APHAKIA AND

PSEUDOPHAKIA

PRESENTER: HARSHIT (B.OPTOMETRY STUDENT)

MODERATOR: MR. MANOJ CHANDOLIYA (OPTOMETRIST)
 CONTENTS
• APHAKIA(DEFINITION)
• CAUSES OF APHAKIA
• OPTICS OF APHAKIA
• CLINICAL FEATURES
• TREATMENT OF APHAKIA
• PSEUDOPHAKIA(DEFINITION)
• CALCULATION OF IOL POWER
• SIGNS OF PSEUDOPHAKIA
• REFRACTIVE STATUS OF
PSEUDOPHAKIC EYE
• MANAGEMENT OF
PSEUDOPHAKIA
• BLUR RETINAL IMAGINARY
 APHAKIA
• DEFINITION- Aphakia literally means absence of
crystalline lens from the eye. However, from the optical
point of view, it may be considered a condition in which
the lens is absent from the pupillary area and does not
take part in refraction. Aphakia produces a high degree
of hypermetropia.
 CAUSES OF APHAKIA
• Congenital absence of lens. May occur in a very rare
condition.
• Surgical aphakia occurring after removal of lens is the
commonest condition.
• Traumatic extrusion of lens from the eye also constitutes a
rare cause of aphakia.
• Posterior dislocation of lens in vitreous(traumatic or
spontaneous) produces optical aphakia.
• Aphakia due to absorption of lens matter is noticed rarely
after trauma in children.
 OPTICS OF APHAKIA

1. CHANGES IN CARDINAL DATA OF THE EYE -

• Total power of the eye is reduced to about +44D FROM +60D. So, the eye
becomes highly hypermetropic.
• Anterior focal point becomes 23.2mm in front of the cornea.
• Posterior focal point is about 31mm behind the cornea, i.e. about 7mm
behind the eyeball(the anteroposterior length of the eyeball is about
24mm).
• Two principal points are almost at the anterior surface of cornea.
• Nodal points are very near to each other and are located about 7.75mm
behind the anterior surface of cornea.
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 cont…..
2. VISUAL ACUITY IN APHAKIA –
• The Snellen’s visual acuity in spectacle corrected aphakia is
falsified due to a large image size.
• The visual acuity of 6/9 in a spectacles corrected aphakic eye
should be considered equivalent to 6/12 of an emmetropic eye.

3. ACCOMODATION IN APHAKIA –
• There occurs a total loss of accommodation due to absence of
lens .
• Therefore, either bifocal or two separate pairs of glasses – one
for distant and another for near vision are required.
• With such glasses, patients do feel handicapped for
intermediate dist. , but they learn to adjust.
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 cont…..
3. IMAGE FORMATION IN APHAKIA –
• The image size magnifies can vary from 20% to as much as
50%, but by an avg. of 30%.
• With contact lens correction, this range is from 5% to 45%,
directly related to the degree of myopia.
• Average image magnification reported by diff. methods of
aphakia correction is about:
> Spectacles : 33%
> Contact lens : 10%
> Anterior chamber IOL : 2%-5%
> Posterior chamber IOL : 0%
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 CLINICAL FEATURES
• SYMPTOMS – The only symptom in aphakia is marked
defective vision for near and far.

• SIGNS –
1. Limbal scar may be seen in surgical aphakia.
2. Anterior chamber is deeper than normal.
3. Pupil is jet black in color.
4. Purkinje’s image test shows only 2 images.
5. Absence of lens from patellar fossa is seen on slit lamp.
6. Fundus examination shows hypermetropic small disc.
7. Retinoscopy reveals high hypermetropia.
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 TREATMENT
• Optical principle – is to correct the error by convex lenses
of appropriate power, so that the image is formed on the retina.

