipolar cells, falls].

VISUAL CODING

The retina analyses the visual image in terms of (a)

colour, (b) form, (c) movement, (d) luminance
and (e) depth.
a. Colour; green, blue and red cones. Cones
contain a filter (opsin) and a light-sensitive bit
(chromophore, called retinal). Green cones have
green filters, red cones have red filters etc.
red cones maximally sensitive to 559nm light
green cones to 531nm
blue cones to 419nm

Colour opponency. Red/green and blue/yellow "centresurround" receptive fields of retinal ganglion cells (see
below) mean that there are retinal ganglion cells sensitive
to red/green contrasts and others sensitive to blue/yellow
differences. (Yellow is made up of output from red/green
cones combined). This aids in colour contrast definition.
Colour-blind people usually lack either a red or green opsin
and have trouble distinguishing red from green (both
appear the same).
b. Form; edge detection, centre-surround receptive
fieldsEach retinal ganglion cell has a receptive field that
corresponds to input from part of the visual field (a small
region of the retina). This receptive field is made up of
information from one to 1000s of photoreceptors arranged
in a "centre-surround" fashion (see diagram).

RECEPTIVE FIELDS
"ON" and "OFF" cells

[Exercise: draw a line down a sheet of paper; (1) light on left, dark on
right; assuming that a constant illumination gives a net output of the
centre-surround receptive field of zero, determine the net output at the
border, for an "ON" centre retinal ganglion cell - as on the left in the
diagram above. You will see that this retinal ganglion cell detects
edges. (2) Now do the same for red on the left, green on the right, for a
(+)green centre/(-)red surround retinal ganglion cell. You will find that
this cell detects red/green edges].

STRUKTUR RETINA

STRUKTUR RETINA

ASPEK KLINIS :

COLOR DEFICIENCY ( BUTA WARNA )

If all the cone receptors work, but one type does not work as well as the other two, an
anomalous trichromatism results. A weakness in the long wavelength (red or L)
cones causes protoanomaly, where more long wavelength light is required in order to
perceive colors the same as a person with normal color vision. A weakness in the medium
wavelength (green or M) cones causes deuteranomaly, where more medium
wavelength light is required in order to perceive colors the same as a person with normal
color vision. A weakness in the short wavelength (blue or S) cones causes
tritanomaly, where more short wavelength light is required in order to perceive colors the
same as a person with normal color vision.
When one type of cone receptor does not work at all, an anomalous dichromatism
results. In protanopia, there is a lack of the receptors sensitive to long (reddish)
wavelengths of light. In deuteranopia, there is a lack of the receptors sensitive to medium
(greenish) wavelengths of light. In tritanopia, there is a lack of the receptors sensitive to
short (bluish) wavelengths of light. These conditions are portrayed as follows:
protanopia (difficulty distinguishing between blue/green and red/green)
deuteranopia (difficulty distinguishing between red/purple and green/purple)
tritanopia (difficulty distinguishing between yellow/green and blue/green)
When only one cone receptor functions, the color deficiency is monochromatism. Very
few people (about 3 in a million) have total color blindness or achromatopsia; they see
things only in shades of white, gray and black. Color deficiencies usually are genetic.
However, sometimes such deficiencies are acquired due to retinal diseases such as glaucoma
or diabetes or by retinal poisoning by certain medications

COLOR DEFICIENCY ( BUTA WARNA )

About 7% of males have a red-green deficiency, compared to about .4% of
females. The genes for the red and green receptors (cones) are carried on the
X chromosome. As a result, a male with a defect in one of these genes does not
have another X chromosome to compensate and, therefore, will be color
deficient. On the other hand, a female with such a defective gene has another
X chromosome which, as a rule, will have a compensating normal gene. With
a red-green deficiency, a person might have difficulty distinguishing between
things such as red and green traffic lights or electrical wiring. Red-green
color perception is altered in conditions such as optic neuritis.
People with a less common type of deficiency cannot distinguish between blues
or yellows. The gene for the blue receptor (cone) is carried on Chromosome
#7. Blue-yellow color vision is diminished in many disorders, including
glaukoma, diabetic retinopathy, cataract, and retinal disease. In some cases, a
reddish X-chrome contact lens, worn in one eye, can help a color deficient
person discern more easily between colors.
You might wish to check your color vision. If so, go to color vision testing .

