Binocular visual performance with aberration correction as a function of light level.

The extent to which monocular visual performance of subjects with normal amounts of ocular aberrations can be improved with adaptive optics (AO) depends on both the pupil diameter and the luminance for visual testing. Here, the benefit of correction of higher order aberrations for binocular visual performance was assessed over a range of luminances for natural light-adapted pupil sizes with a binocular AO visual simulator. Results show that binocular aberration correction benefits for visual acuity and contrast sensitivity increase with decreasing luminances. Also, the advantage of binocular over monocular viewing increases when visual acuity becomes worse. The findings suggest that binocular summation mitigates poor visual performance under low luminance conditions.

Binocular visual acuity for the correction of spherical aberration in polychromatic and monochromatic light.

Correction of spherical (SA) and longitudinal chromatic aberrations (LCA) significantly improves monocular visual acuity (VA). In this work, the visual effect of SA correction in polychromatic and monochromatic light on binocular visual performance is investigated. A liquid crystal based binocular adaptive optics visual analyzer capable of operating in polychromatic light is employed in this study. Binocular VA improves when SA is corrected and LCA effects are reduced separately and in combination, resulting in the highest value for SA correction in monochromatic light. However, the binocular summation ratio is highest for the baseline condition of uncorrected SA in polychromatic light. Although SA correction in monochromatic light has a greater impact monocularly than binocularly, bilateral correction of both SA and LCA may further improve binocular spatial visual acuity which may support the use of aspheric-achromatic ophthalmic devices, in particular, intraocular lenses (IOLs).

Stability of the retinal image under normal viewing conditions and the implications for neural adaptation.

Previous studies have demonstrated that the visual system adapts to the specific aberration pattern of an individual's eye. Alterations to this pattern can lead to reduced visual performance, even when the Root Mean Square (RMS) of the wavefront error remains constant. However, it is well-established that ocular aberrations are dynamic and can change with factors such as pupil size and accommodation. This raises an intriguing question: can the neural system adapt to continuously changing aberration patterns? To address this question, we measured the ocular aberrations in four subjects under various natural viewing conditions, which included changes in accommodative state and pupil size. We subsequently computed the associated Point Spread Functions (PSFs). For each subject, we examined the stability in the orientation of the PSFs and analyzed the cross-correlation between different PSFs. These findings were then compared to the characteristics of a distribution featuring PSF shapes akin to random variations. Our results indicate that the changes observed in the PSFs are not substantial enough to produce a PSF shape distribution resembling random variations. This lends support to the notion that neural adaptation is indeed a viable mechanism even in response to continuously changing aberration patterns.

Intraocular scatter compensation with spatial light amplitude modulation for improved vision in simulated cataractous eyes.

Cataract is one of the common causes of visual impairment due to opacification of the crystalline lens. Increased intraocular scattering affects the vision of cataract patients by reducing the quality of the retinal image. In this study, an amplitude modulation-based scatter compensation (AM-SC) method is developed to minimize the impact of straylight on the retinal image. The performance of the AM-SC method was quantified by numerical simulations of point spread function and retinal images in the presence of different amounts of straylight. The approach was also experimentally realized in a single-pass system with a digital micro-mirror device used as a spatial amplitude modulator. We showed that the AM-SC method allows to enhance contrast sensitivity in the human eyes in vivo with induced scattering.

Increased crystalline lens coverage in optical coherence tomography with oblique scanning and volume stitching.

A three-dimensional optical coherence tomography (OCT) crystalline lens imaging method based on oblique scanning and image stitching is presented. The method was designed to increase OCT imaging volume of crystalline lens in vivo. A long-range swept-source (SS)-OCT imaging system, which can measure the entire anterior segment of eye in a single acquisition, is used to acquire one central volume and 4 extra volumes with different angles between optical axis of OCT instrument and the pupillary axis. The volumes are then stitched automatically by developed software. To show its effectiveness and verify its validity, we scanned the subjects before and after pupil dilation drops and compared the experimental results. By determining the number of voxels representing the signal from the crystalline lens in 3-D OCT images, our method can provide around 17% additional volumetric lens coverage compared with a regular imaging procedure. The proposed approach could be used clinically in early diagnosis of cortical cataract. Wider field of view offered by this method may facilitate more accurate lens biometry in its peripheral zones, which potentially contributes to understanding of lens shape modifications of the accommodating eye.

