Optics of aberroscopy and super vision.

This paper (1) reviews the fundamental limits to visual performance imposed by optical imaging and photoreceptor sampling to determine the limits to the potential gains offered by ideal corrections; (2) examines the predicted losses in vision induced by chromatic aberration, phase shifts, typical ocular aberrations, and the gains possible by correcting the monochromatic aberrations of the eye; (3) discusses the principles of aberration measurement in the eye; and (4) presents methods for measuring and classifying monochromatic aberrations of the eye.

Effect of larger ablation zone and transition zone on corneal optical aberrations after photorefractive keratectomy.

OBJECTIVE: To evaluate the effects of photorefractive keratectomy on corneal optical aberrations using a 5.5-mm optical zone and a 7.0-mm transition zone. METHODS: Videokeratographs of 72 eyes from 47 patients treated for low to moderate (1-9 diopters) myopia were obtained at the preoperative and 1-, 3-, 6-, 12-, and 18-month postoperative examinations. The videokeratoscopy data files were used to calculate the wavefront variance of the corneas for small (3-mm) and large (7-mm) pupils using a previously described method. RESULTS: In general, all optical aberrations decreased postoperatively for 3-mm pupils and increased for 7-mm pupils compared with preoperative values. For 3-mm pupils, the 2 common optical aberrations (comalike [S(3)] and spherical-like [S(4)]) decreased postoperatively and never returned to preoperative values. For 7-mm pupils, however, comalike aberrations increased slightly and spherical-like aberrations increased by nearly an order of magnitude during the postoperative period. Similarly, for 3-mm pupils, the higher order S(5) and S(6) aberrations decreased throughout the postoperative period, with S(6) values showing an approximately 23-fold reduction at 12 and 18 months. For 7-mm pupils, S(5) and S(6) aberrations increased slightly, more so for S(5) (approximately 3-fold) than for S(6). Total wavefront aberrations decreased an average of 2.3 times postoperatively for 3-mm pupils, and increased significantly (P<.05) at all postoperative examinations for 7-mm pupils. Opening the pupil from 3 mm to 7 mm before surgery produced a 14-fold increase in total aberrations, whereas this same change produced an average 113-fold increase after photorefractive keratectomy. CONCLUSIONS: Corneal optical aberrations after photorefractive keratectomy with a larger ablation zone and a transition zone are less pronounced and more physiologic than those associated with first-generation (5-mm) ablations with no transition zone. CLINICAL RELEVANCE: Evaluating the postoperative corneal aberration structure will help us devise ways to minimize the wavefront aberrations of the eye through the creation of an ideal corneal first surface, thereby improving visual results for patients undergoing excimer laser ablations for refractive correction.

Schematic eye models for simulation of patient visual performance.

PURPOSE: To determine if model eyes can simulate the visual performance of normal human eyes under conditions of varying low myopic blur, pupil size, and contrast. METHODS: High and low contrast Bailey-Lovie logMAR visual acuity (VA) of three normal eyes of three subjects were measured for four artificial pupil sizes and ten levels of myopic defocus. Simulated visual acuities were then determined for three model eyes--the Indiana Eye with no spherical aberration, the Indiana Eye with average spherical aberration, and the Kooijman Eye--by generating optically aberrated VA charts for each testing condition using Visual Optics Lab software by Sarver and Associates, Inc, and having the subjects read high resolution printouts of these charts using a 3-mm pupil and optimal spectacle correction. The correlation between real VA and simulated VA was then plotted and a regression line calculated. RESULTS: Slopes for the Indiana Eye, Indiana Eye with spherical aberration, and Kooijman Eye were 0.98, 0.98, and 1.01 for high contrast, and 0.92, 0.67, and 0.75 for low contrast, respectively. The r2 values were 0.73, 0.74, and 0.77, for high contrast, and 0.69, 0.40, and 0.50 for low contrast, respectively. Under low contrast conditions the Indiana Eye VA was significantly closer to the real VA than that of the other two models (P<.0003). CONCLUSION: Visual performance can be simulated by eye models. The simple single surface Indiana Eye with no spherical aberration best modeled both high and low contrast visual acuity.

