Refractive Errors

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CLINICAL DESCRIPTION

Visual problems that arise from inability to focus light accurately on the retina due to an abnormal length or shape of the eyeball. The diagnosis is established after performing a refraction. 

 

HYPEROPIA (FAR-SIGHTEDNESS)

CLINICAL DESCRIPTION

  • Near objects appear blurred

Classification

  • Mild hyperopia error of ≤+2.00 D
  • Moderate hyperopia error of +2.25 to +5.00 D
  • High hyperopia i.e., ≥+5.00 D

SIGNS AND SYMPTOMS

  • Dull frontal headache, usually felt in the afternoon or after doing near work, blurry vision at near, eye strain, fatigue after a close-up task such as reading and difficulty focusing on nearby objects.

 

ASTIGMATISM

CLINICAL DESCRIPTION

Imperfection in the curvature of the refractive surfaces of the eye.  

CLINICAL DESCRIPTION SIGNS AND SYMPTOMS

  • Blurry vision or areas of distorted vision, eyestrain, headache (usually temporal), squinting to try to see clearly, eye discomfort and diplopia.

 

MYOPIA (NEAR-SIGHTEDNESS)

CLINICAL DESCRIPTION

Distant objects appear blurred

Classification based on clinical entity

  • Simple myopia
  • Pathological myopia

SIGNS AND SYMPTOMS

  • Eye strain, headache, squinting (eye misalignment) and difficulty with seeing objects far away such as road signs.

 

PRESBYOPIA 

CLINICAL DESCRIPTION

A condition in which the eyes gradually lose the ability to focus on near objects due to age-related sclerosis of the lens.

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Blurred vision at normal reading distance, eyestrain, headache associated with doing near work and holding reading material at arm’s length.

Diagnosis of refractive errors

  • Perform refraction for near and distant vision
  • In addition to dry refraction, all children should have a wet refraction (give Cyclopentolate eye drops before refraction)

 

TREATMENT 

Management of Refractive errors

  • Correct with spectacles. Reading glasses (readers) if presbyopia
  • Can prescribe multifocal- bifocals, trifocals or progressive lenses, or contact lenses.
    • Consider monovision correction - one eye corrected for near and the other eye for distance in special cases.
    • Refractive surgery.

Management/control of myopia progression

  • Spectacles and contact lenses
  • Consider pharmacological means in children
    • 0.05%  Atropine in children at bedtime 3 to 4 nights a week for a period of 6 months.
  • Behavioral
    • Increase outdoor time and exposure to sunlight.
    • Reduce the time spent doing near work.