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Refractive Error: Diagnosis, Types, and Correction Methods

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Refractive error is among the most prevalent eye disorder worldwide. It causes blurred vision and can significantly affect your quality of life. Refractive errors are the reason why people need to wear eyeglasses or contact lens to see clearly. 

What are Refractive Errors? 

When we look at an object, we don’t often think about the complex process that happens within our eyes to bring that image into clear focus. In simplest terms, our eyes work a bit like a camera: Light from the object enters our eyes and is bent (or “refracted”) by the cornea and lens so that it focuses directly on the retina, the screen at the back of the eye. The retina then sends this image to our brain via the optic nerve. And voila! We see the object in front of us. 

But what if this process isn’t working quite right, and the light doesn’t focus exactly on the retina? That’s when we have a refractive error. The image we see is blurry because our eyes aren’t focusing light properly. It’s a bit like using a camera that’s out of focus. 

Once again, refractive errors are the reason why people need to wear eyeglasses or contact lens to see clearly. These tools work by refocusing light onto the right spot on the retina, much like adjusting a camera lens brings a photo into perfect focus. 

What are the Different Types of Refractive Errors 

  1. Myopia (Short-sightedness, also known as near-sightedness): 

Myopia is a condition where you can see near objects clearly, but distant objects appear blurry. This blurriness occurs because the eye’s length is longer than normal, or the cornea is too curved, causing light to focus before it reaches the retina. Myopia often begins in childhood and may gradually worsen as the person grows, stabilizing in early adulthood. Signs of myopia include squinting, eye strain, headaches, and feeling fatigued when driving or playing sports. 

  1. Hyperopia (Far-sightedness): If you have hyperopia, you can see distant objects clearly, but close-up objects are blurry. This happens because the eye is shorter than normal, or the cornea is too flat, causing light to focus behind the retina. Some children have mild hyperopia that corrects itself as they grow and their eyeballs lengthen. However, adults can also develop hyperopia. Struggling to focus on close-up tasks like reading or computer work are common symptoms. 
  2. Astigmatism: Astigmatism causes blurred or distorted vision at all distances, unlike myopia and hyperopia that affect vision at either close or far distances. It happens when the cornea or lens isn’t evenly curved, almost like a football shape instead of a perfect sphere. This irregularity redirects the light to focus on multiple points around the retina rather than directly on it. Astigmatism can accompany myopia or 

hyperopia and often causes eye strain and headaches, especially after reading or other prolonged visual tasks. 

  1. Presbyopia: Unlike the other refractive errors, presbyopia is an age-related condition that affects near vision. It occurs when the lens inside the eye becomes less flexible over time, making it harder to focus on close objects. Presbyopia typically starts around the age of 40 and affects everyone, even those who have never had a vision problem before. Early signs include needing to hold reading materials at arm’s length, blurred vision at normal reading distance, and eye fatigue along with headaches when doing close-up work. 

Each type of refractive error has unique causes and symptoms, but all result in vision that’s less sharp than it could be. The good news is that all these refractive errors can be effectively corrected with eyeglasses, contact lenses, or refractive surgeries, allowing you to enjoy clear vision once again. 

What Causes Refractive Errors? 

While the exact causes are unknown, refractive errors are often related to the eye’s shape and size and the cornea’s curve and thickness. Genetics also play a significant role, as refractive errors are often hereditary. 

Symptoms of Refractive Errors 

Common signs and symptoms associated with refractive errors include: 

  • Blurred vision, either for near or distant objects 
  • Double vision 
  • Glare or halos around lights 
  • Eye strain or discomfort 
  • Frequent headaches 
  • Squinting 
  • Difficulty with night vision or reading 

Diagnosing Refractive Errors 

An optometrist or ophthalmologist can diagnose refractive errors during a comprehensive eye examination. They usually perform visual acuity tests using a wall chart and a refraction test to determine the lens power needed to correct the refractive error. 

Treatment Options for Refractive Errors 

Addressing refractive errors involves modifying the way light enters your eye, allowing images to focus on the retina and deliver a clear vision. There are several effective treatments for refractive errors, each with its advantages, which your eye care professional can discuss with you in detail. 

  1. Eyeglasses: This is the simplest and safest method to correct refractive errors. Eyeglasses work by adding or subtracting focusing power to the eye’s cornea and lens to sharpen the image on the retina. The wide array of available frame designs and lens types allows for personal customization based on your lifestyle, aesthetics, and comfort. 
  2. Contact Lenses: Contact lenses, placed directly on the surface of the eye, can provide a more natural field of view than eyeglasses. They also eliminate the need for frames, thus offering aesthetic appeal. Various types exist, including soft lenses, rigid gas permeable lenses, and hybrid lenses. Each type has its pros and cons, and your eye care provider can help determine the best option for you. 
  3. Orthokeratology (Ortho-K): This non-surgical procedure involves wearing rigid contact lenses that reshape the cornea while you sleep, temporarily correcting mild to moderate amounts of myopia or astigmatism. Once you remove the lenses in the morning, the temporary reshaping allows for clearer vision during the day. 
  4. Refractive Surgery: Surgical procedures aim to eliminate or reduce the need for eyeglasses or contact lenses. Common types include: 

  • LASIK (Laser-Assisted In Situ Keratomileusis): The surgeon creates a thin flap in the cornea, removes some corneal tissue using an excimer laser, and then repositions the flap. The laser reshapes the cornea, allowing light entering the eye to be properly focused onto the retina for clearer vision. 
  • PRK (Photorefractive Keratectomy): In PRK, the surgeon removes the cornea’s outer layer and uses an excimer laser to reshape it, correcting the refractive error. PRK does not involve creating a corneal flap, making it a suitable option for people with thinner corneas. 
  • SMILE (Small Incision Lenticule Extraction): A minimally invasive procedure where a small piece of corneal tissue is removed, changing the cornea’s shape and correcting the refractive error. SMILE has a faster recovery time and a lower risk of complications compared to other procedures. 
  • Refractive Lens Exchange (RLE): RLE involves removing the eye’s natural lens and replacing it with an artificial one. This procedure is typically used for people with presbyopia or extreme farsightedness. 

  1. Implantable Lenses (Phakic IOLs): For patients with high levels of myopia or hyperopia, or those who aren’t good candidates for corneal reshaping procedures, implantable lenses can be an option. The surgeon inserts these lenses into the eye without removing the natural lens, providing high-quality, high-definition vision. 

Each treatment has its risks and benefits, and the best choice depends on several factors, including your refractive error’s type and severity, your lifestyle, your age, and your eye’s overall health. A comprehensive discussion with your eye care provider will ensure that you choose the best treatment for your specific needs. 

Source URL: https://harleyvision.com/conditions/refractive-error/