Volumetric Optical Imaging and Quantitative Analysis of Age-Related Changes in Anterior Human Vitreous.

Purpose: The purpose of this study was to characterize age-related changes in anterior human vitreous with 3-D swept source optical coherence tomography (SS-OCT) and evaluate associations with axial length (AL) and contrast sensitivity function (CSF). Methods: There were 49 phakic eyes in 49 patients (40.0 ± 19.3 years) had 3-D volumetric scanning of the lens and retrolental vitreous with SS-OCT at 1050 nm. OCT-derived indices of vitreous optical density (VOD), vitreous opacification ratio (VOR), and lens optical density (LOD) were correlated with AL and double-pass assessment of retinal point spread function (Objective Scatter Index [OSI]). CSF was measured using an adaptive-optics visual simulator (area under log-log contrast sensitivity function [AULCSF]). Results: Vitreous SS-OCT detected gel vitreous, liquefied lacunae, Berger's space, retrolental laminae, and fibrous opacifications. VOD, VOR, and LOD showed high reproducibility (intraclass correlation coefficients 0.968, 0.975, and 0.998, respectively). VOD was highly correlated with VOR (Pearson's R = 0.96, P < 0.000001). VOD, VOR, and LOD correlated with age (R = 0.48, 0.58, and 0.85, P < 0.001 for each). VOR and LOD correlated with OSI (R = 0.36, P = 0.0094, and R = 0.36, P = 0.0096, respectively). VOR correlated negatively with AULCSF (R = -0.53, P < 0.00009), which was related to OSI. Myopic eyes had higher OSI than nonmyopic eyes (P = 0.0121), consistent with correlation between OSI and AL (R = 0.37, P = 0.0091). Multivariable regression confirmed these findings. Conclusions: SS-OCT visualized microstructural features of anterior human vitreous, where opacification is associated with increased light scattering and CSF degradation. SS-OCT enables high-resolution optical evaluation of vitreous opacities.

Visual effect of the combined correction of spherical and longitudinal chromatic aberrations.

An instrument permitting visual testing in white light following the correction of spherical aberration (SA) and longitudinal chromatic aberration (LCA) was used to explore the visual effect of the combined correction of SA and LCA in future new intraocular lenses (IOLs). The LCA of the eye was corrected using a diffractive element and SA was controlled by an adaptive optics instrument. A visual channel in the system allows for the measurement of visual acuity (VA) and contrast sensitivity (CS) at 6 c/deg in three subjects, for the four different conditions resulting from the combination of the presence or absence of LCA and SA. In the cases where SA is present, the average SA value found in pseudophakic patients is induced. Improvements in VA were found when SA alone or combined with LCA were corrected. For CS, only the combined correction of SA and LCA provided a significant improvement over the uncorrected case. The visual improvement provided by the correction of SA was higher than that from correcting LCA, while the combined correction of LCA and SA provided the best visual performance. This suggests that an aspheric achromatic IOL may provide some visual benefit when compared to standard IOLs.

Hybrid adaptive-optics visual simulator.

We have developed a hybrid adaptive-optics visual simulator (HAOVS), combining two different phase-manipulation technologies: an optically addressed liquid-crystal phase modulator, relatively slow but capable of producing abrupt or discontinuous phase profiles; and a membrane deformable mirror, restricted to smooth profiles but with a temporal response allowing compensation of the eye's aberration fluctuations. As proof of concept, a phase element structured as discontinuous radial sectors was objectively tested as a function of defocus, and a correction loop was closed in a real eye. To further illustrate the capabilities of the device for visual simulation, we recorded extended images of different stimuli through the system by means of an external camera replacing the subject's eye. The HAOVS is specially intended as a tool for developing new ophthalmic optics elements, where it opens the possibility to explore designs with irregularities and/or discontinuities.

Vision with pulsed infrared light is mediated by nonlinear optical processes.