Color Vision Testing

Pseudo-Isochromatic Plates frequently are used by eye specialists to get an idea of ones
color efficiency or deficiency. To a color-deficient person, all the dots in one or more of the
plates will appear similar or the sameisochromatic. To a person without a color
deficiency, some of the dots will appear dissimilar enough from the other dots to form a
distinct figure (number) on each of the platespseudo-isochromatic.
In the following plate, even a color-deficient person will be able to distinguish an orange
25 on a turquoise background:

Pemeriksaan fundus oculi

1.
2.
3.

ALAT YANG DIPAKAI OFTALMOSKOP: OFTALMOSKOP DIREKT &

OFTALMOSKOP INDIRECT.
YANG DIPAKAI : OFTALMOSKOP DIRECT
PROSEDUR PEMERIKSAAN :
A. PEMERIKSAAN DILAKUKAN DIRUANGAN GELAP
B. ATURLAH ALAT OFTALMOSKOP SEHINGGA BERADA
PADA POSISI F
C. SESUAIKAN UKURAN LENSA PADA OFTALMOSKOP
SESUAI DENGAN KEADAAN REFRAKSI ANDA(PEMERIKSA)
DAN KEADAAN REFRAKSI PASIEN. MIS NYA : PEMERIKSA
MIOP - 2 D DAN PENDERITA EMETROP MAKA PAKAILAH
LENSA PADA OFTALMOSKOP 2. BILA BAIK PENDERITA MAUPUN
PASIENNYA EMETROP, PAKAILAH LENSA PADA OFTALMOSKOP 0

OFTALMOSKOP DIREKT

OFTALMOSKOP

FUNDUSCOPI

VENA RETINALIS

ARTERI RETINALIS

PAPILA
NERVI
OPTICI

ASPEK KLINIS:
OPTIC ATROPHY.
Optic atrophy of the optic disk (visible to an eye doctor
looking inside the eye) is the result of degeneration of the nerve
fibers of the optic nerve and optic tract. It can be congenital
(usually hereditary) or acquired. If acquired, it can be due to
vascular disturbances (occlusions of the central retinal vein or
artery or arteriosclerotic changes within the optic nerve itself),
may be secondary to degenerative retinal disease (e.g., optic
neuritis or papilledema), may be a result of pressure against the
optic nerve, or may be related to metabolic diseases (e.g.,
diabetes), trauma, glaucoma, or toxicity (to alcohol, tobacco, or
other poisons). Loss of vision is the only symptom. A pale optic
disk and loss of pupillary reaction are usually proportional to
the visual loss. Degeneration and atrophy of optic nerve fibers is
irreversible.

GAMBARAN FUNDUS OCULI PASIEN RETINOPATHY DIABETICUM

GAMBARAN FUNDUS OCULI PASIEN GLAUKOMA

GLAUKOMA
Glaucoma is an insidious disease which damages the optic nerve, typically because the
intraocular pressure (IOP) is higher than the retinal ganglion cells can tolerate. This
eventually results in the death of the ganglion cells and their axons which comprise the optic
nerve, thereby causing less and less visual impulses from the eye to reach the brain. In advanced
glaucoma, the peripheral retina is decreased or lost, leaving only the central retina (macular
area) intact, resulting in tunnel vision. Elevated IOPwhich can be measured by a
tonometry testis a result of too much fluid entering the eye and not enough fluid leaving the
eye. Normally, fluid enters the eye by seeping out of the blood vessels in the ciliary body. This
fluid eventually makes its way past the crystaline lens, through the pupil (the central opening in
the iris), and into the irido-corneal angle, the anatomical angle formed where the iris and the
cornea come together. Then the fluid passes through the trabecular meshwork in the angle and
leaves the eye via the canal of Schlemm.
If too much fluid is entering the eye, or if the trabecular meshwork drain gets clogged up (for
instance, with debris or cells) so that not enough fluid is leaving the eye, the pressure builds up
in what is known as open angle glaucoma. Open angle glaucoma also can be caused when the
posterior portion of the iris, surrounding the pupil, somehow adheres to the anterior surface of
the lens (creating a pupillary block), preventing intraocular fluid from passing through the
pupil into the anterior chamber. On the other hand, if the angle between and iris and the cornea
is too narrow or is even closed, then the fluid backs up, causing increased pressure in what is
known as closed angle glaucoma.An internal pressure more than that which the eye can
tolerate can deform the lamina cribrosa, the small cartilaginous section of the sclera at the back
of the eye through which the optic nerve passes. Deformation of the lamina cribrosa seems to
pinch nerve fibers passing though it, eventually causing axon death. Untreated glaucoma
eventually leads to optic atrophy and blindness

