CHAPTER I
INTRODUCTION
1.1 Background Issues
At this time the better health and thus life expectancy also increased, to keep abreast of contemporary public interest to read more meningkat.Semakin growing interest in the need for reading glasses then.
Glasses are needed by the community obtained from an optical. According to the Ministry of Health Decree No. 1424/Menkes/SK/XI/2002 stating that bifocal is a means of organizing health care basic eye examination, inspection and service refraction correction glasses and contact lenses.
At this time the response to refractive disorders more common to use glasses, refractive disorders experienced by children and adults, and also by the age of 40 years is called presbyopia. Presbyopia is a habit which the eye near vision decreases caused by lower power usage is necessary accommodation for glasses with bifocal lenses for reading and serves to look far.
Glasses are also able to beautify and enhance the patient's face to produce the glasses are comfortable to wear, it should be standardized because it is not only improper correction that can affect the wearer comfort, but also influenced by the high segment, the segment is not exactly high when the patient was uncomfortable wearing glasses .
In making a Refraksionis Optisien glasses should be able to put higher and higher segment installation in accordance with the needs of patients that glasses are comfortable to wear. Factors affecting the use of bifocal lenses such as posture, height and type of work. People who work indoors requires high placement higher segment of people - those who work in the field, because if
high placement segment that is too high will interfere with vision so difficult to walk.
For high measurement segment to do with subjective and objective methods. Subjective method is a method that involves marking the center line of the lens demolens horizontal and vertical lines marked every 2 mm, glasses and paired to the patient and observe the patient. The method is a method that uses objective measurements using a ruler PD. But this is not shed a point or pre - marking the lens. But the ruler used to measure directly the height. Orientation to vertical hatching PD should. The practitioner then measure the distance between the reference point to the lowest part of which is located below the rim (leaving for the bevel).
Effect of high measurement inaccuracy and high segment installation can impair vision. Therefore higher segment a supporting factor in the provision of bifocal lenses in patients with presbyopia. This will provide comfort to patients with presbyopia novice adaptation takes a long time.
1.2 Scope of the Problem
Based on the background of the writing of this proposal the scope of issues to be discussed is the change in height of segment bifocal glasses.
1.3 Discussion and Focus Issues
In this proposal are necessary restrictions so that aspect will be discussed enough on track the truth. Focus on issues to be discussed are subscription "High Influence Seen From Segi Job Segments"
1.4 The purpose Writers
The reason the authors chose the discussion material object of this proposal are as follows:
1. To complete one of the requirements in completing the Diploma program at Foundation Academy Refraction Optisi Binalita Sudama.
2. To deepen the knowledge of the change in height of the bifocal lens segment in terms of employment.
3. The author hopes that this paper provides benefits to the reader, especially for the writer himself.
CHAPTER III
CASE DETERMINATION OF STEPS
3.1. Refraction Examination
Examination of refraction can be done by two methods, namely the examination objective examination of the subjective examination.
Objective examination is a method of examination in which the examination is determined by the sipemeriksa hasit. Sipemeriksa must be skilled in using the tools of examination. The tools that band is used: Autorefrakto, streak retinoscopy, Keratometer.
Examination of opinion is a method of examination in which the yield is determined from the examination of good cooperation between the examiner and patient. Tools used: optotype, trial frame, triai lensset, red green, card reading Refraction examination.
Patient data:
Name: Rudi
Age: 52 Years
Address: Jln. Fishing rod I Martubung
Gender: Male - Male
Occupation: Owned Enterprises
a Anamnesa
- Blurred vision near and far
- Wear sunglasses ± 5 years
- Examination of glasses last I year ago
- Want to replace the old glasses, because it is not bad to use
b Inspection Observation clan
- Examining the patient's eyes watched the ball and there were no abnormalities of the eyelids, eyeball, pupil, cornea and tastes
- By means of bifocal flashlight and ruler to measure pupil inspectors observed clan.
- Diameter pupil: 4 mm
- Form pupil: round
- Uptown pupil: average
- Reflek.s pupil: fast
3.2. Preliminary examination
3.2.1. PD measurement distance away binoculars
a. Patients sit parallel to the examiner clan is at a distance of 40 cm
b. Examining a close eye on the right clan berfiksasi patient's left eye examiner open
c. Examiner to use a flashlight to see the light reflex in the right eye patients
d. Examining put the bar across the nose PD patients, ie zero scale on the patient's right eye pupil center
e. Then the examiner's left eye closed and opened his right eye right where patients berfiksasi kemata open inspectors.
f. Examining how the scale reading on the ruler at the center of the patient's left eye pupil shows the scale 62 mm, so far binocular PD patients 62 mm.
