eye doctor

Human eye

The human eye is similar to most mammalian eyes.

Dynamic range

The retina has a static contrast ratio of around 100:1 (about 6 1/2 stops). As soon as the eye moves (saccades) it re-adjusts its exposure both chemically and by adjusting the iris. Initial dark adaptation takes place in approximately four seconds of profound, uninterrupted darkness; full adaptation through adjustments in retinal chemistry (the Purkinje effect) are mostly complete in thirty minutes. Hence, a dynamic contrast ratio of about 1,000,000:1 (about 20 stops) is possible. The process is nonlinear and multifaceted, so an interruption by light merely starts the adaptation process over again. Full adaptation is dependent on good blood flow; thus dark adaptation may be hampered by poor circulation, and vasoconstrictors like alcohol or tobacco.

Eye movement

The visual system in the brain is too slow to process information if the images are slipping across the retina at more than a few degrees per second. Thus, for humans to be able to see while moving, the brain must compensate for the motion of the head by turning the eyes. Another complication for vision in frontal-eyed animals is the development of a small area of the retina with a very high visual acuity. This area is called the fovea, and covers about 2 degrees of visual angle in people. To get a clear view of the world, the brain must turn the eyes so that the image of the object of regard falls on the fovea. Eye movements are thus very important for visual perception, and any failure to make them correctly can lead to serious visual disabilities.

Having two eyes is an added complication, because the brain must point both of them accurately enough that the object of regard falls on corresponding points of the two retinas; otherwise, double vision would occur. The movements of different body parts are controlled by striated muscles acting around joints. The movements of the eye are no exception, but they have special advantages not shared by skeletal muscles and joints, and so are considerably different.

Extraocular muscles

Each eye has six muscles that control its movements: the lateral rectus, the medial rectus, the inferior rectus, the superior rectus, the inferior oblique, and the superior oblique. When the muscles exert different tensions, a torque is exerted on the globe that causes it to turn, in almost pure rotation, with only about one millimeter of translation. Thus, the eye can be considered as undergoing rotations about a single point in the center of the eye. Once the human eye sustains damage to the optic nerve, the impulses will not be taken to the brain. Eye transplants can happen but the person receiving the transplant will not be able to see. As for the optic nerve, once it is damaged it cannot be fixed.

Rapid eye movement

Rapid eye movement, or REM for short, typically refers to the stage during sleep during which the most vivid dreams occur. During this stage, the eyes move rapidly. It is not in itself a unique form of eye movement.

Saccades

Saccades are quick, simultaneous movements of both eyes in the same direction controlled by the frontal lobe of the brain. Some irregular drifts, movements, smaller than a saccade and larger than a microsaccade, subtend up to six minutes of arc.

Microsaccades

Even when looking intently at a single spot, the eyes drift around. This ensures that individual photosensitive cells are continually stimulated in different degrees. Without changing input, these cells would otherwise stop generating output. Microsaccades move the eye no more than a total of 0.2° in adult humans.

Vestibulo-ocular reflex

The vestibulo-ocular reflex is a reflex eye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field. For example, when the head moves to the right, the eyes move to the left, and vice versa.

Smooth pursuit movement

The eyes can also follow a moving object around. This tracking is less accurate than the vestibulo-ocular reflex, as it requires the brain to process incoming visual information and supply feedback. Following an object moving at constant speed is relatively easy, though the eyes will often make saccadic jerks to keep up. The smooth pursuit movement can move the eye at up to 100°/s in adult humans.

It is more difficult to visually estimate speed in low light conditions or while moving, unless there is another point of reference for determining speed.

Optokinetic reflex

The optokinetic reflex is a combination of a saccade and smooth pursuit movement. When, for example, looking out of the window at a moving train, the eyes can focus on a 'moving' train for a short moment (through smooth pursuit), until the train moves out of the field of vision. At this point, the optokinetic reflex kicks in, and moves the eye back to the point where it first saw the train (through a saccade).