Eye pressure is measured by using a tonometer (with the test being

called tonometry), and the standard tonometer generally is
considered to be the Goldmann tonometer. The normal range of
intraocular pressure (IOP) is 10 mm Hg to 21 mm Hg, with an average
of about 16 mm Hg. Typically, eyes with intraocular pressure
measurements of 21 mm Hg or higher, using a Goldmann tonometer,
are considered suspect for glaucoma. However, although glaucoma
typically is associated with elevated IOP, the amount of pressure which
will cause glaucoma varies from eye to eye and person to person.
Many people with glaucoma have IOPs in the normal range (low
tension glaucoma), possibly indicating that their lamina cribrosas are
too weak to withstand even normal amounts of pressure; whereas,
many people with IOPs which would be considered high have no
evidence of glaucomatous damage.
Visual field loss, caused by optic nerve damage, is measured by using a
visual field analyzer or perimeter. The procedure is known as
perimetry. Field loss due to glaucoma usually is not even
measurable until 25% to 40% of the optic nerves axons have been
destroyed.

PROSES AKOMODASI
*MATA DLM KEADAAN ISTIRAHAT: SINAR
SEJAJAR YG BERASAL DARI BENDA TAK BER
HINGGA (> 6 M) MEMP FOKUS TEPAT DIRETINA
(TANPA AKOMODASI)

*SINAR YANG DATANG SECARA DIVERGEN

AKAN DIFOKUSKAN PADA TITIK DIBELAKANG
RETINA
< 6M

BAYANGAN BENDA TIDAK JELAS

*UNTUK DAPAT MELIHAT SUATU BENDA PADA

JARAK LEBIH DEKAT LAGI DARI 6M DENGAN
JELAS MAKA MATA HARUS BERAKOMODASI

MEKANISME AKOMODASI
ZONULA
ZINII

* LENSA ELASTIS : DLM KEADAAN ISTIRAHAT

DIREGANGKAN OLEH ZONULA ZINII

*M.SILIARIS BERKONTRAKSI( SRBT SIRKULER

& RADIAL
BAG BLKG ZONULA ZINII BER
GERAK KEDEPAN & KEDALAM
MENGENDOR
LENSA LEBIH CEMBUNG
PADA SAAT TATAPAN DIARAHKAN
PADA OBJEK YG LEBIH DEKAT

OTOT SILIARIS (SIRKULER & RADIAL)

ACCOMODATTION
When the ciliary muscle in the ciliary body relaxes, the ciliary processes pull
on the suspensory ligaments, which in turn pull on the lens capsule around its
equator. This causes the entire lens to flatten or to become less convex,
enabling the lens to focus light from objects at a far away distance. Likewise,
when the ciliary muscle works or contracts, tension is released on the
suspensory ligaments, and subsequently on the lens capsule, causing both
lens surfaces to become more convex again and the eye to be able to refocus
at near. This adjustment in lens shape, to focus at various distances, is
referred to as accommodation or the accommodative process and is
associated with a concurrent constriction of the pupil

FOCUSSING
Focussing involves:
1.moving the lens towards the back of the eye
2.turning the eyes inward towards the nose (convergence)
3.pupil constriction
4.fattening of the lens

REFRAKSI MATA
1.
2.
3.
4.

MATA EMETROP
MATA MYOP
MATA HIPERMETROP
MATA ASTIGMATISMUS

MATA EMETROP

The eye allows us to see and interpret the shapes, colors, and dimensions of objects in the
world by processing the light they reflect or emit. The eye is able to see in bright light or in
dim light, but it cannot see objects when light is absent.
Light from an object (such as a tree) enters the eye first through the clear cornea and then
through the pupil, the circular aperture (opening) in the iris

Next, the light is converged by the crystalline lens to a nodal point immediately
behind the lens; at that point, the image becomes inverted. The light progresses
through the gelatinous vitreous humor and, ideally, back to a clear focus on the
retina, the central area of which is the macula. (If the eye is considered to be a
type of camera, the retina is equivalent to the film inside the camera.) In the
retina, light impulses are changed into electrical signals and then sent along the
optic nerve and back to the occipital (posterior) lobe of the brain, which interprets
these electrical signals as visual images. Actually, then, we do not see with our
eyes but, rather, with our brains; our eyes merely assist with the process.