3.2.2 Measurement of PD Close
a. Investigator and patient sit within 30 cm
b. Examining the dominant eye in the middle of putting the patient's nose
c. Examining blind eye is not
d. Patients berfiksasi to open eyes
e. Examining PD Meter puts the right eye at the center of the pupil to the center of the patient's left eye pupil
f. So close binocular PD patients 60 mm
3.2.3 Measurements Near the convergence point (NPC)
a. PD ruler placed on the outside of the eye patients kantus
b. Examiner told the patient to see objects that are in the hands of the examiner.
c. Object slowly brought closer to the eye patients
d. Then the examiner asked the patient to say stop when the objects are shaded.
e. At the shaded object at a distance of 10 cm.
3.2.4 Second Eye Movement Examination (Version)
a. Patients were told to see the object inspector indicated above, down, left and right.
b. Seen muscle movement skills in a position that is made to get the value of the ability of the muscles of the eyeball movements of the patient, by asking the patient to follow the movement of the object (finger probe)
c. Patients with good follow movement. Means the movement of the eyeballs of normal patients all directions.
3.2.5 Test Eye Dominance
a. The patient holds the paper size IS x 15 cm with a 2 cm diameter hole in the middle as far as long-hand.
b. Patients see optotype located at a distance of 6 m
c. Both eyes open and slowly lifted the paper to see the letters E through the hole.
d. Then the patient's eyes closed alternately
e. At the time the right eye left eye closed optotype but look at his left eye closed right eye patients can not see eye optotype so patients are left eye dominant.
3.2.6 Long Eye Examination
a. Examination of old eyeglasses by using the tools Lensometer
b. Turn lensometer, stel oculer so objects appear sharper and clearer where the scale of power in the zero position
c. Place the right lens glasses with a position back vertex power
d. Then the object does not look very clear on the size away
e. Turn the scale so that the object looks the sharpest, the importance of the size of the remote for the RS + 1:00 D, then the lens is moved in the segment to see the size of him.
f. Then place the lens segment and obscures any lensometer
g. Turn the power scale so it looks the sharpest, the importance of the size of the nearby S + 300 D.
h. Repeat examination of the left eye, which results in the right eye and the left alike.
i. So to ADDnya is S + 2:00 D
3.3. In Objective Refraction Examination Using Retinoscopy Streak
3.3. 1 Inspection Procedure For OD:
a. Examination conducted diruangan dark
b. Investigator and patient sitting across from a distance of 50 cm
c. Pair trial frame using the working lens +2. OOD
d. Point Streak Retinoscopy on the patient's right eye while the left eye to light berfiksasi patients who are at a distance of 6 m, it will show the direction of movement in the direction of reflex pale color, not very wide and slow moving, so these patients have abnormal hypermetropia
e. Then the examiner gives the lens correction starts from S +0.50 D then put another reflex is sloppy or neutral shadows, the correction given S + 1:00 D.
The procedure checks for OS:
a. Do the same as above at point a, b, c and d.
b. Then give the lens correction starts from S + 0.75 D but there is no change then add another S + 1:00 D so its movement so chaotic or neutral.
3.4. In Subjective Refraction Examination
- Visual acuity Old Glasses 6/22 - * S + 1:00 D ODS A. For Eyes Right
a. The patient sits facing the Snellen card at a distance of 6 m.
b. In the face of our patients with PD pair of trial frames 62 mm.
c. On our left eye lid with oculuder.
d. Patients were asked to read the Snellen card of the greatest letters and continued until the patient can see clearly clan read the letter.
e. Apparently the patient can not read anymore on row 3, the visual acuity without corrective lenses only achieved 6/30.
f. Put the lens correction (-) first and answering patient escape, then we give the lens (+) patients apparently expressed more brightly then given corrective lenses Visusnya S + 1:00 D 6/30.
g. The addition of + 1.25 S lenses virus reaches 6/6
h. Means we give patients the lens correction S + 1, 25 D Reach 6/6
B. Left Eye
a. Do the same thing at point of 1-10, where the corrections S + 1, 25 D reached 6/6
b. Patients were asked to adapt to ± 15 minutes.
With the addition of Add appropriate age
a. Then the examiner gives the patient card reading.
b. Then the patients were told to look at card reading, it turns out the patient as a whole can not be read only until the J-4
a. Patients given lens correction S + 2.25 D according to age for left and right eyes.
b. Patients were told to look at reading cards, which patients can read up to a line Jl.
c. So proximity correction S + 3.50 D.
3.5. Test accuracy of mononuclear
By using red green test:
a. Pair trial frame according to the PD 62 mm with lens correction R / L S +1.25 D.
b. The patient was told to see a line of black circles on the card is red-green.
c. We closed one eye is on the patient's left eye and ask Iingkaran black on green black and red are the same.
d. When red means over black clearer, more vivid green means under correction.
e. Close your eyes open is the right eye which the patient sees the red and green circles. Patients say Iingkaran black on red and green for both eyes (ODS) as black. Means the correction of errors for both eyes is right.