When the eye is exposed to pulsed infrared (IR) light, it is perceived as visible of the corresponding half wavelength. Previous studies have reported evidence that this is due to a non-linear two-photon absorption process. We have carried out a study which provides additional support to this nonlinear hypothesis. To this end, we have measured the spectral sensitivity at 2 different pulse repetition rates and have developed a theoretical model to account for the experimental observations. This model predicts a ratio between the minimum powers needed to detect the visual stimulus at the 2 pulse repetition rates employed of 0.45 if the stimulus were detected through a nonlinear effect and 1 if it were caused by a linear effect as in normal vision. The value experimentally found was 0.52 ± 0.07, which supports the hypothesis of a nonlinear origin of the two-photon vision phenomena.

Two-dimensional peripheral refraction and retinal image quality in orthokeratology lens wearers.

Orthokeratology (O-K) is a common procedure that uses rigid contact lenses to reshape the cornea while worn overnight. Beyond the correction of refractive error, it has been suggested that this approach can also be used to reduce myopia progression, possibly because it induces changes in peripheral optics. As this hypothesis remains unproven, the aim of the present study was to explore changes in peripheral retinal optical quality in a group of myopic children following O-K treatment. We provide a comprehensive description of optical characteristics in a group of myopes before and after achieving stable corneal reshaping using overnight O-K lenses. These characteristics extended across the central visual field (60° horizontal x 36° vertical) as measured with a custom Hartmman-Shack wavefront sensor. After corneal reshaping, peripheral refraction was found to be asymmetrically distributed, with a myopic relative refraction of approximately 3D in the temporal retina. Astigmatism and higher order aberrations also increased in the temporal side. Based on corneal topography following treatment, subjects were divided into two groups: Centred Treatment (CT, decentration ∈ [-0.5 + 0.5] mm) and Slightly Decentred Treatment (subjects with more decentred lenses). The process was also modelled by ray-tracing simulation. The results indicate that increased myopia in the temporal retina is caused by the decentration of lenses towards the temporal side. Peripheral optics differ significantly following O-K lens treatment, but further research is required to determine whether this is likely to affect myopia progression.

In vivo SS-OCT imaging of crystalline lens sutures.

We demonstrate in vivo three-dimensional (3-D) visualization of crystalline lens sutures in healthy eyes using swept source optical coherence tomography (SS-OCT). Volumetric data sets of the crystalline lenses were acquired and processed to obtain enhanced contrast projection images and to extract suture patterns in both anterior and posterior lens. The results presented different types of the sutures including Y-sutures, simple and complex star sutures. Age-related changes in suture arrangement were characterized quantitatively. Crystalline lens suture imaging with SS-OCT might be a useful tool in fundamental studies on development and ageing of human lens.

Impact of scattering and spherical aberration in contrast sensitivity.

We investigated the impact in spatial visual performance of the combined presence of different amounts of spherical aberration and intraocular scattering in the eye. In a group of subjects, contrast sensitivity at 6 cycles per degree was measured when viewing through holographic diffusers to produce different levels of scattering and with their spherical aberration simultaneously controlled using an adaptive-optics visual simulator. For elevated levels of scattering, the addition of small amounts of spherical aberration either does not decrease, or even may slightly increase, contrast sensitivity under some conditions. This seems to be due to an optical effect also demonstrated in an artificial eye. Although the visual effect is quite small, this finding could suggest a balancing mechanism where larger spherical aberration could keep relatively stable the retinal image quality under the presence of elevated scattering. This is actually the situation in older eyes with both spherical aberration and intraocular scatter being higher than in young eyes.

Adaptation to Brightness Perception in Patients Implanted With a Small Aperture.