MATA EMETROP

The Nearsighted Eye (Myopia)

Myopia is the most common refractive condition and
affects one in four people in North America. Myopic
individuals are nearsighted: they see near objects
clearly, but distant objects are blurry. Myopia
occurs when light rays entering the eye are focused
in front of your retina instead of directly on it.
Nearsightedness can be corrected by eyeglasses,
contact lenses, or refractive surgery. The tendency
to develop myopia runs in families. Myopia
(nearsightedness) usually starts in childhood and
typically stabilizes in the late teens or early
adulthood

MATA MYOP

Far Source

Near Source

THE FAR-SIGHTED EYE

Hyperopia (far-sightedness),
is the opposite of myopia.
Here, your eye is too short or
your cornea is less curved.
Consequently, light rays
entering your eye fall behind
the retina. This results in
blurred vision which is
worse at near distances than
far.

MATA HIPERMETROP

THE ASTIGMATIC EYE

Astigmatism occurs when your
cornea is shaped like a football with
two different curvatures. Images
appear blurred or ghost-like because
light rays are refracted unequally. In
extreme cases, images both near and
far appear blurred. Many people
who have myopia also have
Inastigmatism.
the case of astigmatism, one or more
surfaces of the cornea or lens (the eye
structures which focus incoming light)
are not spherical (shaped like the side of
a basketball) but, rather, are cylindrical
or toric (shaped more like the side of a
football). As a result, there is no distinct
point of focus inside the eye but, rather, a
smeared or spread-out focus.
Astigmatism is the most common
refractive error

MATA ASTIGMATISMUS

MATA PRESBYOP

PRESBYOPIA
After age 40 in most people, and by age 45 in virtually all, a clear, comfortable
focus at a near distance becomes more difficult with eyes which see clearly
(whether with or without glasses) at a far distance. This normal condition is
known as presbyopia, and it is due both to a lessening of flexibility of the
crystalline lens and to a generalized weakening of the ciliary muscle which causes
the lens to accommodate (change focus). By the time one reaches age 65 or so, the
crystalline lens is virtually incapable of changing shape. Unless one is
nearsighted, it is not possible to focus objects (such print on a page) clearly at even
an arm's length distance.

MATA PRESBYOP

Note that presbyopia is not the same as

hyperopia (farsightedness). Presbyopia is an agerelated condition, resulting in difficulty keeping a
clear, comfortable focus at a near distance, even
with an eye which is not hyperopic (farsighted). On
the other hand, hyperopia is a refractive error which
makes it more difficult than normal to maintain a
focus at a near distance than at a far away distance
at any age (although, if one has a moderate to high
degree of hyperopia, even maintaining a clear focus
far away is difficult).

REFLEK-REFLEKS
PENGLIHATAN
1. REFLEKS PUPIL / CAHAYA
2. NEAR RELEKS
3. OCCULOCEPHALIC

JALUR LINTASAN REFLEK PENGLIHATAN

NEAR REFLEKS
PUPIL : MYOSIS
GERAKAN MATA : KONVERGEN
LENSA : BERTAMBAH CEMBUNG

LIGHT REFLEX / REFLEK CAHAYA :

In bright light, the parasympathetic nervous system causes the circular
sphincter muscle of the iris to contract and pupil constriction occurs. In
dim light, the sympathetic nervous system causes the radial muscle to
contract, dilating the pupil
dark:
main iris muscle set involved is RADIAL
radial

MIDRIASIS

light:
main iris muscle set involved is CIRCULAR
circular

MYOSIS

REFLEK CAHAYA:
LANGSUNG

TIDAK LANGSUNG

* PADA KEADAAN PATOLOGIS DAPAT TERJADI : PUPIL TIDAK

MENIMBULKAN RESPON (MYOSIS) TERHADAP CAHAYA TETAPI RESPON
AKOMODASI MASIH BAIK
LESI PADA DAERAH TECTAL

PUPIL ARGYLL ROBERTSON

PEMERIKSAAN TAJAM PENGLIHATAN(VISUS)

