1. OPTOMETRY VISION SCIENCE

2. Eyeball

3. Refractive system the basic conditions of clear vision: 1. transparence 2. Imaging on fovea 3. Intact visual pathway

4. Refractive system Cornea Aqueous humor Lens Vitreous Refraction ： the process of imaging on retina that lights enter eye through refractive system Refractive system

5. Schematic eye Gullstrand Schematic eye refractive surfaces ： anterior/posterior surface of cornea, anterior/posterior surface of lens cortex, anterior/posterior surface of lens nucleus

6. Refractive system Gullstrand Refractive system –Total refractive power of eye ： 58.64D ， on maximum accommodation ： 70.57D –Refractive power of cornea ： 43.05D –Refractive power of lens ： 19.11D –Axis of eye ： 24mm

7. Reduced eye

8. Imaging of retina reverse imaging

9. Emmetropia Emmetropia ： the refractive condition in focus on fovea that parallel lights enter eye through refractive system without accommodation Punctum remotum of emmetropia: infinite

10. Accommodation the capability that eyes change refractive condition in order to acquire clear near sight

11. Accommodation Helmhotz accommodation mechanism Schachar accommodation mechanism Ciliary muscle contract Lens zonule relax accommodation Elastic deformation of lens See near Ciliary muscle contract Ante-&post-lens zonule relax accommodation Peripheral lens flatten See near equatorial lens zonule tension Central lens project

12. Accommodation punctum remotum Diopter ＝ 1 ／ distance of punctum remotum Static refraction Dynamic refraction

13. Accommodation Accommodation = diopter for far － diopter for near Range of accommodation ＝ distance of far point — distance of near point

14. Accommodation & convergence Triad Phenomena of eye –accommodation –convergence –Contraction of pupil

15. Ametropia Ametropia ： the refractive condition out of focus on fovea that parallel lights enter eye through refractive system on static refraction classification –myopia –hyperopia –astigmatism

16. Myopia Myopia: the refractive condition that parallel lights enter eye through refractive system and focus before fovea on static refraction Punctum remotum of myopia: a point before eye

17. Myopia classification Function –Simple myopia –Pathologic myopia Refractive factor –Axis myopia –Refractive myopia Degree –mild ： < -3.00D –middle: -3.00D~-6.00D –severe: > -6.00D Accommodation –Pseudomyopia (accommodative myopia) –nonaccommodative myopia –Mixed myopia

18. Myopia Clinical manifestation –vision ： far sight –Asthenopia –strabismus ： exophoria ／ exotropia –Change of eyeball ： long eye axis ， exophthalmos –Change of fundus ： tessellation ； myopic conus ； change of macula ； posterior scleral staphyloma ； change of peripheral fundus

19. Myopia

21. Complications –Disorder of vitreous body –Retinal detachment –glaucoma –cataract Myopia

22. Treatment –Spectacles: concave lens – principle ： the lowest diopter for BCVA –contact lens –Refractive operation –Treatment of complications Myopia

24. Hyperopia Hyperopia ： the refractive condition that parallel lights enter eye through refractive system and focus after fovea on static refraction Punctum remotum of myopia: a point after eye

25. Refractive factor Axis hyperopia Refractive hyperopia Degree mild ： < ＋ 3.00D middle: ＋ 3.00D~ ＋ 6.00D severe: > ＋ 6.00D Hyperopia

26. Clinical manisfestation sight degree of hyperopia, accommodation, amblyopia Asthenopia Esotropia Pathological change Hyperopia

27. Correction: convex lens –Infant and adolescent ： dilation pupil to examine eyesight –adult ： best sight ， comfort Hyperopia

28. Myopia and correctionHyperopia and correction Hyperopia

29. Astigmatism Astigmatism ： the refractive status that parallel lights can’t focus through refractive system on static refraction because refractive power of individual meridian is different

31. Regulation –Irregular astigmatism –Regular astigmatism Regular astigmatism –astigmatism with rule strong refractive-power meridian : 90 °±20 ° –astigmatism against rule strong refractive-power meridian : 180°±20 ° –oblique astigmatism axis: 45°or 135°±20 ° Astigmatism