Anterior corneal optical aberrations induced by photorefractive keratectomy for hyperopia.

PURPOSE: Photorefractive keratectomy (PRK) for hyperopia requires both a steepening of the central cornea and a flattening of the mid-periphery to achieve its effect and is likely to affect the optical aberrations of the eye. METHODS: Nine patients underwent PRK to correct between +2.00 and +4.00 D of hyperopia (first eye treated for each patient) using the Summit Technology Apex Plus excimer laser. Anterior corneal aberrations for pupil diameters of 3, 5.5 and 7 mm were estimated from corneal topography data (TMS-1), assuming a uni-index, single surface cornea. Refractive error was assessed using retinoscopy and standard subjective tests. RESULTS: Apart from the intended change in refraction (mean spherical equivalent manifest refraction, +4.60 +/- 1.60 D before surgery and +0.70 +/- 1.60 D at 1 year after surgery), the most significant change was in spherical aberration. Anterior corneal spherical aberration was positive (+1.60 +/- 0.60 D for a 5.5-mm pupil) before surgery and became negative after surgery (-1.80 +/- 1.20 D at 1 year). The change in spherical aberration was related to the achieved change in refractive error. CONCLUSIONS: The large change (approximately 3.00 D) in spherical aberration (from positive to negative aberration) has implications for the optical performance of the whole eye, where the effects of lenticular aberration must also be considered.

Corneal first surface optical aberrations and visual performance.

PURPOSE: Wavefront analysis has demonstrated that refractive surgery-induced corneal first surface aberrations are large, are dominated by symmetric aberrations (spherical-like aberrations), and are correlated to measures of visual performance. It is not clear whether the correlation between corneal first surface aberrations and visual performance can be generalized to other corneal conditions where large asymmetric aberrations (coma-like aberrations) may dominate the aberration structure. The purpose of the research reported here was to determine the general utility of corneal first surface wavefront analysis in predicting visual performance. METHODS: Patients were 13 normals and 78 patients with a variety of corneal conditions including surgically removed pterygia, penetrating keratoplasty, keratoconus, radial keratotomy, laser in situ keratomileusis, and others. Videokeratographs were taken for all patients and used to calculate corneal first surface wavefront variance for 3 and 7 mm pupils. Similarly, visual performance was quantified by measurements of contrast sensitivity and high and low contrast acuities through both 3 and 7 mm pupils. RESULTS: Statistically significant correlations existed between all three measures of visual performance and the corneal wavefront variance. All relationships were stronger for the 7 mm diameter-pupil condition than the 3 mm pupil. CONCLUSION: Regardless of the cause, corneas with increased wavefront variance showed a quantifiable decrease in visual performance that was pupil size dependent.

Limits to vision: can we do better than nature?

Non-invasive wavefront sensing of the human eye provides the necessary information to design corrections which minimize the monochromatic optical errors of the eye beyond simple sphere (defocus) and cylinder (astigmatism). These "ideal" corrections must move with the eye, maintaining proper alignment with the eye's optics. Viable modes of correction include contact lenses, refractive surgery and intraocular lenses. Will these "ideal" corrections lead to better vision? If so, how much better? Here we explore the limits imposed by the optical and neural design of the eye. For larger pupil sizes (>3 mm diameter) "ideal" corrections improve the optical quality of the retinal image beyond the limits imposed by photoreceptor spacing. Photoreceptor spacing limits visual acuity to between 20/8 and 20/10. Correcting the higher order aberrations will provide images with higher contrast and crisper edges. When perfected, "ideal" corrections will provide for high contrast visual acuity between 20/8 and 20/10.

Reference axis selection: subcommittee report of the OSA Working Group to establish standards for measurement and reporting of optical aberrations of the eye.

It is the committee's recommendation that the ophthalmic community use the line of sight as the reference axis for the purposes of calculating and measuring the ocular optical aberrations.

Entoptic foveal avascular zone measurement and diabetic retinopathy.