Vergence movement

When a creature with binocular vision looks at an object, the eyes must rotate around a vertical axis so that the projection of the image is in the centre of the retina in both eyes. To look at an object closer by, the eyes rotate 'towards each other' (convergence), while for an object farther away they rotate 'away from each other' (divergence). Exaggerated convergence is called cross eyed viewing (focusing on the nose for example) . When looking into the distance, or when 'staring into nothingness', the eyes neither converge nor diverge.

Vergence movements are closely connected to accommodation of the eye. Under normal conditions, changing the focus of the eyes to look at an object at a different distance will automatically cause vergence and accommodation.

Diseases, disorders, and age-related changes

There are many diseases, disorders, and age-related changes that may affect the eyes and surrounding structures.

As the eye ages certain changes occur that can be attributed solely to the aging process. Most of these anatomic and physiologic processes follow a gradual decline. With aging, the quality of vision worsens due to reasons independent of aging eye diseases. While there are many changes of significance in the nondiseased eye, the most functionally important changes seem to be a reduction in pupil size and the loss of accommodation or focusing capability (presbyopia). The area of the pupil governs the amount of light that can reach the retina. The extent to which the pupil dilates also decreases with age. Because of the smaller pupil size, older eyes receive much less light at the retina. In comparison to younger people, it is as though older persons wear medium-density sunglasses in bright light and extremely dark glasses in dim light. Therefore, for any detailed visually guided tasks on which performance varies with illumination, older persons require extra lighting. Certain ocular diseases can come from sexually transmitted diseases such as herpes and genital warts. If contact between eye and area of infection occurs, the STD can be transmitted to the eye.

With aging a prominent white ring develops in the periphery of the cornea- called arcus senilis. Aging causes laxity and downward shift of eyelid tissues and atrophy of the orbital fat. These changes contribute to the etiology of several eyelid disorders such as ectropion, entropion, dermatochalasis, and ptosis. The vitreous gel undergoes liquefaction (posterior vitreous detachment or PVD) and its opacities — visible as floaters — gradually increase in number.

Various eye care professionals, including ophthalmologists, optometrists, and opticians, are involved in the treatment and management of ocular and vision disorders. A Snellen chart is one type of eye chart used to measure visual acuity. At the conclusion of an eye examination, an eye doctor may provide the patient with an eyeglass prescription for corrective lenses. Some disorders of the eyes for which corrective lenses are prescribed include myopia (near-sightedness) which affects one-third of the population, hyperopia (far-sightedness) which affects one quarter of the population, and presbyopia, a loss of focusing range due to aging.

Eye injury and safety

Accidents involving common household products cause 125,000 eye injuries each year in the U.S. More than 40,000 people a year suffer eye injuries while playing sports. Sports-related eye injuries occur most frequently in baseball, basketball and racquet sports.

Occupational eye injury

Each day about 2000 U.S. workers have a job-related eye injury that requires medical treatment. About one third of the injuries are treated in hospital emergency departments and more than 100 of these injuries result in one or more days of lost work. The majority of these injuries result from small particles or objects striking or abrading the eye. Examples include metal slivers, wood chips, dust, and cement chips that are ejected by tools, wind blown, or fall from above a worker. Some of these objects, such as nails, staples, or slivers of wood or metal penetrate the eyeball and result in a permanent loss of vision. Large objects may also strike the eye/face causing blunt force trauma to the eyeball or eye socket. Chemical burns to one or both eyes from splashes of industrial chemicals or cleaning products are common. Thermal burns to the eye occur as well. Among welders, their assistants, and nearby workers, UV radiation burns (welder’s flash) routinely damage workers’ eyes and surrounding tissue.

In addition to common eye injuries, health care workers, laboratory staff, janitorial workers, animal handlers, and other workers may be at risk of acquiring infectious diseases via ocular exposure.

Anatomy

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