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    HYPEROPIAANATOMY Before we can describe hypermetropia let's compare the eyeball to a camera for better understanding. When we take a picture, light after reflecting from an object enters the camera and passes through; First, a transparent glass in front of the aperture of the camera then secondly, a lens that helps us in focusing light rays and lastly, a film on which light is focused for a clear picture. Eye is somewhat similar, as when we see an object, light after reflection from that object enters our eye through; Firstly, cornea (the transparent curved front part of eye) then secondly, through the crystalline lens that helps us in focusing light rays and lastly, the retina (light-sensitive receptor cells in the posterior part of eyeball) on which light is focused for a clear image. Definition It is a form of refractive error (inability to refract/ bend/focus the light rays properly) in which parallel rays of light (i.e. Coming from a distinct object) after entering the eye are focused behind the retina with accommodation (eye muscles) at rest. Key features this refractive error has three key features 1. image is formed behind the retina, as in normal people image has to be focused on the retina for it to be clear.2. Parallel light rays (the rays that only come from objects at 6 meters or beyond) must be used for assessment. As when objects come closer than 6 meters, light rays start to diverge, changing their focus. That is why we place Snellen’s chart at 6 meters.3. The eye is must be at rest. Just like a DSLR camera’s focusing power can be changed by rotating its zoom lens, eye changes its focusing power by changing the shape of its lens with the help of contraction and relaxation of certain muscles located inside the eyeball. These muscles must be at rest to correctly access the eye's focusing power. Misnomer Both hypermetropia and myopia have abnormal instant vision i.e. they cannot focus distant objects clearly. But a unique thing about hypermetropia is that if these patients increase the power of their lens (by contraction of certain intraocular muscles)they can focus the image accurately on their retina. This will result in excessive and continuous use of intraocular (ciliary) muscles in order to keep the image focused on the retina resulting in pain. Also, when they try to see near objects theireyes will require even more focusing power which these muscles can no longer providence causing near objects to become blurry. (This is also the reason why we use cycloplegic (or muscle paralyzing) drops before estimating the amount of refractive error) So, a lot of hypermetropic patients (not all)(with less degree of hypermetropia) will say that they see distant objects clearly but they have pain/discomfort in their eyes or their eyes get tired and also near vision is mostly not that good.

    Hence these patients are mistakenly called far-sighted.CAUSE 

    1. Curvature: the curvature of the cornea or lens is flatter than normal.
    2. Axial: short axial length of the eye
    3. Index: decrease in refractive index (i.e. light bending/focusing power) of the lens(e.g. in cortical cataract) 
    4. Positional: posterior displacement of lense.g. after trauma.
    5. Aphakia: the absence of lens in the eye...

    therefore eye cannot focus light rays on the retina.TYPES Total hypermetropia is the total refractive error calculated after complete cycloplegia (intraocular muscle paralysis) induced by certain drops. 

    1. Latent hypermetropia. amount of hypermetropia corrected by (the focusing power produced due to) normal tone of intraocular(ciliary) muscles (It is usually 1 diopter)
    2. Manifest hypermetropia is the remaining portion of hypermetropia. 

    Divided into the facultative amount of hypermetropia corrected by (the focusing power produced due to) active contraction of intraocular (ciliary) muscles. Absolute amount of hypermetropia cannot be corrected even by contraction of intraocular (ciliary) muscles. CLINICAL FEATURES SYMPTOMSEye straining or discomfort (asthenopia) including eye tiredness, pain, headache or mild photophobia. Blurred vision with eye-straining: when muscle contraction attempts but fails to correct hypermetropia. Blurred vision only: when a refractive error is high and cannot be corrected at all by muscle contraction efforts. inward deviation of eye (convergent squint)(normal pts require to move their eyes inward while focusing near objects..... this is enhanced in hypermetropic pts causing their eye to move inwards intermittently or constantly)SIGNS small eyeball corneal diameter may be small Retinal exam might show false changes due to distortion of image when hypermetropia exceeds 5 dioptersDIAGNOSIS Retinoscopy (a hand-held device that throws light in the eye and allowing us to observe its movements and reflection, hence helping to confirm the refractive error) A-scan (a small ultrasound probe that throws waves in the eyeball and then detects their reflections or echo timings, calculating the eyeball length) short length NOTE:At birth all eyes are hypermetropic (+2.5 to +3) i.e. light is focused behind the retina.

    As the eyeball grows and at about 6-7 yrs age eyeball is of normal size and emmetropic i.e. light is focused on the retina. Some people continue to grow causing myopia i.e. light is focused in front of the retina. TREATMENTUnlike the camera, maximum (2/3rd) focusing in an eye is done by the transparent front part(cornea) while the rest (1/3rd) is done by the lens. So, while treating these patients we have to increase the focusing power of the eye so that image is formed on the retina instead of in behind it. This can be done by using either a converging lens e.g. NON-SURGICAL treatment glasses Contact lenses some surgical procedures can be done to increase the focusing power of either the cornea or the lens. SURGICAL TREATMENT




     Life is beautiful is another picture that your friend posted when he saw Schindler's List. The concentration camp, the Nazi army, and so on reminds us of the Schinder's list, but the nature of the images is as spacious as the two poles.

     The picture shows the life of Guido Orefice. No matter how many comedies you say, the last one is eye-watering. The film vividly portrays love, friendship and suffering. On top of all that, a good father-son son can be seen.

      The performance of Roberto Benigni's Guido Orefice was excellent. It is reminiscent of Charlie Chaplin's comedy. As well as the relics. He also won the Academy Award that year for Best Actor.

     Guido Orefice's face still trying to make his son happy at the last minute. Of course everyone can see. Although the second half of the film is in concentration camp. Schinder's list doesn't show anything so intense. So be brave.

      1. making the central part of cornea more curved. This includes different methods that were changed and advanced depending upon the reduction of side effects and recovery time and improvement of the degree of vision.PRK (Photorefractive keratectomy) Remove corneal epithelial cells by a solution then use a laser to reshape the cornea (i.e. making it steeper) and then apply a bandage contact lens. Side effects include pain and recovery is in 1 week at least. 

    It corrects 2D hypermetropiaLAS I K (Laser In-situ Keratomileusis): corrects up to 4DA famous and frequently performed surgery nowadays. In this procedure a bigger flap of cornea 160 micrometers is taken by a device (keratome), the laser is applied to change the corneal shape and then the flap is repositioned. Advantages over other procedures -Absence of post-operative pain-More rapid visual rehabilitation Conductive keratoplasty: it involves giving radiofrequency energy to corneal stroma causing a change in its shape.