• Modalities for correcting aphakia include:

>Spectacles
>Contact lens
>IOL
>Refractive corneal surgery

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cont…..
1. SPECTACLES –
• It was commonly used in past, use of aphakic spectacles has been
decreased.
• Roughly, about +10D with cylindrical lenses used for correcting
aphakia.
• An addition +3 to +4D is required for near vision to compensate for
loss of accommodation.
ADVANTAGES-
• Cheap, easy and safe method of correcting aphakia
DISADVANTAGES-
• Image magnification
• Spherical(pincushion) and prismatic aberration
• Restricted field of vision
• Cosmetic blemish 11
•
 cont…..
2. CONTACT LENSES-
ADVANTAGES-
• Less magnification
• Elimination of aberrations and prismatic effect
• Wider and better field of vision
• Better suited for uniocular aphakia
DISADVANTAGES-
• More cost
• Corneal complications may be associated
• Cumbersome to wear

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3. IOL Implantation – IOL implantation is the best
available method of correcting aphakia. Therefore, it is the
commonest modality being employed nowadays.

4. Refractive corneal Surgery – It is under trial

for the correction of aphakia.
It includes > Keratophakia
> Epikeratophakia
> Hyperopic LASIK
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 PSEUDOPHAKIA
• DEFINITION – The condition of aphakia when
corrected with implantation of an IOL is referred to as
pseudophakia, or more precisely artiphakia.

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 CALCULATION OF IOL POWER

• Power of an IOL to be implanted is calculated by taking

into consideration the keratometric reading and axial
length of the eyeball.
• The most commonly used formula for the implantation of
IOL is based on the “SRK”(Sanders Retzlaff and Kraff).
• SRK formula is given as – P = A -2.5L -0.9K
where P = dioptric power of the implanted IOL
A = constant specific for each lens
L = axial length in mm
K = avg. keratometry in dioptres

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 SIGNS OF PSEUDOPHAKIA
• Surgical limbal/corneal scar may be seen.
• Anterior chamber is slightly deeper than normal.
• Purkinje image test shows four images.
• Pupil is blackish in color, but when light is thrown in
pupillary area, shining reflexes are observed.
• Visual and refraction status will vary, depending
upon the power of IOL implanted.
• Presence of IOL is confirmed when examination under
magnification after dilating the pupil.

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REFRACTIVE STATUS OF PSEUDOPHAKIC
EYE
It depends upon the power of the IOL implanted-
• Emmetropia is produced when the power of the IOL
implanted is exact. It is the most ideal situation. Such
patients need only plus glasses for near vision.
• Consecutive myopia occurs if the IOL implanted
overcorrects the refraction of eye. Such patients require
glasses to correct the myopia for distance vision and may
or may not need glasses for near vision depending upon
the degree of myopia.
• Consecutive hypermetropia develops when the
underpower IOL is implanted. Such patients require plus
glasses for distance vision and additional +2 to +3D for
near vision.
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 MANAGEMENT
• Spectacles for near vision only are often required
following monofocal IOL implantation.
• Bifocal/progressive add glasses may be required for
correcting associated consecutive refractive error along
with near vision deficiency due to loss of accommodation.
• Nowadays, many patients and surgeons are opting for
trifocal, and multifocal IOLs and such patients may have
near normal uncorrected visual acuity for near as well as
distance.

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 BLUR RETINAL IMAGINARY
• Blur retinal imaginary occurs when light entering eye does
not focus precisely on the retina, leading to the loss of
sharpness & clarity of image. This can be caused by various
factors.
• CAUSES :
1. Refractive error : Myopia (front of retina)
Hyperopia (back of retina)
Astigmatism (multiple focal points)

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cont…..
2. Ocular conditions : Cataract
Glaucoma
Macular degeneration
Retinal detachment
Diabetic Retinopathy etc.
3. External factors : Poor light, Dust, Fog etc.

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 cont…..
• TREATMENT :
1. Corrective lenses
2. LASIK
3. Cataract surgery
4. Retinal surgery
5. Medications (eyedrops, antiVEGF inj.)

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