3.6. Balance Test
a. After obtaining a lens correction ODS: S + 1.25 D Add: S +2.25 D
b. Enter oculuder the patient's left eye and right eye can see said optotype on the eighth line is clear.
a. Then the patient's right eye lid. Here also said that as obvious as the patient's right eye.
3.7. Test End Point Binocular
Using the elder duke test:
a. After correction for the right eye and left eye visual acuity obtained with both 6/6 then do test DE (Duke Elder Test), by placing the lens S + 0.25 D in both eyes and then asked to see the patient and told to compare optotype clear whether a given lens plus a added new or obscure.
b. If the patient says that with plus 5 +0.25 D lens blurred vision correction is the right means.
c. The assessment for the Duke Elder Test is negative.
3.8. Cover Test
a. Patients were told to sit facing the optotype at a distance of 6 m.
b. Pair trial frame according to the PD patients with corrective lenses ODS S +1.25 D.
c. Patients berfiksasi on line 8 or 6/6
d. Then the left eye (OS) of patients means closed eyes open is the right eye (OD), left eye closed if there is no movement in the right eye then the eye is not julingl
e. Then when the left eye is opened we noticed that young no eye movement left no phoria.
f. Both eyes means ortophoria.
3.9. Diagnosis
From the results of the above diagnoses for both eyes is Hypermetropia ODS + presbyopia.
3.10. Translating Recipes
1. Patients are advised to wear goggles in accordance with the results of the examination are:
a. ODS: S + 1.25 D
b. Add: S + 1.25 D
2. Patients are recommended to control 6 months
3. The patient noticed a good reading distance is a distance of 30 - 40 cm. do not
read a dim place.
CHAPTER II
LITERATURE REVIEW
2.1 presbyopia
2.1.1 Definition and Causes Presbyopia.
Presbyopia is a vision disorder close in the suffering by people who are elderly.
Causes of presbyopia occurs because:
1. It is the process of aging itself.
The older a person the functions of the organs in the body also caused additional power menurun.Penurunan hardening that occurs in the lens of the eye, as well as reduced power contraction of the muscles that cause relaxation zonulla ciliaris zenii be imperfect situation occurs physiologically.
2. Age Factor
That someone more rapid aging process whiskers patient age 37 years but because of the process ketuaanya faster then the patient should wear glasses when reading.
3. Hormones decline
The decrease in hormones that lens development is interrupted, for example in menopausal women.
As a result of additional disorders patients aged over 40 years will have complaints while reading the watery eyes, the eyes feel sore, can not read small letters.
2.1.2 Addition Addisi By Age The Used In Indonesia. AGES Add
40 years
42-44 years
45 years
47-49 years
50 years
52-54 years
55 years
57-59 years
60 years
And so on
+1.00 Diopters
+1.25 Diopters
+1.50 Diopters
+1.75 Diopters
+2.00 Diopters
+2.25 Diopters
+2.50 Diopters
+2.75 Diopters
+3.00 Diopters
+3.00 Diopters
2.2. Lens Bifocals
2.2.1. Definition Lens Bifocals
Bifocal lens is a lens that has two points of focus, namely distance and close range. Bifocal lens was first invented by Benjamin Franklin in 1785 and used to correct presbyopia sufferers. Bifocal lens consists of two parts, namely:
a. At the top is called the major lens (lens master) that serves to correct distant vision.
b. The lower part of the lens is called the segment that serves to correct near vision to read the correct distance.
There are 2 types of bifocal lenses:
a. System Fused bifocal
This lens is made with ingredients and different refractive index while the same curvature resulting in different strengths. Examples: bifocals, kryptok, flat top, one piece.
b. Solid System Bifocals
These lenses are made where the material and the same refractive index, causing different curvature while power berbeda.Contohnya: Lens executive.
2.2.2. Bifocals Lens Type
Bifocals Lens division based forms a segment. Executive
Forms straigh across the major lens (lens parent) and segments separated by a straight line. The form of this segment are the executive segment in the form of a straight segment across the segment boundaries are very clear
FIG. Executive
b. Round Top
Round top shape segments are segments that form rounded at its peak. There is one piece on the lens, kryptok. Limitation or the line between the lens and the major segments are not so clear on the central segment OC kelihatanjetak geometik segment.
FIG. Round Top
c. Flat Top
A form of segments that have peaks and thicker straight segments of Round Top. Put the OC segment in the middle of the round, in terms of cosmetics is not good because of the segment looked lenses.
Image: Flat Top
2.3. Factors Affecting High-Segment View of Work
Work requiring a much larger field of view, and needs a little close (like driving) will require a lower segment, while prioritizing work Iebih close will require a higher segnien.