VISUS SESEORANG DITENTUKAN DGN CARA
MEMBANDINGKAN KETAJAMAN ORANG TERSEBUT
DENGAN ORANG NORMAL
ALAT YANG DIPAKAI UNTUK MEMERIKSA VISUS
ADALAH OPTOTIPE SNELLEN : BESAR HURUF-HURUF
YANG ADA SUDAH DITENTUKAN/DITERA SESUAI DGN
JARAK YANG DIPERLUKAN OLEH ORANG NORMAL
UNTUK DAPAT MELIHATNYA DENGAN JELAS.
PADA PINGGIR SETIAP BARIS TERDAPAT KODE ANGKA
DGN SATUAN FEET/METER, YANG MENUNJUKAN
BERAPA METER HURUF SEBESAR ITU OLEH MATA
NORMAL MASIH DAPAT DIBACA

OPTOTIP SNELLEN

PROSEDUR PEMERIKSAAN VISUS

1. ORANG PERCOBAAN DUDUK PADA JARAK 6 METER TEPAT
DIDEPAN OPTOTIPE SNELLEN
2. PERIKSALAH MATA KANAN TERLEBIH DAHULU,
KEMUDIAN MATA SEBELAH KIRI(MONOKULER)
3. MINTALAH ORANG PERCOBAAN UNTUK MENGINDENTIFIKASI
HURUF YG ADA PADA OPTOTIPE MULAI DARI ATAS SAMPAI
HURUF PADA BARIS 6/6
4. BILAMANA ORG PERCOBAAN HANYA DPT MEMBACA DENGAN
JELAS & BENAR HURUF-HURUF PADA BARIS BERKODE 20
METER MISALNYA & JARAK OP KE OPTOTIPE ADALAH 6
METER MAKA PENULISAN VISUSNYA ADALAH : 6/20
5. BILA HURUF E TIDAK DAPAT TERBACA MAKA LAKUKAN
PROSEDUR : FINGER COUNTING, HAND MOVEMENT DAN
LIGHT PERCEPTION

KESIMPULAN PEMERIKSAAN VISUS

BILA DIDAPAT HASIL PEMERIKSAAN VISUS MATA KANAN
ADALAH = 6/6 ( VOD=6/6),
KESIMPULAN : MATA KANAN OP EMETROP ATAU
HIPERMETROP.
UNTUK MEMASTIKAN DIAGNOSA LAKUKAN
PEMERIKSAAN DENGAN LENSA SFERIS NEGATIF 0,12D, BILA
OP MENGATAKAN DGN LENSA TSB HURUF DI OPTOTIPE
PADA BARIS 6/6 MENJADI LEBIH JELAS MAKA DIGNOSA OP :
HIPERMETROP
SEBALIKNYA BILA HURUFNYA MENJADI LEBIH BURAM
MAKA DIGNOSA MATA KANAN OP = EMETROP / NORMAL
2. BILA DIDAPAT HASIL PEMERIKSAAN VISUS MATA KANAN
ADALAH = 6/9 (VOD=6/9) ,
KESIMPULAN : MATA KANAN OP MYOP
1.

KOREKSI KELAINAN VISUS

1. BILA DIAGNOSA KELAINAN REFRAKSI ADALAH MYOP MAKA
DILAKUKAN KOREKSI DENGAN LENSA SFERIS NEGATIF.
PROSEDURE :
- GUNAKAN LENSA SFERIS NEGATIF DENGAN KEKUATAN
YANG TERKECIL DAHULU (-0,12 D)
LALU TENTUKAN
BERAPA VISUSNYA
- TAMBAHKAN KEKUATAN LENSA NEGATIF SECARA
BERTAHAP 0,12, -0,25, -0,50, -0,75 DST SAMPAI OP DAPAT
MEMBACA HURUF-HURUF PADA BARIS KE 7 ATAU 6/6
- BESAR KEKUATAN DIOPTRI LENSA YANG DIPAKAI ADALAH :
LENSANEGATIF DENGAN KEKUATAN TERKECIL YANG
MASIH DAPAT MEMBERIKAN DAYA PENGLIHATAN TERJELAS
PADA OP.

