Subjective measurement of high-order aberrations of the eye.

We used an apparatus similar to Tscherning's aberroscope, and analyzed subjects' drawings to obtain the wave aberration surfaces of 55 eyes. This analysis permitted a Taylor series representation of the wave aberrations to terms of the fourth order. The results revealed a wide variety in type and severity of high-order aberrations in which "cylindrical" aberrations were prominent and cases of classical spherical aberrations were rare. We computed the monochromatic modulation transfer function curves for the range of observations. The overall findings suggest a more prominent role for monochromatic high-order aberrations in degrading the visual image than has hitherto been assumed.

Infant astigmatism measured by photorefraction.

Photorefraction of a sample of 93 infants of ages 1 day to 12 months showed that 63 percent of the subjects had astigmatism of 0.75 diopter or greater, and 12 percent greater than 2 diopters. Seventy percent of these astigmatisms were in the horizontal-vertical meridians. By comparison, only 8 percent of a sample of 26 adults tested by the same method showed astigmatism (all 0.75 to 1 diopter). The high incidence of infant astigmatism has implications for critical periods in human visual development and for infant acuity.

Ultraviolet video-viewing: the television camera as an insect eve.

A television camtiera, like the eyes of some insects, is sensitive to ultraviolet light. When equipped with an appropriate ultraviolet-transmitting lens, such a camera can be used for the direct examtiination of ultraviolet reflectiont patterns (for example, on flowers, butterflies) that are invisible to us, but visible to inisects.

A photorefractive characterization of focusing ability of infants and young children.

The authors have used isotropic and orthogonal photorefraction to examine the focusing ability of 360 normal uncyclopleged infants and young children (ages, 2 mo to 5 yr). Photorefractive reflexes were recorded on 400 ASA color transparency film at 1.5 m, and the subject viewed the photographer's face located directly above the camera. The photographs of reflexes were projected at X 20 on a computer-driven digitizing tablet and converted to the ophthalmic prescriptions that would correct the subject for the camera distance. Using these prescriptions the authors established 95% confidence limits as a function of age for each of four different tests: net sphere of most defocused eye; cylinder of most astigmatic eye; difference in spheres between two eyes; and difference in cylinder between two eyes. Spheric defocus was found to decrease uniformly as a function of age, as did the cylinder of the most astigmatic eye. However, the symmetry of focus of the eyes, as judged by spheric and cylindric differences, was established within the first year of life. By relaxing the limits of each individual test, a test battery was constructed that was failed by 5% of the subject population, with the individual tests contributing in approximately equal proportions to the failure rate. The use of this test battery for detecting focusing conditions in infancy and early childhood that can lead to amblyopia is discussed.

Photorefractive measurements of astigmatism in infants and young children.

We have photorefracted 312 infants and young children in Tompkins county in New York state and characterized the magnitude and axes of their astigmatisms. The population was solicited by letter from birth announcements or photographed at nursery schools, and was composed of children free of ocular problems. As had been previously reported, we found that the prevalence of astigmatisms of greater than 1 diopter decreased with increasing age. Roughly 7 of 10 infants aged 1 year of younger had one eye with at least 1 diopter of astigmatism or more, while only 1 out of 10 children of age four or more had an eye with 1 or more diopters of astigmatism. A longitudinal study of 26 infants also showed a decrease in the amount of astigmatism over the first three years of life. In infants up to 2 years of age from Tompkins County, the ratio of against-the-rule:oblique:with-the-rule astigmatisms was 15:9:1 in the most astigmatic eye. Generally the axes of oblique astigmatism showed bilateral symmetry. Photorefraction of a group of 159 infants from the city of Seattle showed a similar prevalence of astigmatism, but a slightly different ratio of kinds of astigmatism.

The anatomy of the ciliary region of the chicken eye.

PURPOSE: To describe the detailed anatomy of the ciliary region of the chicken eye. METHODS: Fifty-two eyes from White Leghorn chickens were examined in the course of this study. Descriptions are based on specimens examined using microdissection and bright field microscopy of sections embedded in paraffin or epon. Microdissection was assisted through the use of an iodine-based stain. RESULTS: The ciliary region of the chicken eye is asymmetric through the horizontal plane, with the distance from the limbus to the equator of the eye being greatest temporally. This asymmetry is reflected in the relative development of the ciliary musculature. The nasal ciliary muscle fibers are the shortest of any of the quadrants, and the nasal quadrant lacks a well-developed scleral venous sinus. The ciliary musculature is approximately 2.5 mm in extent (temporally) and is composed of two regional groups (anterior and posterior) within which five distinct arrangements of muscle fibers can be recognized. The majority of fibers insert on fibrous elements associated with the inner or outer walls of the scleral venous sinus, which, in turn, are continuous with the inner stromal elements of the cornea. CONCLUSIONS: The ciliary musculature of the chicken eye is composed of two major muscle groups within which five arrangements of muscle fibers have been identified. The anatomy of the ciliary muscle is consistent with the recently proposed functions of altering the corneal curvature for corneal accommodation and moving the ciliary body anteriorly as a part of the lenticular accommodative mechanism. The ciliary muscle also may serve in the regulation of aqueous dynamics within the eye.

