LENS SHAPES
1. MENISCUS LENSES
- used for making spectacles
2. LENTICULAR FORM 3. ASPHERIC LENSES
LENSES - Used for aphakic lenses by
- central portion is modifying the lens
corrective curvature peripherally
- peripheral surfaces are - reduce aberrations and
parallel provide better peripheral
vision
Power Lenses (Single vs Multiple)

1. Single vision lens

same corrective power over the entire surface
correct myopia, hypermetropia, astigmatism or presbyopia
2. Bifocal lenses
Upper (for distant vision) and lower (for near vision) segments
3. Trifocal lenses
upper (for distant vision), middle (for intermediate
rangevision) and lower (for near vision)
4. Multifocal (varifocal) or progressive lenses

Tinted Lenses
Tinted glasses
- reduce the amount of light they
transmit and provide comfort,
safety and cosmetic effect
- almost all of the ultraviolet and
infrared rays
Photochromatic lenses
- alter their colour according to
the amount of ultraviolet exposure
Centring and
Decentring
Decentring of the lens is
indicated where prismatic
effect is required.
Reading glasses
- should be decentred by about
2.5 mm medially and about
6.5 mm downward
- as the eyes are directed down
and in during reading
Frames
SPECIAL CONSIDERATIONS
1. Comfortable i.e. neither tight nor loose, light in weight
and should not put pressure on the nose or temples of
the patient, and should be of optimum size
2. Children: large glasses are recommended
to prevent viewing over the spectacles
3. Ideally, the lenses should be worn 15.3 mm from the
cornea (the anterior focal plane of eye)
at this distance the images formed on the retina
CONTACT LENS

artificial device whose front surface

substitutes the anterior surface of the
cornea

1. Correction of refractive error

2. Correction of irregularities of the front surface
of cornea
CONTACT LENS Standard Nomenclature

1. Diameters of the Lens

2. Curves of the Lens
a. Base Curves meant to
b. Peripheral Curves (IPC and PPC) focus
Serve as reservoir of tears rays on retina
c. Central Anterior Curve
Det. Power of contact lens
d. Peripheral Anterior Curve
e. Intermediate Anterior Curve
3. Edge of the Lens
4. Power of the Lens
5. Thickness of the Lens
6. Tint (color)
CONTACT LENS Types
1. Hard lenses
Polymethylmethacrylate (PMMA)
2. Rigid gas permeable lenses
copolymer of PMMA and silicone
containing vinyl monomer
3. Soft lenses
Hydroxymethymethacrylate
(HEMA)
Disadvantages
1. PMMA is practically impermeable
to O2
2. Being hard: Can cause corneal
abrasions
3. Being hydrophobic: resists
wetting but a stable tear film can
be formed over it
Advantages
oxygen permeable, they are most
comfortable and so well tolerated
Disadvantages
wettability, proteinaceous
deposits, getting cracked, limited
life, inferior optical quality, more
chances of corneal infections
CONTACT LENS Indications
1. Optical indications
anisometropia, unilateral aphakia, high myopia, keratoconus and irregular astigmatism
2. Therapeutic indications
Corneal dse, glaucoma, dses of iris
3. Preventive indications
4. Diagnostic indications
5. Operative indications
6. Cosmetic indications
7. Occupational indications
Refractive Surgery of Myopia Radial Keratotomy

refers to making deep (90

percent of corneal thickness)
radial incisions in the
peripheral part of cornea
leaving the central 4 mm
optical zone
These incisions on healing
flatten the central cornea
thereby reducing its refractive
power
Disadv: weakened cornea
risk for globe rupture
Refractive Surgery of Myopia Photorefractive Keratectomy

central optical zone of

anterior corneal
stroma is photoablated
using excimer laser
(193-nm UV flash) to
cause flattening of the
central cornea
Disadv: healing is
slow; more expensive
Refractive Surgery ofMyopia LASIK
Laser in-situ keratomileusis (LASIK)

Refractive surgery of choice for

myopia
Adv: Minimal or no postoperative
pain; aerly recovery of vision; No
risk of perforation during surgery
and later rupture of globe due to
trauma unlike RK; No residual
haze
Disadv: potential risk of flap
related complications:
wrinkling of the flap on
repositioning
dislocation/subluxation
Refractive Surgery of Myopia
Extraction of clear crystalline lens (Fucala's operation)
Recently, clear lens extraction with intraocular lens implantion of appropriate power is
being recommended as the refractive surgery for myopia (more than 12D)
Phakic intraocular lens or intraocular contact lens
special type of intraocular lens is implanted in the anterior chamber or posterior chamber
anterior to the natural crystalline lens
Intercorneal ring (ICR)
implantation into the peripheral cornea at approximately 2/3 stromal depth
flattens the central cornea, decreasing myopia
Reversible
Orthokeratology
non-surgical reversible method of molding the cornea with overnight wear unique rigid gas
permeable contact lenses,
It can be used even in the patients below 18 year of age
Diseases of the Lens
Applied Physiology and Biochemistry
Crystalline lens transparent structure; main role in the
focusing mechanism for vision