size of a 20/20 letter(=6/6)

When an eye doctor sets up an examination room, care should be taken in calibrating the size of the
letters on the visual acuity chart (which usually is projected onto a highly reflective screen).
The correct size of a 20/20 letter can be calculated using the diagram below, where
the letters visual angle subtended at the eye is 5' of arc (one-half of which is 2.5' of arc),
d is the distance (or virtual distance, if using a mirror), along the line of sight, from the eye to
the chart in feet, and
h is one-half the height of the 20/20 letter in millimeters.
As an example, lets say that the viewing distance, d, is 20 feet.
Since a right angle is formed by the line of sight and the plane of the acuity chart, then simple
trigonometry can be used:
1.2.5' of arc 60 = 0.04167
2.tangent 0.04167 = h d = h 20 feet
3.0.0007272 = h 6,096 millimeters
4.h = 4.433 millimeters
5.2h = total height of a 20/20 letter at 20 feet = 8.866 millimeters
In general, the size of a 20/20 letter (in millimeters) is .4433 d (where d is the viewing distance in
feet).

20/20 or 6/6 visual acuity

The reason that the number 20 is used in visual acuity measurements is because, in
the United States, the standard length of an eye exam room (that is, the distance from
the patient to the acuity chart) is about 20 feet. (In Great Britain, where meters are
used instead of feet, a typical eye exam room is about 6 meters long; 6 meters is 19.685
feet, which is close to 20 feet, since this is considered to be close enough to
optical infinity. Therefore, instead of using 20/20 for normal vision, they commonly
use 6/6.)
Someone with 20/20 or 6/6 vision (visual acuity) is just able to decipher a letter that
subtends a visual angle of 5 minutes of arc (written 5') at the eye. (5' of arc is 5/60 of a
degree, because there are 60' of arc in 1 degree.) What this means is that if you draw a
line from the top of a 20/20 letter to the eye and another line from the bottom of the
letter to the eye, the size of the angle at the intersection of these two lines at the eye is 5'
of arc. (Also, the individual parts of the letter subtend a visual angle of 1' of arc at the
eye.) It does not matter how far away something is from the eye; if it subtends an angle
of 5' of arc at the eye, then a person with 20/20 visual acuity will just be able to
determine what it is.
A person with 20/20 vision could stand 30 feet away from a test chart and just decipher
a 20/30 letter on the chart, since at that distance a 20/30 letter would subtend an angle
of 5' of arc at the persons eye. That same person could stand 80 feet away from the
chart and be able to decipher a 20/80 letter, or 200 feet away to be able to decipher a
20/200 letter.

20/20 compared with other acuities

Now, someone with 20/20 visual acuity does not have perfect vision, since it is quite possible
to see better than 20/20. The less the bottom number in the visual acuity ratio, the better the
acuity; and the greater the bottom number, the worse the acuity. Therefore, 20/15 acuity is better
than 20/20 acuity, and 20/30 acuity is worse than 20/20 acuity. Also, 20/15 acuity is equivalent
to 6/4.5 acuity, while 20/30 acuity is the same as 6/9 acuity.
As noted before, although 20/20 is "normal" visual acuity for most people, it is possible (and, in
fact, very common) to be able to see better than that. For instance, many people have 20/15
visual acuity. A person with 20/15 acuity can stand 20 feet away from an object and see it as
well as a person with 20/20 acuity moving up to 15 feet away from the object to view it. If that
is true, lets take a person with 20/15 vision looking at an object from 100 feet away. Where
would a person with 20/20 vision need to stand to see the object just as well? The answer is 75
feet away from the object. (That is, 15/20 100 feet = 75 feet.)
It is even possible, although not too common, for someone to have 20/10 visual acuity. Lets say
a person with 20/20 vision can just barely detect a ship which is 25 miles away out on the ocean.
A person with 20/10 acuity could be 50 miles away from the ship and still be able to just detect
it. That is, if a person with 20/10 acuity can just tell what an object is, a person with 20/20 vision
would need to stand half that distance away to be able to see what it is.
You can use the same rationale when considering someone with less than 20/20 acuity. Consider
a person with 20/40 visual acuity (which is what someone needs in most states to get a drivers
license). If a person with 20/20 acuity can just read a sign which is 60 feet down the road, the
person with 20/40 acuity would have to be 30 feet away to read the same sign. Also, a person
with 20/15 acuity could be 80 feet away, and a person with 20/10 acuity 120 feet away, to read
the same sign