2.4. Fitting Precautions Current Already Wearing Bifocals
High position size relative to segment the limbus at the spectacles now. High position segments on the same frame when the patient had to wear bifocal lenses before and was satisfied with the high current segment ini.Maka in high need of the same segment.
Bifocal specs will be the same if the selected frame is the same as the previous. To get a point references the same in the eyes of patients who choose a different frame, then a different height. Factors ¬ factors such as frame size, frame shapes clan bridge will affect the final height was in order.
2.5 Relationship Position Segment Frame With tinggu
The principle that must be held in an RO frames ministry perkacamataan is to be purchased by the patient should be in a standard position, if the frame, bought in a state that does not cause disruption of the standard vision and comfort in the use of bifocal eyeglasses especially sunglasses.
Some parts of the frame that must be considered to determine whether a frame is standard or not the position of the second temple, angle and position nosepad pantoscopic.
a. Both positions Rim
if in a second frame rim is not standard then result in:
• X-ING: A condition in which the second frame rim each other
cross / spinning.
• Variant Vlaens: A condition in which the position of the frame rim parallel
but one little fall, this happens when
mounting frame, especially on a plastic frame.
• Face Form: A condition where there is a corner of the frame
Excessive between the nasal edge at the time of measurement.
If the above occurs in a frame, it can be high causing the segment is not the same between the two lenses on the glasses, it's certainly going memgganggu the vision and comfort of use.
To solve the above problem, then we need to fix certain parts in order to frame a standard that is:
- Hold the frame along with two lenses and two eyewire with the thumb on the side of the lens towards the second luar.Lengkungkan needed around the bridge, as the bridge is a fulcrum.
- Hold both hands eyewire and rotate in the opposite direction until the second field to be parallel.
b. The position of Second Temple
- In a frame that we need to consider is the handle of the temple opening angle tersebut.Apakah angle narrowed or widened. If the temple be narrowed opening angle up the pressure on the temples and the base of the ear, causing pain in the eyeglass wearers.
And if the second wide receiver opening angle lens will go down and touching pipijika views of cosmetics is not good.
In this case the use of bifocal lenses will interfere with the top of the segment near objects or far vision area.
When opening up the temple wide angle then be overcome by:
- Angled End piece towards the
- Add Face form
- Angled handle frames when dipelukan
- Lekukanlah band along the track down into the ear goggles sipemakai
When opening up the angle narrows the temple be overcome by:
- Angled outward endpiece
- Reduce face form
- Angled handle frames when dipelukan
- Lekukanlah band down out / solved in accordance with the patient's ear path
c. Angle Pantoscopic
Pantoscopic angle is the angle of inclination on a frame / sunglasses. If pantoscopic angle less than 4 ° will result in glasses riding position that will touch the eyebrows mata.Dan if greater than 18 ° position of the glasses will go down and touch pipi.Hal clearly affects the use of glasses both in terms of cosmetics and in terms of vision . bifocal glasses for usage greatly affect the segmen.Sebab when a frame is too up or too down it will disrupt their vision either through segments or the lens away.
If the glasses rise up to touch the eyebrows then be overcome by:
- Increase the slope of the angle pantoscopic
- Spreading bridge (bridge bends towards the outside)
- Lowering the glasses frame to widen the distance with both nosepad
- Shortening the arm guard
And when the glasses down so that it touches the cheek then be overcome by:
- Reduce the slope of the angle pantoscopic
- Narrows bridge (bridge bends inward)
- Increase the distance narrows frames with both nosepad
- Grow long arm guard
d. Second Position Nosepad
In this area there are three angles nosepad a benchmark to determine if the position is standard or belum.Ketiga nosepad angle:
1. Frontal angle when viewed from the front, the frontal angle the standard 200
2. Splay angle when viewed from the front, but the frame is reversed, the standard large splay angles between 25 ° -30 °
3. Vertical angle when viewed from the side, the standard vertical angle between 10-1 5.Apabila nosepad second distance is too wide, then the frame will come down to touch his cheek. And when the second position nosepad narrows the nasal surface suppress painful and position the frame up that may affect the use of bifocal lenses if you want to see close objects and less in terms of cosmetics look good.
If both nosepad widened and lead glasses down to touch his cheek, then be overcome by:
- Raise the glasses frame by narrowing the distance nosepad
- Narrowing bridge, the bridge towards the mambengkokan
- Grow long arm guard
- Reduce the slope of the angle pantoscopic.
And when the second position nosepad narrowed the lead frame which can suppress surface up nose then be overcome by means of:
- Spreading bridge, the bridge bend outward.
- Shortening the arm guard
- Adding the slope of the angle pantoscopic.
- Lowering the glasses frame to widen the distance with both nosepad.
