Jannes Fritz Tan

. Anamnesa 1. Dilakukan dengan ramah2. Mencatat identitas pasien3. Menggali * keluhan utama * keluhan tambahan * Perjalanan penyakit 4. Mengetahui riwayat pengobatan dan penyakit terdahulu.

Pemeriksaan Visus dan Refraksi

Menentukan visus tiap mata: a. Optotip Snellen : 6/50 6/6 b. Menghitung jari : 1/60 6/60 c. Gerakan tangan 1/300. Pemeriksaan proyeksi cahaya dari segala arah (atas, bawah, nasal, temporal) d. Membedakan terang gelap 1/~. Pemeriksaan proyeksi cahaya menilai fungsi retina. Contoh: arah atas tidak dapat membedakan terang gelap 1/~ proyeksi bawah (-). e. Tidak dapat membedakan terang gelap : Nol. f. Menentukan kemampuan membaca dengan kartu baca. g. Koreksi plus >> & koreksi minus

*Distance Vision

Parallel (distant images)light is refracted by the Cornea & the LensLight is focused on the Fovea & images are clear

*Near VisionDivergent (near images) light rays focus behind the retinaThe lens changes shape (more convex) to focus near images on the retina (accommodation)

*Decreasing AccommodationThe lens can not accommodate enough to focus near imagesThe aging eye starts to lose its ability to accommodateBifocals or reading glasses are required

*Nearsightedness

Parallel (distant images) rays are focused in front of the fovea The Cornea is too Steep &/or the eye is too Long for its refractive capability

*Contact Lenses or GlassesA CONCAVE lens diverges parallel light raysThe focal point moves back & distant images are clear

*Laser Refractive SurgeryThe cornea is reshaped, decreasing its convergent powerParallel rays of light focus on the fovea

*Near VisionNearsighted people, without their glasses, can often focus near objects on the retina with little or no accommodationThe Divergent rays of objects near the eye are focused by the cornea & lens

*FarsightednessThe Cornea is too Flat &/or the eye is too ShortLight focuses in back of the FoveaBoth Distant & Near images are blurred

*Latent or Manifest HyperopesYoung farsighted people can use accommodation to focus distant objectsLatent or Manifest Hyperopes will eventually need distance & reading glasses as their accommodative potential decreases with age

*Absolute HyperopesFull accommodation does not have enough power to focus distant images on the retinaA Convex lens is required to converge light rays on the fovea

*Laser Vision CorrectionThe peripheral cornea is reshaped with the excimer laserA Convex lens is required to converge light rays on the fovea

*Near VisionLatent or Manifest Hyperopes usually need glasses to read because they have used all their accommodative potential to correct their distance vision

*The Cornea is Steep in one axis & Flat in the otherMultiple focal points in the eyeImages are blurred &/or distorted F1F2

*9018045 D42 D42.00 / 45.00 X090With-The-RuleAstigmatismSteep Axis Vertical9018042 D45 D42.00 / 45.00 X180Against-The-RuleAstigmatismSteep Axis Horizontal{Steep K & Axis

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*The cornea is reshaped in an ovoid patternThe focal points coincide at the fovea

Huruf terdiri atas sudut 5 menit bila dilihat pada jarak tertentuMerupakan dasar pembuatan kartu uji tajam penglihatan Snellen

Pada jarak tertentu memberikan sudut 5 menitSetiap baris menunjukkan angka jarak dimana huruf dapat dilihat jelas karena membentuk sudut 5 menit

Lensa coba dipakai untuk alat uji koreksi tajam penglihatanTerdiri atasLensa negatif 0.25-20 DLensa positif 0.25-20 DLensa silinder 0-25-10DLensa prismaLempeng pinhole

Dipakai sebagai pemegang lensa coba pada uji kelainan refraksi

Lensa sferis titik jauhKoreksi silinderAnak koreksi penuhDewasa coba penuhHiperopia: rendah (-)Silinder koreksiEsotropia koreksi penuh + sikloplegikAnisometropia koreksi penuh; ambliopia th/ oklusiBAGIAN MATA FK UKI

BAGIAN MATA FK UKI

Loupe untuk melihatPembesaran lensa 3-6 dptSentolopMemberikan penerangan

Memeriksa organ mata secara sistematis.1. Bentuk, posisi dan gerak bola mata, alis, bulu mata dan kelopak mata atas/ bawah. Area lakrimalis, konjungtiva bulbi. Melipat kelopak mata konjungtiva tarsalis.2. Sistem optik mata. kacamata pembesar dan senter. a Sinari kornea: Reflex kornea yaitu reflex cahaya pada permukaan kornea 1). Cerah / mengkilat: kornea jernih, jaringan parut ( putih ) 2). Suram : erosi konea, radang kornea atau edema kornea Reflex cahaya pada kedua permukaan kornea ( Tes Hirschberg).di tengah pupil (ortofori), salah satu tidak ditengah pupil (heterofori -juling ) b. Bilik mata depan ( BMD ) dan iris. Iris yang baik memiliki cekungan radier ( kripti). Kejernihan BMD: 1). Kripti iris jelas : jernih 2). Kripti iris tidak jelas : keruhKedalam BMD: sinari iris dari samping luasnya permukaan iris yang mendapat penyinaran. 1). Sebagian kecil permukaan iris mendapat sinar : BMD dangkal 2). Seluruh iris tersinari : BMD dalam.

c. P u p i lPupil yang tidak bulat/ teratur sinekia .Reaksi pupil langsung: pupil

D. Funduskopi ( dokter ) 1. Perhatikan reflex fundusjarak pemeriksaan : 30 cm.media refraksi jernih: reflex fundus berwarna merah kekuningan.media refraksi keruh ( kornea, lensa, badan kaca ) bercak hitam di depan latar belakang yang merah kekuninganKatarak matur reflex fundus negatif. 2. Melihat retina dan pupil N II oftalmoskop didekatkan sedekat mungkin ke mata pasien.