PERGERAKAN DAN
PERSARAFAN BOLA MATA

OTOT-OTOT EXTRAOCULER
Ada 6 otot extraoculer yang berperan untuk gerakan rotasi mata kearah : Vertikal ,Horizontal,
dan anteroposterior. Otot tersebut adalah :
medial rectus (MR), the external rectus (ER), the superior rectus (SR), the inferior rectus (IR), the superior
oblique (SO), and the inferior oblique (IO).

GERAKAN OTOT :
medial rectus (MR)moves the eye toward the nose
external rectus (ER)moves the eye away from the nose
superior rectus (SR)primarily moves the eye upward and secondarily rotates the top of the eye
toward the nose
inferior rectus (IR)primarily moves the eye downward and secondarily rotates the top of the eye
away from the nose
superior oblique (SO)primarily rotates the top of the eye toward the nose and secondarily moves
the eye downward
inferior oblique (IO)primarily rotates the top of the eye away from the nose and secondarily moves
the eye upward

PERSARAFAN OTOT :
Each extraocular muscle is innervated by a specific cranial nerve:
medial rectus (MR)cranial nerve III
external rectus (ER)cranial nerve VI
superior rectus (SR)cranial nerve III
ER6(SO4)3.
inferior rectus (IR)cranial nerve III
superior oblique (SO)cranial nerve IV
inferior oblique (IO)cranial nerve III
The following can be used to remember the cranial nerve innervations of the six extraocular muscles:

cardinal positions of gaze

The cardinal positions are six positions of gaze which allow comparisons of the horizontal, vertical,
and diagonal ocular movements produced by the six extraocular muscles. These are the six cardinal
positions:

up/right
right
down/right
down/left
left
up/left

MR = Medial Rectus
SR = Superior Rectus

ER = Exteral Rectus
IR = Inferior Rectus

ASPEK KLINIS :
STRABISMUS (HETEROTROPIA)
The angle of deviation of the strabismus is measured in prism diopters. If the angle of deviation
remains the same in all cardinal positions of gaze (see the previous section), the strabismus is classified
as concomitant (or nonparalytic). If the angle of deviation is not the same in all cardinal positions
of gaze, the strabismus is classified as nonconcomitant (or paralytic).
Below, views of the two most common types of strabismusesotropia and extropiaare displayed:
Esotropia

Exotropia

Esotropia can be congenital (a muscle imbalance present from birth), and usually the angle
of deviation is large. Management involves surgical correction (at age six months or
earlier). Some cases of low-angle esotropia respond successfully to visual therapy,
especially in a child or an adult for which the esotropia is of recent onset and for which
there is no macular damage (that is, the strabismic eye is capable of good visual acuity).

LINTASAN PERSARAFAN
PENGLIHATAN DAN
KELAINANNYA

visual pathway
As the optic nerve leaves the back of the eye, it travels to the optic chiasm,
located just below and in front of the pituitary gland (which is why a tumor on
the pituitary gland, pressing on the optic chiasm, can cause vision problems). In
the optic chiasm, the optic nerve fibers emanating from the nasal half of each
retina cross over to the other side; but the nerve fibers originating in the temporal
retina do not cross over.
From there, the nerve fibers become the optic tract, passing through the thalamus
and turning into the optic radiation until they reach the visual cortex in the
occipital lobe at the back of the brain. This is where the visual center of the brain
is located. The visual cortex ultimately interprets the electrical signals produced
by light stimulation of the retina, via the optic nerve, as visual images.