BACKGROUND: Entoptic visualization of the foveal avascular zone (FAZ) provides a noninvasive method for measurement of the FAZ. To determine if repeatability of measurement with this technique is good enough to monitor changes in diabetic retinopathy, we quantify (1) the repeatability of entoptic FAZ measurement in healthy subjects and (2) the relationship between measured FAZ diameter and the severity of retinopathy. METHODS: (1) To determine FAZ measurement repeatability, 10 healthy adults entoptically measured their FAZ diameters in 11 separate testing sessions. (2) In a separate experiment, 53 patients with varying levels of diabetic retinopathy and 21 control subjects used a vascular entoptoscope to measure their FAZ diameters. RESULTS: The disease-related increase in FAZ diameter is large (approximately 400 microm) compared to the repeatability of the entoptic measurement within a subject (SD approximately 35 microm). CONCLUSION: Entoptic measurements have the repeatability necessary to reliably monitor increases in FAZ diameter of the magnitude of those induced by diabetes.

Changes in corneal wavefront aberrations with aging.

PURPOSE: To investigate whether corneal wavefront aberrations vary with aging. METHODS: One hundred two eyes of 102 normal subjects were evaluated with videokeratography. The data were decomposed using Taylor and Zernike polynomials to calculate the monochromatic aberrations of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: For a 3-mm pupil, the amount of total aberrations (Spearman rank correlation coefficient r(s) = 0.145; P = 0.103) and spherical-like aberrations (r(s) = -0.068; P = 0.448) did not change with aging, whereas comalike aberrations exhibited a weak but statistically significant correlation with age (r(s) = 0.256; P = 0.004). For a 7-mm pupil, total aberrations (r(s) = 0.552; P < 0.001) and comalike aberrations (r(s) = 0.561; P < 0.001) significantly increased with aging, but spherical-like aberrations showed no age-related changes (r(s) = 0.124; P = 0.166). Simulated pupillary dilation from 3 mm to 7 mm caused a 38.0+/-28.5-fold increase in the total aberrations, and the extent of increases significantly correlated with age (r(s) = 0.354; P < 0.001). Pupillary dilation influenced the comalike aberrations more in the older subjects than in the younger subjects (r(s) = 0.243; P = 0.006), but such age dependence was not found for spherical-like aberrations (r(s) = 0.141; P = 0.115). CONCLUSIONS: Comalike aberrations of the cornea correlate with age, implying that the corneas become less symmetrical along with aging. Spherical-like aberrations do not vary significantly with aging. Pupillary dilation markedly increases wavefront aberrations, and those effects are more prominent in older subjects than in younger subjects.

Accuracy of the tomey topographic modeling system in measuring surface elevations of asymmetric objects.

BACKGROUND: Most studies have assessed the accuracy of videokeratographic systems using spheres, ellipsoids, or toric surfaces. Most human corneas are asymmetric to some degree and many pathological corneas are markedly asymmetric. To date, little work has been done to ascertain the accuracy of videokeratographic systems for measuring the shape of asymmetric objects. PURPOSE: The purpose of this study is to determine the accuracy with which the Tomey Topographic Modeling System can evaluate the topography of asymmetric surfaces. METHODS: Calibrated ellipsoidal test objects were tilted with respect to the videokeratometric axis to create asymmetric test surfaces with known characteristics. RESULTS: Root mean squared error of all the measured surface elevations varied from 0.7 microm to 11.3 microm. Although there was a trend for greater error with the more asymmetric surfaces, the trend was not statistically significant. Accuracy was not dependent on apical radius. Measurement error increased toward the periphery. CONCLUSIONS: For the Tomey Topographic Modeling System, the accuracy in measurement of smooth, asymmetric surfaces is comparable the accuracy in measurement of symmetric surfaces.

Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis.