32. Classification on refraction –Simple hyperopic astigmatism （ SHA) –Compound hyperopic astigmatism （ CHA) –Simple myopic astigmatism （ SMA) –Compound myopic astigmatism （ CMA) –Mixed astigmatism （ MA) Astigmatism

38. Clinical manifestation –diminution of vision –asthenopia correction –Preventing overcorrection

40. Anisometropia Anisometropia ： the refractive status that refraction of both eye is different Clinical presentation –Eruption of binocular single vision Fusion limitation the difference of imagination on both retina —— 25 ％ the difference of diopter on both eyes ——3.0D –Asthenopia –alternative fixation –amblyopia

41. Presbyopia Presbyopia ： the decrease of physiological accommodation with aging cause –Crystal sclerosis ， decreased elasticity –Decreased Ciliaris contraction –late ： enlargement of lens

42. Presbyopia Clinical presentation –Difficulty in reading or working in a short distance –Read in bright light –asthenopia –Accommodation delay Correction —— convex lens

43. Extraocular muscles

45. Main ActionSecondary Action Medial rectusPronation —— Lateral rectusExtorsion —— Superior rectusSuperior Turning Pronation, Internal rotation Inferior rectusInferior Turning Pronation, External rotation Superior obliquusInternal rotation Inferior Turning, Extorsion Inferior obliquusExternal rotation Superior Turning, Extorsion Roles of Extraocular muscles

46. Extraocular muscles Synergist ： the same eye antagonist ： the same eye Yoke muscles ： double eyes

47. Strabismus Strabism: both eyes can’t be fixed on the target simultaneously and the optic axes are divergent. one eye is fixing on the target and the other eye is deviating from it. Classification –Comitant strabismus –Non-concomitant strabismus –Special strabismus

48. Check of strabismus History Sight and refraction mydriasis and refraction Divergence of eye ／ compensatory head position ocular movement Quantu determination –Corneal light reflection test –triangular prism and cover test –Arc perimetry –triangular prism and Maddox –synoptophore

49. Check of strabismus

50. Comitant strabismus Direction –Concomitant esotropia –Concomitant exotropia Period –Heterophoria –Heterotropia Constancy strabismus Alternating strabismus intermittent strabismus accommodation –Accommodation esotropia –Part Accommodation esotropia –Non-accommodation esotropia Secondary –Paralysis compensation –Postoperation –perception

51. Comitant strabismus Therapeutics –Correction of refractive errors –Amblyopia discipline –Position discipline –operation

52. Non-concomitant strabismus Etiological factor –congenital –aquired ： trauma,inflammation, vascular disease, tumor, Metabolic disease –Physical eyeball motor disturbance

53. Non-concomitant strabismus clinical situation –Diplopia and Vertigo –Compensatory head position –Divergence of eye position –Limitation of motion –2 nd angle of strabismus >1 st angle of strabismus

54. Non-concomitant strabismus Therapeutics –etiological factor –Drug –triangular prism –operation

55. Difference between non- and Comitant strabismus Non-concomitant strabismusComitant strabismus Onset ageAny age< 5 years cause Congenital; aquired （ nervous system disease, trauma,inflammation, vascular disease, tumor, Metabolic disease ） unknown symptomDiplopia, Vertigo, Compensatory head positionNo significant ocular movement limitednormal Strabism angle 2 nd angle >1 st angle Fixation to limited direction : angle increase 1 st angle ＝ 2 nd angle Constant angle

56. Amblyopia

57. the visual development dysfunction of single/ double eye(s) because of insufficiency of visual stimulation into eye(s)—— form deprivation, and (or) difference between double eyes vision import which causes competition inhibition on the key period of visual development. BCVA ≤0.8

58. Amblyopia Classification and causes –strabismic amblyopia –Anisometropic amblyopia –ametropic amblyopia –form deprivation amblyopia –Other causes Degree –slight BCVA: 0.6 ～ 0.8 –middle BCVA: 0.2 ～ 0.5 –severe BCVA: ≤0.1

59. Amblyopia Clinical situation –Poor vision –Crowding phenomenon –Abnormal fixation –PVEP abnormality –Disfunction of binocular single vision –Elimination of other visual disfunction

60. Amblyopia Therapeutics –correction of refractive errors –amblyopia exercise