The Optic Nerve

The optic nerve (also known as cranial nerve II) is a continuation of the axons of the ganglion
cells in the retina. There are approximately 1.1 million nerve cells in each optic nerve. The optic
nerve, which acts like a cable connecting the eye with the brain, actually is more like brain tissue
than it is nerve tissue

NEURAL PATHWAYS
* AXON DARI SEL-SEL GANGLION NERVUS OPTICUS DAN TRACTUS OPTICUS,
MENUJU KE GENICULATUM LATERALIS (DI TALAMUS)
* SERABUT-SERABUT DARI MASING-MASING HEMIRETINA NASAL
BERPOTONGAN DIDAERAH CHIASMA OPTICUM
* DIDALAM GENICULATUM BODY , SERABUT-SERABUT YANG
BERASAL DARI SETENGAH BAGIAN NASAL RETINA DAN SETENGAH
BAGIAN TEMPORAL AKAN BERSINAPS PADA SATU SEL YANG
AKSONNYA AKAN MEMBENTUK TRACT GENICULOCALCARINA, DAN
TRACT INI AKAN MENUJU KE LOBUS OCCIPITAL CORTEX CEREBRI
* AKSON AKSON SEL GANGLION DARI TRACT OPTICUS AKAN MENUJU KE
REGIO PRETECTAL(MIDBRAIN) DAN SUPERIOR COLICULUS( MEMPERANTARAIREFLEK PENGLIHATAN)
* AKSON-AKSON LAIN DARI CHIASMA OPTICUM AKAN MENUJU KE NUKLEUS
SUPRACHIASMATIC DI HIPOTALAMUS( MEMPERANTARAI HUBUNGAN
ANTARA BERBAGAI MACAM HORMON DAN IRAMA SIRKADIAN DENGAN
SIKLUS GELAP-TERANG

NEURAL PATHWAY
* SERABUT-SERABUT YANG BERASAL DARI HEMIRETINA
BAGIAN TEMPORAL SATU MATA DITERUSKAN
SEJALAN DENGAN N OPTICUS YANG IPSILATERAL
* SERABUT YANG BERASAL DARI HEMIRETINA BAG NASAL
AKAN DITERUSKAN DAN BERJALAN BERSAMA N OPTICUS
SISI YG KONTRALATERAL
* N OPTICUS
TRACT OPTICUS, BERHUBUNGAN DENGAN :
NUKLEUS GENICULATUM LATERAL,COLICULUS SUPERIOR,
NUKLEUS TRCT OPTICUS, NUKLEUS TRACT OPTICUS
ACESSORIUS, PRETECTAL REGION DAN HIPOTALAMUS
* PROYEKSI DARI RETINA BERHUBUNGAN DENGAN NUKLEUS
GENICULATUM LATERAL, YG TDD : 6 LAP SEL YAITU :
2 LAP MAGNOSELULER & 4 LAP PARVOSELULER.
AKSON DARI HEMIRETINA TEMPORAL YG IPSILATERAL AKAN
BERAKHIR PADA 3 LAPISAN INI DAN AKSON YG HEMIRETINA
KONTRALATERAL AKAN BERAKHIR DI 3 LAP LAINNYA

NEURAL PATHWAY
* AKSON-AKSON DARI NUKLEUS GENICULATUM MELALUI
RADIATIO OPTICA AKAN BERHUB DGN SEL SYARAF DI
CORTEX PENGLIHATAN PRIMER(AREA 17 CORTEX
OCCIPITAL), AREA INI BERHUB DGN CORTEX
PENGLIHATAN SECUNDER, CORTEX PENGLIHATAN
TERTIER & DAERAH INTEGRASI PENGLIHATAN
OCCIPITOPARIETAL / OCCIPITOTEMPORAL).
PROYEKSI JALUR PENGLIHATAN DI NUK GEN LAT
MELIPUTI PENGENALAN : WARNA, GERAKAN BENDA DAN
KWALITAS PERSEPSI PENGLIHATAN STEREOSKOPIK
* HUB ANTARA RETINA DAN HYPOTHALAMUS BERHUBUNGAN DENGAN:
PERUBAHAN SIANG DAN MALAM DENGAN HORMONAL DIDALAM
TUBUH MELALUI PENGATURAN IRAMA SIRKADIAN ATAU IRAMA
BANGUN & TIDUR , OLEH KARENA ITU RETINA JUGA MEMPENGARUHI
PIGMENTASI PADA KULIT( HORMON MSH)
* HUB ANTARA RETINA & PRETECTAL REGIO : BERHUB DGN UKURAN /
DIAMATER PUPIL (MYOSIS & MIDRIASIS)

KELAINAN LINTASAN PERSARAFAN

LAPANG PANDANG BINOKULER

PERIMETRI

LAPANG PANDANG BINOKULER