Physiological aspects:
Lens transparency
Metabolic activities of the lens
Accommodation
Lens Transparency
Factors that play significant role in maintaining
outstanding clarity and transparency of lens are:
Avascularity
Tightly-packed nature of lens cells
The arrangement of lens proteins
Semipermeable character of lens capsule
Pump mechanism of lens fibre membranes that regulate the
electrolyte and water balance in the lens, maintaining relative
dehydration
Auto-oxidation and high concentration of reduced glutathione in the
lens
Metabolism
Lens requires a continuous supply of energy (ATP)
for active transport of ions and amino acids
maintenance of lens dehydration
for a continuous protein and GSH synthesis
Most of the energy produced is utilized in the epithelium
major site of all active transport processes
Metabolism
Source of nutrient supply
The crystalline lens, being
an avascular structure is dependent for its metabolism
on chemical exchanges with the aqueous humour
chemical composition of the lens vis a vis aqueous
humour and the chemical exchange between the two
Metabolism
Pathways of glucose metabolism
Glucose: imp
Metabolic activity of the lens is largely limited to epithelium,
and cortex, while the nucleus is relatively inert. In the
lens, 80% glucose is metabolised anaerobically by the
glycolytic pathway, 15 percent by pentose hexose
monophosphate (HMP) shunt and a small proportion via
oxidative Kreb's citric acid cycle
it is extremely important in the production of cataract in
diabetic and galactosemic patients.

Definition
I. Congenital
II. Acquired cataract
Etiological Classification
Crystalline lens is a transparent structure
Its transparency may be disturbed due to degenerative
process leading to opacification of lens fibres
Development of an opacity in the lens is known as
CATARACT and developmental cataract
1. Senile cataract
2. Traumatic cataract
3. Complicated cataract
4. Metabolic cataract
5. Electric cataract
6. Radiational cataract
7. Toxic cataract e.g.,
i Corticosteroid-induced cataract
ii. Miotics-induced cataract
iii. Copper and iron induced cataract
8. Cataract associated with skin diseases
9. Cataract associated with osseous diseases.
10. Cataract with miscellaneous syndromes e.g.,
i. Dystrophica myotonica
ii. Down's syndrome.
iii. Lowe's syndrome
Morphological Classification 1. Capsular cataract
involves the capsule and may be:
a. Anterior capsular cataract
b. Posterior capsular cataract
2. Subcapsular cataract
It involves the superficial part of the cortex (just
below the capsule) and includes:
a. Anterior subcapsular cataract
b. Posterior subcapsular cataract
3. Cortical cataract
It involves the major part of the cortex
4. Supranuclear cataract
It involves only the deeper parts of cortex (just
outside the nucleus)
5. Nuclear cataract
It involves the nucleus of the crystalline lens
6. Polar cataract
It involves the capsule and superficial part of the
cortex in the polar region only and may be:
a. Anterior polar cataract
b. Posterior polar cataract
Congenital and Developmental Cataracts
 Congenital Cataract Developmental Cataract

- Occur before birth - Occur from infancy to

- Therefore, in congenital adolescence
cataract the opacity is - Therefore, such opacities may
limited to either involve infantile or adult
embryonic or fetal nucleus, deeper parts of
nucleus cortex or capsule
Etiology
Heredity Fetal or Infantile Factors
Maternal Factors
Genetically-determined 1. Deficient oxygenation
cataract is due to an (anoxia) owing to placental
1. Malnutrition during
anomaly in the haemorrhage
pregnancy
chromosomal pattern of 2. Metabolic disorders
2. Infections
the individual such as galactosemia,
Rubella
1/3 of CC galactokinase
Toxoplasmosis
deficiency and neonatal
cytomegalo-inclusion
Common familial hypoglycemia
disease
cataracts include: 3. Cataracts associated with
3. Drugs ingestion
cataracta pulverulenta, other congenital anomalies
Thalidomide
zonular cataract (also 4. Birth trauma
Corticosteroids
occurs as non-familial), 5. Malnutrition in early infancy
4. Radiation
coronary cataract and may also cause
total soft cataract (may developmental cataract
also occur due to rubella)
Clinical Types

I. Congenital capsular cataracts

1. Anterior capsular cataract
2. Posterior capsular cataract
II. Polar cataracts
1. Anterior polar cataract
2. Posterior polar cataract
III. Nuclear cataract
IV. Lamellar cataract
V. Sutural and axial cataracts
1. Floriform cataract
2. Coralliform cataract
3. Spear-shaped cataract
4. Anterior axial embryonic cataract
VI. Generalized cataracts
1. Coronary cataract
2. Blue dot cataract
3. Total congenital cataract
4. Congenital membranous cataract
Congenital capsular cataracts
1.Anterior capsular
cataract

2.Posterior capsular
cataract
Assoc with persistent hyaloid
remnants
Polar cataracts
1.Anterior polar cataract
d/t delayed devt of anterior
chamber
d/t corneal perfusion
2. Posterior polar cataract
Nuclear cataracts
Lamellar cataracts
Developmental cataract in which the opacity occupies
a discrete zone in the lens
It is the most common type of congenital cataract
presenting with visual impairment
Etiology
It may be either genetic or environmental (Vit D)
Maternal rubella infection contracted between 7th and 8th week of gestation
Characteristic features
zone of fetal nucleus surrounding the embryonic nucleus
Occasionally two such srings of opacity
Main mass of the lens internal and external to the zone of cataract is clear,
except for small linear opacities like spokes of a wheel (riders) which may be
seen towards the equator
Bilateral; freq causes severe visual defects
Sutural and axial cataracts
Coronary cataracts
Blue dot cortical cataracts
Total Congenital cataracts
The lens matter may remain soft or
may even liquefy (congenital
Morgagnian cataract)

Congenital rubella cataract may

occur alone or as part of the classical
rubella syndrome which consists of:
1. Ocular defects (congenital
cataract, salt and pepper
retinopathy and microphthalmos)
2. Ear defects (deafness due to
destruction of organ of Corti)
3. Heart defects (patent ductus
arteriosus, pulmonary stenosis
and ventricular septal defects)
Congenital membranous cataracts