INTRODUCTION
1.1 Background Issues
At this time the better health and thus life expectancy also increased, to keep abreast of contemporary public interest to read more meningkat.Semakin growing interest in the need for reading glasses then.
Glasses are needed by the community obtained from an optical. According to the Ministry of Health Decree No. 1424/Menkes/SK/XI/2002 stating that bifocal is a means of organizing health care basic eye examination, inspection and service refraction correction glasses and contact lenses.
At this time the response to refractive disorders more common to use glasses, refractive disorders experienced by children and adults, and also by the age of 40 years is called presbyopia. Presbyopia is a habit which the eye near vision decreases caused by lower power usage is necessary accommodation for glasses with bifocal lenses for reading and serves to look far.
Glasses are also able to beautify and enhance the patient's face to produce the glasses are comfortable to wear, it should be standardized because it is not only improper correction that can affect the wearer comfort, but also influenced by the high segment, the segment is not exactly high when the patient was uncomfortable wearing glasses .
In making a Refraksionis Optisien glasses should be able to put higher and higher segment installation in accordance with the needs of patients that glasses are comfortable to wear. Factors affecting the use of bifocal lenses such as posture, height and type of work. People who work indoors requires high placement higher segment of people - those who work in the field, because if
high placement segment that is too high will interfere with vision so difficult to walk.
For high measurement segment to do with subjective and objective methods. Subjective method is a method that involves marking the center line of the lens demolens horizontal and vertical lines marked every 2 mm, glasses and paired to the patient and observe the patient. The method is a method that uses objective measurements using a ruler PD. But this is not shed a point or pre - marking the lens. But the ruler used to measure directly the height. Orientation to vertical hatching PD should. The practitioner then measure the distance between the reference point to the lowest part of which is located below the rim (leaving for the bevel).
Effect of high measurement inaccuracy and high segment installation can impair vision. Therefore higher segment a supporting factor in the provision of bifocal lenses in patients with presbyopia. This will provide comfort to patients with presbyopia novice adaptation takes a long time.
1.2 Scope of the Problem
Based on the background of the writing of this proposal the scope of issues to be discussed is the change in height of segment bifocal glasses.
1.3 Discussion and Focus Issues
In this proposal are necessary restrictions so that aspect will be discussed enough on track the truth. Focus on issues to be discussed are subscription "High Influence Seen From Segi Job Segments"
1.4 The purpose Writers
The reason the authors chose the discussion material object of this proposal are as follows:
1. To complete one of the requirements in completing the Diploma program at Foundation Academy Refraction Optisi Binalita Sudama.
2. To deepen the knowledge of the change in height of the bifocal lens segment in terms of employment.
3. The author hopes that this paper provides benefits to the reader, especially for the writer himself.
CHAPTER III
CASE DETERMINATION OF STEPS
3.1. Refraction Examination
Examination of refraction can be done by two methods, namely the examination objective examination of the subjective examination.
Objective examination is a method of examination in which the examination is determined by the sipemeriksa hasit. Sipemeriksa must be skilled in using the tools of examination. The tools that band is used: Autorefrakto, streak retinoscopy, Keratometer.
Examination of opinion is a method of examination in which the yield is determined from the examination of good cooperation between the examiner and patient. Tools used: optotype, trial frame, triai lensset, red green, card reading Refraction examination.
Patient data:
Name: Rudi
Age: 52 Years
Address: Jln. Fishing rod I Martubung
Gender: Male - Male
Occupation: Owned Enterprises
a Anamnesa
- Blurred vision near and far
- Wear sunglasses ± 5 years
- Examination of glasses last I year ago
- Want to replace the old glasses, because it is not bad to use
b Inspection Observation clan
- Examining the patient's eyes watched the ball and there were no abnormalities of the eyelids, eyeball, pupil, cornea and tastes
- By means of bifocal flashlight and ruler to measure pupil inspectors observed clan.
- Diameter pupil: 4 mm
- Form pupil: round
- Uptown pupil: average
- Reflek.s pupil: fast
3.2. Preliminary examination
3.2.1. PD measurement distance away binoculars
a. Patients sit parallel to the examiner clan is at a distance of 40 cm
b. Examining a close eye on the right clan berfiksasi patient's left eye examiner open
c. Examiner to use a flashlight to see the light reflex in the right eye patients
d. Examining put the bar across the nose PD patients, ie zero scale on the patient's right eye pupil center
e. Then the examiner's left eye closed and opened his right eye right where patients berfiksasi kemata open inspectors.
f. Examining how the scale reading on the ruler at the center of the patient's left eye pupil shows the scale 62 mm, so far binocular PD patients 62 mm.