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.

Prevalence of anisometropia in volunteer laboratory and school screening populations.

For 10 years our laboratory has conducted, a longitudinal study of focusing and motor behavior of a volunteer population of 686 subjects aged 3 months to 9 years. Its purpose is to characterize normal refractive development in infants and children and to relate refractive anomalies to subsequent visual problems. Using age-related criteria for anisometropia adjusted to detect the most unusual 5% of the refractions on a test battery, we have found 19 nonstrabismic, anisometropic subjects (2.8% of total subject population). Of these, eight were either seen once or their anisometropia appeared at their last visit. Of the remaining 11 subjects, all had a reduction of their anisometropia to within normal limits on subsequent visits. Thus our current best estimate of persistent infant anisometropia is 0%, a startling result. By comparison, we found ten strabismic subjects (1.46%), two of whom had persistent anisometropia. Although we did not believe that anisometropic subjects could self-select and not participate in the study, it was possible that the volunteer laboratory population had characteristics atypical of the county at large. Thus we conducted a screening of 374 Head Start and first-grade pupils throughout the county, using the same methods. We found virtually no difference in the average refractive conditions between the laboratory and school populations and no significant difference in the prevalence of visual disorders. The very low prevalence of anisometropia in infants and young children in both populations has important implications for the etiology of anisometropic amblyopia.

Magnification and visual acuity in refractive surgery.

In comparisons of retinal image size within the same eye before and after refractive surgery, a change in the plane of correction from the spectacle to the cornea induces a change in retinal magnification. Comparing retinal image size between eyes of different individuals, a change in the plane of correction as well as the type of ametropia (axial or refractive) interacts to change the retinal magnification. Consequently, comparing acuity before and after refractive surgery without considering the effects of retinal magnification can be misleading. Magnification effects can be large, accounting for a visual acuity increase of 1 line or more. Here we model the magnification induced by refractive surgery in various reference eyes and discuss implications in the context of current clinical trials.

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.

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.

Photorefractive studies of normal and handicapped infants and children.

We have photorefracted 360 infants and children of ages 2 months to 5 years from and around Tompkins County, New York, who were free of any obvious ocular pathology. From these studies we have established 95% confidence limits for largest cylinder, largest sphere, and spherical and cylindrical differences between eyes as a function of age. Using this normal data we have begun to photorefract handicapped children from special childrens' centers in and around Tompkins County. Our preliminary data indicate a higher prevalance (greater than 4 X ) of refractive anomalies in handicapped children, as compared to normal children, even when allowance for ocular pathology is made.

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.

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.

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.

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.

Properties of the feedback loops controlling eye growth and refractive state in the chicken.

Recent experiments in chickens provide evidence that axial eye growth and refractive state are guided by mechanisms sensitive to refractive error. To determine whether or not the sign of refractive error is derived from longitudinal chromatic aberration we raised chicks with spectacle lenses in monochromatic light. The eyes showed an appropriate growth response to correct for the defocus imposed by the lenses no different than in previous experiments in white light. Thus, in normally accommodating chicks chromatic cues are not necessary for emmetropization to occur. We examined the linearity of feedback loops controlling axial eye growth: positive spectacle lenses were found to inhibit axial growth very efficiently making the eyes shorter than normal whereas negative lenses had little effect on axial elongation: feedback loops for regulation of axial growth are highly nonlinear and act most efficiently on the myopic side. We found that, subsequent to a period of binocular deprivation of form vision, the refractive errors acquired are highly correlated in both eyes. Since both eyes grew without visual feedback we conclude that the gains in the feedback loops that control axial growth must be similar in both eyes. We suggest that the gains are genetically determined and are typical for each individual. Chicks made near-sighted in both eyes by "deprivation of form vision" were corrected by appropriate negative lenses. Three out of five chicks recovered from myopia despite the correction. Also two chicks that were made near-sighted in one eye recovered with no regard to the correcting lens. Three chicks remained more myopic than the correcting lens required and finally started to recover while the lens was still in place. Two out of three chicks that were made far-sighted showed recovery despite appropriate correction by positive lenses. We conclude that there must be a nonvisual mechanism highly sensitive to abnormal eye shape. During expt (4) we found unexpectedly that the development of form deprivation myopia is inhibited if no part of the retina in an animal is exposed to normal visual experience. The result indicates that some communication between both eyes exists, although form deprivation myopia itself has been shown to develop independently in both eyes.

On the gekko pupil and Scheiner's disc.

The four pinhole apertures of the constricted gekko pupil are an adaptation for decreasing the depth of field of the eye, while decreasing the total light flux to the retina. This may be useful for distance estimation at high light levels.