E. Pemeriksaan lapangan pandang (test konfrontasi)

Jarak pemeriksa dan pasien: 60 cm.mata kiri diperiksa mata kanan pasien ditutup. Mata kiri pasien berhadapan dengan mata kanan pemeriksa. Gerakan jari/benda dari segala arah, dari luar kedalam. Catat bila ada bagian lapang pandang, yang masih terlihat oleh pemeriksa, tetapi tidak oleh pasien.Ulangi dengan cara yang sama pada mata kanan.

F. Tonometri: Tonometer Schiotz Kedua mata ditetes anestesi topikal.Tonometer ditera pada tes blok jarumkkan angka nol pada skala dan plunger bergerak bebas dalam silindernya. beban terkecil 5,5 gr foot plate di desinfeksi dengan kapas alcohol 70 %.Tonometer vertikal di atas kornea penderita, kelopak mata pasien dibuka secukupnya tanpa menekan bola mata.tonometer diturunkan foot plate menekan kornea. Angka skala yang ditunjuk jarum pada saat itu dicatat

G. Pemeriksaan tambahanPemeriksaan Anel : menyuntikkan cairan garam fisiologi melalui pungtum lakrimalis dengan jarum bengkok yang tumpul.Pemeriksaan Buta Warna: mempergunakan buku Ishihara. Ditetapkan buta warna total atau sebagian.Pemeriksaan Hb dan gula darah: perlu dalam pemeriksaan operasi katarak di-samping menilai keadaan umum pasien.

Pemeriksaan tonometri dengan alat aplanasi GoldmannPasien duduk di depan lampu celah Tonometer diletakan pada pemukaan kornea

a,. Kinetic perimetryb. Static perimetry

Pada Kampus OD mata normalBatas batasNasal 60Temporal 90Bawah 75Atas 60Bintik Buta temporanl 10- 18

Warna papil pucatMata kiri : Nasalisasi pembuluh darahGaungan papil dengan C/D rasio 0.8

Pembuluh darah terletak lebih ke nasal ( nasalisasi )

USG, untukMengukur panjang bola mataMelihat adanya perubahan struktur mata

B-scan: vitreus haemorrhage dan total tractional retinal detachmentA-scanHRT display

Prinsip ERGERG normalMultifocal ERGNormal OCT

*An eye that has no refractive error is emmetorpic.*An emmetropic eye focuses divergent light rays from near objects by changing the shape & location of the crystalline lens.*As the eye ages, the crystalline lens is no longer capable of changing shape & can no longer focus on near objects. This age related loss of accommodation is referred to as presbyopia.

*Myopia is a condition where the eye is too long d&/or the cornea is too steep. Distant images are focused in front of the retina.*Myopia is corrected by placing a concave lens in front or on the eye. The lens diverges the light rays moving the focal point further back in the eye.*Myopia can also be corrected by changing the shape of the cornea through refractive surgery. Incisional refractive procedures flatten the cornea & laser refractive procedures reshape the cornea. The most popular laser refractive procedure is LASIK.*Most myopes have no difficulty reading because the divergent rays of near objects can be effectively focused by the lens. Many myopes may even be able to read as they become presbyopic depending on the degree of their myopia.

Most Myopic presbyopes with require reading glasses or bifocals as they age. *Hyperopoes or farsighted people have an eye that is too short &/or a cornea that is too flat. Parallel light rays focus behind the eye.*Hyoperopes are classified as latent /manifest or absolute. Young Latent / Manifest hyperopes are able to use their accommodation to overcome their farsightedness.Unfortunately, this means they have little accommodation left for near vision & will require reading glasses at a young age. *Absolute hyperopes have a significant amount of farsightedness & are unable to focus distance or near objects. A convex lens in glasses or contact lenses help converge light rays so images can be focused on the retina. All absolute hyperopes require reading glasses or bifocals.*Hyperopia can also be corrected with laser refractive surgery. The laser steepens the central cornea allowing light rays to converge on the retina.*Manifest hyperopes usually require reading glasses in their late teens or early 20s when their accommodative potential can no longer correct their distance as well as their near vision.*Astigmatism is primarily a result of an aspheric cornea. Multiple focal points are created in the eye as a result of steeper & flatter refractive surfaces on the cornea.

Occasionally, the crystalline lens can also induce small degrees of astigmatism.*Astigmatism is categorized as with the rule or against the rule. The curvature of the cornea is measured in refractive power or diopters. Corneas with more power in the vertical axis are with the rule & corneas with greater power in the horizontal axis are against the rule. *Astigmatism is categorized by where the focal points occur in the eye. Simple astigmatism has one focal point on the retina & one, or more, focal points in front or behind the retina.

Mixed astigmatism has one focal point in front of the retina & one behind.*Compound astigmatism occurs when both focal points are in front or behind the eye.*Astigmatism is corrected by glasses or contact lenses that accommodate for the irregular shape of the cornea. Laser refractive surgery can also correct astigmatism.