3.2.2 Measurement of PD Close
a. Investigator and patient sit within 30 cm
b. Examining the dominant eye in the middle of putting the patient's nose
c. Examining blind eye is not
d. Patients berfiksasi to open eyes
e. Examining PD Meter puts the right eye at the center of the pupil to the center of the patient's left eye pupil
f. So close binocular PD patients 60 mm
3.2.3 Measurements Near the convergence point (NPC)
a. PD ruler placed on the outside of the eye patients kantus
b. Examiner told the patient to see objects that are in the hands of the examiner.
c. Object slowly brought closer to the eye patients
d. Then the examiner asked the patient to say stop when the objects are shaded.
e. At the shaded object at a distance of 10 cm.
3.2.4 Second Eye Movement Examination (Version)
a. Patients were told to see the object inspector indicated above, down, left and right.
b. Seen muscle movement skills in a position that is made to get the value of the ability of the muscles of the eyeball movements of the patient, by asking the patient to follow the movement of the object (finger probe)
c. Patients with good follow movement. Means the movement of the eyeballs of normal patients all directions.
3.2.5 Test Eye Dominance
a. The patient holds the paper size IS x 15 cm with a 2 cm diameter hole in the middle as far as long-hand.
b. Patients see optotype located at a distance of 6 m
c. Both eyes open and slowly lifted the paper to see the letters E through the hole.
d. Then the patient's eyes closed alternately
e. At the time the right eye left eye closed optotype but look at his left eye closed right eye patients can not see eye optotype so patients are left eye dominant.
3.2.6 Long Eye Examination
a. Examination of old eyeglasses by using the tools Lensometer
b. Turn lensometer, stel oculer so objects appear sharper and clearer where the scale of power in the zero position
c. Place the right lens glasses with a position back vertex power
d. Then the object does not look very clear on the size away
e. Turn the scale so that the object looks the sharpest, the importance of the size of the remote for the RS + 1:00 D, then the lens is moved in the segment to see the size of him.
f. Then place the lens segment and obscures any lensometer
g. Turn the power scale so it looks the sharpest, the importance of the size of the nearby S + 300 D.
h. Repeat examination of the left eye, which results in the right eye and the left alike.
i. So to ADDnya is S + 2:00 D
3.3. In Objective Refraction Examination Using Retinoscopy Streak
3.3. 1 Inspection Procedure For OD:
a. Examination conducted diruangan dark
b. Investigator and patient sitting across from a distance of 50 cm
c. Pair trial frame using the working lens +2. OOD
d. Point Streak Retinoscopy on the patient's right eye while the left eye to light berfiksasi patients who are at a distance of 6 m, it will show the direction of movement in the direction of reflex pale color, not very wide and slow moving, so these patients have abnormal hypermetropia
e. Then the examiner gives the lens correction starts from S +0.50 D then put another reflex is sloppy or neutral shadows, the correction given S + 1:00 D.
The procedure checks for OS:
a. Do the same as above at point a, b, c and d.
b. Then give the lens correction starts from S + 0.75 D but there is no change then add another S + 1:00 D so its movement so chaotic or neutral.
3.4. In Subjective Refraction Examination
- Visual acuity Old Glasses 6/22 - * S + 1:00 D ODS A. For Eyes Right
a. The patient sits facing the Snellen card at a distance of 6 m.
b. In the face of our patients with PD pair of trial frames 62 mm.
c. On our left eye lid with oculuder.
d. Patients were asked to read the Snellen card of the greatest letters and continued until the patient can see clearly clan read the letter.
e. Apparently the patient can not read anymore on row 3, the visual acuity without corrective lenses only achieved 6/30.
f. Put the lens correction (-) first and answering patient escape, then we give the lens (+) patients apparently expressed more brightly then given corrective lenses Visusnya S + 1:00 D 6/30.
g. The addition of + 1.25 S lenses virus reaches 6/6
h. Means we give patients the lens correction S + 1, 25 D Reach 6/6
B. Left Eye
a. Do the same thing at point of 1-10, where the corrections S + 1, 25 D reached 6/6
b. Patients were asked to adapt to ± 15 minutes.
With the addition of Add appropriate age
a. Then the examiner gives the patient card reading.
b. Then the patients were told to look at card reading, it turns out the patient as a whole can not be read only until the J-4
a. Patients given lens correction S + 2.25 D according to age for left and right eyes.
b. Patients were told to look at reading cards, which patients can read up to a line Jl.
c. So proximity correction S + 3.50 D.
3.5. Test accuracy of mononuclear
By using red green test:
a. Pair trial frame according to the PD 62 mm with lens correction R / L S +1.25 D.
b. The patient was told to see a line of black circles on the card is red-green.
c. We closed one eye is on the patient's left eye and ask Iingkaran black on green black and red are the same.
d. When red means over black clearer, more vivid green means under correction.
e. Close your eyes open is the right eye which the patient sees the red and green circles. Patients say Iingkaran black on red and green for both eyes (ODS) as black. Means the correction of errors for both eyes is right.