PURPOSE: To compare changes in the corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis. METHODS: In a prospective randomized study, 22 patients with bilateral myopia received photorefractive keratectomy on one eye and laser in situ keratomileusis on the other eye. The procedure assigned to each eye and the sequence of surgery for each patient were randomized. Corneal topography measurements were performed preoperatively, 2 and 6 weeks, 3, 6, and 12 months after surgery. The data were used to calculate the wavefront aberrations of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: Both photorefractive keratectomy and laser in situ keratomileusis significantly increased the total wavefront aberrations for 3- and 7-mm pupils, and values did not return to the preoperative level throughout the 12-month follow-up period. For a 3-mm pupil, there was no statistically significant difference between photorefractive keratectomy and laser in situ keratomileusis at any postoperative point. For a 7-mm pupil, the post-laser in situ keratomileusis eyes exhibited significantly larger total aberrations than the post-photorefractive keratectomy eyes, where a significant intergroup difference was observed for spherical-like aberration, but not for coma-like aberration. This discrepancy seemed to be attributable to the smaller transition zone of the laser ablation in the laser in situ keratomileusis procedure. Before surgery, simulated pupillary dilation from 3 to 7 mm caused a five- to six-fold increase in the total aberrations. After surgery, the same dilation resulted in a 25- to 32-fold increase in the photorefractive keratectomy group and a 28- to 46-fold increase in the laser in situ keratomileusis group. For a 3-mm pupil, the proportion of coma-like aberration increased after both photorefractive keratectomy and laser in situ keratomileusis. For a 7-mm pupil, coma-like aberration was dominant before surgery, but spherical-like aberration became dominant postoperatively. CONCLUSIONS: Both photorefractive keratectomy and laser in situ keratomileusis increase the wavefront aberrations of the cornea and change the relative contribution of coma- and spherical-like aberrations. For a large pupil, laser in situ keratomileusis induces more spherical aberrations than photorefractive keratectomy. This finding could be attributable to the smaller transition zone of the laser ablation in the laser in situ keratomileusis procedure.

Assessment of the accuracy of the crossed-cylinder aberroscope technique.

Simulations of the optics of the Howland crossed-cylinder aberroscope technique show that errors in alignment, data collection, and analysis can lead to unexpected asymmetries of the determined aberrations in a rotationally symmetric system. In particular, coma can be incorrectly indicated. The magnitude of the error in aberration measurement depends on the magnitude of the alignment, data collection, and alignment errors. These findings indicate that the tolerances for setting up the technique and data collection should be analyzed thoroughly before quantitative significance is given to the determined aberration coefficients.

Corneal aberrations and visual performance after radial keratotomy.

BACKGROUND: Refractive surgery and videokeratography have allowed us to study the effects on visual performance of relatively large changes in corneal aberration structure induced by surgical changes in corneal shape. METHODS: We quantified in one eye of nine normal and 23 radial keratotomy patients, the area under the log contrast sensitivity function (AULCSF) and corneal first surface wavefront variance for two artificial pupil sizes (3 and 7 mm). Contrast sensitivity was measured with sine-wave gratings at six spacial frequencies. Wavefront variance was derived from videokeratographs using Zernike polynomials. RESULTS: For normals eyes there were no significant changes over time. For eyes that had radial keratotomy, there were significant pupil size-dependent changes. For the 3 mm pupil, there were significant surgery-induced changes in the corneal wavefront variance which became large (approximately 30 times preoperative values) at 7 mm. Significant correlated changes in AULCSF for the 7 mm pupil but not for the 3 mm pupil occurred immediately following surgery and remained. CONCLUSIONS: Radial keratotomy, like photorefractive keratectomy, shifts the distribution of aberrations from third order dominance (coma-like aberrations) to fourth order dominance (spherical-like aberrations). Radial keratotomy-induced aberrations and loss in contrast sensitivity are reduced with increasing clear zone diameter. Radial keratotomy induces an increase in the optical aberrations of the eye and the increase for large pupils (7 mm) but not small (3 mm) is correlated to a decrease in contrast sensitivity.

Effect of pupillary dilation on corneal optical aberrations after photorefractive keratectomy.