3.6. Balance Test
a. After obtaining a lens correction ODS: S + 1.25 D Add: S +2.25 D
b. Enter oculuder the patient's left eye and right eye can see said optotype on the eighth line is clear.
a. Then the patient's right eye lid. Here also said that as obvious as the patient's right eye.
3.7. Test End Point Binocular
Using the elder duke test:
a. After correction for the right eye and left eye visual acuity obtained with both 6/6 then do test DE (Duke Elder Test), by placing the lens S + 0.25 D in both eyes and then asked to see the patient and told to compare optotype clear whether a given lens plus a added new or obscure.
b. If the patient says that with plus 5 +0.25 D lens blurred vision correction is the right means.
c. The assessment for the Duke Elder Test is negative.
3.8. Cover Test
a. Patients were told to sit facing the optotype at a distance of 6 m.
b. Pair trial frame according to the PD patients with corrective lenses ODS S +1.25 D.
c. Patients berfiksasi on line 8 or 6/6
d. Then the left eye (OS) of patients means closed eyes open is the right eye (OD), left eye closed if there is no movement in the right eye then the eye is not julingl
e. Then when the left eye is opened we noticed that young no eye movement left no phoria.
f. Both eyes means ortophoria.
3.9. Diagnosis
From the results of the above diagnoses for both eyes is Hypermetropia ODS + presbyopia.
3.10. Translating Recipes
1. Patients are advised to wear goggles in accordance with the results of the examination are:
a. ODS: S + 1.25 D
b. Add: S + 1.25 D
2. Patients are recommended to control 6 months
3. The patient noticed a good reading distance is a distance of 30 - 40 cm. do not
read a dim place.
CHAPTER II
LITERATURE REVIEW
2.1 presbyopia
2.1.1 Definition and Causes Presbyopia.
Presbyopia is a vision disorder close in the suffering by people who are elderly.
Causes of presbyopia occurs because:
1. It is the process of aging itself.
The older a person the functions of the organs in the body also caused additional power menurun.Penurunan hardening that occurs in the lens of the eye, as well as reduced power contraction of the muscles that cause relaxation zonulla ciliaris zenii be imperfect situation occurs physiologically.
2. Age Factor
That someone more rapid aging process whiskers patient age 37 years but because of the process ketuaanya faster then the patient should wear glasses when reading.
3. Hormones decline
The decrease in hormones that lens development is interrupted, for example in menopausal women.
As a result of additional disorders patients aged over 40 years will have complaints while reading the watery eyes, the eyes feel sore, can not read small letters.
2.1.2 Addition Addisi By Age The Used In Indonesia. AGES Add
40 years
42-44 years
45 years
47-49 years
50 years
52-54 years
55 years
57-59 years
60 years
And so on
+1.00 Diopters
+1.25 Diopters
+1.50 Diopters
+1.75 Diopters
+2.00 Diopters
+2.25 Diopters
+2.50 Diopters
+2.75 Diopters
+3.00 Diopters
+3.00 Diopters
2.2. Lens Bifocals
2.2.1. Definition Lens Bifocals
Bifocal lens is a lens that has two points of focus, namely distance and close range. Bifocal lens was first invented by Benjamin Franklin in 1785 and used to correct presbyopia sufferers. Bifocal lens consists of two parts, namely:
a. At the top is called the major lens (lens master) that serves to correct distant vision.
b. The lower part of the lens is called the segment that serves to correct near vision to read the correct distance.
There are 2 types of bifocal lenses:
a. System Fused bifocal
This lens is made with ingredients and different refractive index while the same curvature resulting in different strengths. Examples: bifocals, kryptok, flat top, one piece.
b. Solid System Bifocals
These lenses are made where the material and the same refractive index, causing different curvature while power berbeda.Contohnya: Lens executive.
2.2.2. Bifocals Lens Type
Bifocals Lens division based forms a segment. Executive
Forms straigh across the major lens (lens parent) and segments separated by a straight line. The form of this segment are the executive segment in the form of a straight segment across the segment boundaries are very clear
FIG. Executive
b. Round Top
Round top shape segments are segments that form rounded at its peak. There is one piece on the lens, kryptok. Limitation or the line between the lens and the major segments are not so clear on the central segment OC kelihatanjetak geometik segment.
FIG. Round Top
c. Flat Top
A form of segments that have peaks and thicker straight segments of Round Top. Put the OC segment in the middle of the round, in terms of cosmetics is not good because of the segment looked lenses.
Image: Flat Top
2.3. Factors Affecting High-Segment View of Work
Work requiring a much larger field of view, and needs a little close (like driving) will require a lower segment, while prioritizing work Iebih close will require a higher segnien.
2.4. Fitting Precautions Current Already Wearing Bifocals
High position size relative to segment the limbus at the spectacles now. High position segments on the same frame when the patient had to wear bifocal lenses before and was satisfied with the high current segment ini.Maka in high need of the same segment.
Bifocal specs will be the same if the selected frame is the same as the previous. To get a point references the same in the eyes of patients who choose a different frame, then a different height. Factors ¬ factors such as frame size, frame shapes clan bridge will affect the final height was in order.
2.5 Relationship Position Segment Frame With tinggu
The principle that must be held in an RO frames ministry perkacamataan is to be purchased by the patient should be in a standard position, if the frame, bought in a state that does not cause disruption of the standard vision and comfort in the use of bifocal eyeglasses especially sunglasses.
Some parts of the frame that must be considered to determine whether a frame is standard or not the position of the second temple, angle and position nosepad pantoscopic.
a. Both positions Rim
if in a second frame rim is not standard then result in:
• X-ING: A condition in which the second frame rim each other
cross / spinning.
• Variant Vlaens: A condition in which the position of the frame rim parallel
but one little fall, this happens when
mounting frame, especially on a plastic frame.
• Face Form: A condition where there is a corner of the frame
Excessive between the nasal edge at the time of measurement.
If the above occurs in a frame, it can be high causing the segment is not the same between the two lenses on the glasses, it's certainly going memgganggu the vision and comfort of use.
To solve the above problem, then we need to fix certain parts in order to frame a standard that is:
- Hold the frame along with two lenses and two eyewire with the thumb on the side of the lens towards the second luar.Lengkungkan needed around the bridge, as the bridge is a fulcrum.
- Hold both hands eyewire and rotate in the opposite direction until the second field to be parallel.
b. The position of Second Temple
- In a frame that we need to consider is the handle of the temple opening angle tersebut.Apakah angle narrowed or widened. If the temple be narrowed opening angle up the pressure on the temples and the base of the ear, causing pain in the eyeglass wearers.
And if the second wide receiver opening angle lens will go down and touching pipijika views of cosmetics is not good.
In this case the use of bifocal lenses will interfere with the top of the segment near objects or far vision area.
When opening up the temple wide angle then be overcome by:
- Angled End piece towards the
- Add Face form
- Angled handle frames when dipelukan
- Lekukanlah band along the track down into the ear goggles sipemakai
When opening up the angle narrows the temple be overcome by:
- Angled outward endpiece
- Reduce face form
- Angled handle frames when dipelukan
- Lekukanlah band down out / solved in accordance with the patient's ear path
c. Angle Pantoscopic
Pantoscopic angle is the angle of inclination on a frame / sunglasses. If pantoscopic angle less than 4 ° will result in glasses riding position that will touch the eyebrows mata.Dan if greater than 18 ° position of the glasses will go down and touch pipi.Hal clearly affects the use of glasses both in terms of cosmetics and in terms of vision . bifocal glasses for usage greatly affect the segmen.Sebab when a frame is too up or too down it will disrupt their vision either through segments or the lens away.
If the glasses rise up to touch the eyebrows then be overcome by:
- Increase the slope of the angle pantoscopic
- Spreading bridge (bridge bends towards the outside)
- Lowering the glasses frame to widen the distance with both nosepad
- Shortening the arm guard
And when the glasses down so that it touches the cheek then be overcome by:
- Reduce the slope of the angle pantoscopic
- Narrows bridge (bridge bends inward)
- Increase the distance narrows frames with both nosepad
- Grow long arm guard
d. Second Position Nosepad
In this area there are three angles nosepad a benchmark to determine if the position is standard or belum.Ketiga nosepad angle:
1. Frontal angle when viewed from the front, the frontal angle the standard 200
2. Splay angle when viewed from the front, but the frame is reversed, the standard large splay angles between 25 ° -30 °
3. Vertical angle when viewed from the side, the standard vertical angle between 10-1 5.Apabila nosepad second distance is too wide, then the frame will come down to touch his cheek. And when the second position nosepad narrows the nasal surface suppress painful and position the frame up that may affect the use of bifocal lenses if you want to see close objects and less in terms of cosmetics look good.
If both nosepad widened and lead glasses down to touch his cheek, then be overcome by:
- Raise the glasses frame by narrowing the distance nosepad
- Narrowing bridge, the bridge towards the mambengkokan
- Grow long arm guard
- Reduce the slope of the angle pantoscopic.
And when the second position nosepad narrowed the lead frame which can suppress surface up nose then be overcome by means of:
- Spreading bridge, the bridge bend outward.
- Shortening the arm guard
- Adding the slope of the angle pantoscopic.
- Lowering the glasses frame to widen the distance with both nosepad.
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