BACKGROUND: Complaints of glare, halos, and disturbances of night vision after photorefractive keratectomy (PRK) probably result from changes in the corneal aberration structure induced by the laser ablation procedure. The purpose of this article is to characterize changes in the corneal aberration structure after PRK and to demonstrate the effect of pupil dilation on these changes. METHODS: Videokeratographs obtained preoperatively (n = 112) and at 1 (n = 94), 3 (n = 103), 6 (n = 91), 12 (n = 60), 18 (n = 53), and 24 (n = 44) months postoperatively from 112 eyes of 89 patients who had undergone PRK for myopia were analyzed. The data were used to calculate the wavefront variance of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: For both the 3- and 7-mm pupil, coma-like aberrations increased significantly from preoperative values to 1-month postoperative values (P < .05 and P < .001, respectively); for 7-mm pupils, the postoperative values never returned to preoperative values (P < .001, 24 months). For the 3-mm pupil, spherical-like aberrations decreased significantly 1 month after surgery (P < .001), and never returned to preoperative values. For the 7-mm pupil, spherical-like aberrations increased significantly 1 month after surgery (P < .001) and did not return to preoperative values. Opening the pupil from 3 to 7 mm increased spherical-like aberrations only 7-fold before PRK. After PRK, however, pupillary dilation caused a 300-fold increase in this type of aberration. For both pupil sizes at all times after PRK, the magnitude of the surgically induced aberration correlated with the amount of the attempted correction (P < .001, r2 = 0.6 at 1 month for a 7-mm pupil). CONCLUSIONS: Photorefractive keratectomy increases the wavefront variance of the cornea; PRK changes the relative contribution of coma-like and spherical-like aberrations; after PRK, the diameter of the entrance pupil greatly affects the amount and character of the aberrations; and the magnitude of the aberration increases with the attempted correction. CLINICAL RELEVANCE: Quantitative characterization of irregular astigmatism with the measurement of aberration structures following corneal surgery and the correlation of these data with visual performance in clinical trials provide the basis for understanding patient complaints and for improving surgical approaches. Our analysis shows that, whereas induced aberrations are minimal for simulated day-time vision (3-mm pupil), the increase in aberrations measured for simulated night vision (7-mm pupil) supports the use of large treatment zones to reduce visual disturbances such as glare and halos.

Entoptic image quality of the retinal vasculature.

Spatial details of entoptically visible retinal vessels were investigated using transcleral and Maxwellian-view stimulators. Nine normal subjects provided detailed drawings of the entoptic images which were digitized and superimposed onto digitized fundus photographs and fluorescein angiograms from the same eyes. Subjects also used a tracing method to locate visible entoptic features. The trans-scleral method provided images similar in detail to standard fundus photography (lacking capillary detail, but capturing larger arteries, veins, arterioles and venules) in the macula and around the disk. The Maxwellian-view method illuminated the fovea (7.7 degree field) and provided foveola capillary detail (capillaries traversing the foveola, the capillary arcade forming the FAZ) as well as the larger foveal vessels supplying the foveola, and often contained more foveal detail that available with fluorescein angiography.

Mathematical model of a Placido disk keratometer and its implications for recovery of corneal topography.

The purpose of this paper is to illustrate the importance of radial contours in the target pattern of a Placido disk keratometer. We do so by presenting an example of a corneal surface which cannot be determined solely by the use of Placido ring images, but rather which requires radial contours for its determination. In order to prove our assertions, we derive partial differential equations (called the corneal transform), which relate the ring targets to their images.

Refractive surgery, optical aberrations, and visual performance.

Visual optics is taking on new clinical significance. Given that current refractive procedures can and do induce large amounts of higher order ocular aberration that often affects the patient's daily visual function and quality of life, we can no longer relegate the considerations of ocular aberrations to academic discussions. Instead, we need to move toward minimizing (not increasing) the eye's aberrations at the same time we are correcting the eye's spherical and cylindrical refractive error. These are exciting times in refractive surgery, which need to be tempered by the fact that after all the research, clinical, and marketing dust settles, the level to which we improve the quality of the retinal image will be guided by the trade-off between cost and the improvement in the quality of life that refractive surgery offers.