PURPOSE: Small apertures are successfully used to extend depth of focus in presbyopic patients implemented either as corneal inlays or intraocular lenses. The use of small apertures reduces retinal illuminance. In this study, we quantify the relative perceived brightness in the 2 eyes of patients implanted monocularly with a small-aperture inlay. DESIGN: Prospective case series. METHODS: We used a binocular adaptive optics vision simulator to determine the relative perceived brightness. Four patients implanted monocularly with the KAMRA corneal inlay (1.6 mm) and a group of control subjects participated in the study. The projected pupil on the eye implanted with the inlay alternated in diameter between 0 and 2.5 mm (effective 1.6 mm) to eliminate potential for light to project around the periphery of the inlay while the corresponding fellow eye projected pupil alternated between 0 and 3.0 mm or 0 and 4.0 mm at a frequency of 1 Hz. Alternation on both eyes was synchronized so that only 1 eye at a time had a nonblocked pupil. At equal transmittance, a flickering was perceived. Patients' task consisted of modifying the transmittance of the pupil corresponding to the fellow eye until the perceived flickering, owing to the different perceived brightness, was minimized. This equalizing transmittance (ET) value indicates the relative perceived brightness. RESULTS: In the KAMRA's patients, ET was found to be greater than expected considering the difference in pupil sizes and the Stiles-Crawford effect, showing an enhanced a greater brightness perception in the eye with the small aperture in comparison with the fellow eye. Compared with the control subjects, this difference was on average bigger by a factor of ×1.42. CONCLUSIONS: Patients implanted with the small-aperture corneal inlay exhibited an enhanced brightness perception with the eye implanted, in comparison with their untreated fellow eye. The amount of this increase is much larger than what could be expected owing to the Stiles-Crawford effect and was probably attributable to a neural adaptation process. This phenomenon could explain a reported equalization of brightness between eyes in patients with unilateral inlays and implies that the expected reduction of brightness may have a less significant impact on these patients, as expected.

Effect of Crystalline Lens Aberrations on Adaptive Optics Simulation of Intraocular Lenses.

PURPOSE: To evaluate the impact of the lens aberrations on the adaptive optics visual simulation of pseudophakic intraocular lens (IOL) profiles. METHODS: In 20 right phakic eyes, lens higher order aberrations (HOAs) were calculated as the whole eye minus the corneal aberrations. Visual simulation using low and high contrast corrected distance visual acuity (CDVA) testing was carried out with the VAO instrument (Voptica, SL, Murcia, Spain), considering three optical conditions of the lens: removing HOA (no lens-HOA), removing spherical aberration (no lens-SA), and with lens HOA (natural condition). In addition, a through-focus visual simulation of a trifocal diffractive IOL profile with high contrast CDVA was also measured in two conditions: no lens-HOA and natural condition. Three different pupil sizes (3, 4.5, and 6 mm) were tested for all conditions. RESULTS: There were no significant intersubject differences between the three optical conditions and in the IOL simulation for all pupil sizes (P > .05). For 4.5- and 6-mm pupils, mean VA values of the no-lens SA and no lens-HOA conditions were similar and slightly worse than those of the natural condition. Individual differences between the no lens-HOA condition and the other two optical conditions, estimated as 95% limits of agreement, were acceptable for 3-mm pupil but worse as pupil diameter increased. CONCLUSIONS: The effect of lens aberrations on visual simulation is imperceptible for a small pupil diameter of 3 mm. Although the increment of pupil size increases the probability of patients with significant visual impact of lens HOAs, the mean intersubject VA differences are negligible. [J Refract Surg. 2019;35(2):126-131.].

Single-pixel imaging of the retina through scattering media.

Imaging the retina of cataractous patients is useful to detect pathologies before the cataract surgery is performed. However, for conventional ophthalmoscopes, opacifications convert the lens into a scattering medium that may greatly deteriorate the retinal image. In this paper we show, as a proof of concept, that it is possible to surpass the limitations imposed by scattering applying to both, a model and a healthy eye, a newly developed ophthalmoscope based on single-pixel imaging. To this end, an instrument was built that incorporates two imaging modalities: conventional flood illumination and single-pixel based. Images of the retina were acquired firstly in an artificial eye and later in healthy living eyes with different elements which replicate the scattering produced by cataractous lenses. Comparison between both types of imaging modalities shows that, under high levels of scattering, the single-pixel ophthalmoscope outperforms standard imaging methods.

A wavelength tunable wavefront sensor for the human eye.

We have designed and assembled an instrument for objective measurement of the eye's wave aberrations for different wavelengths with no modifications in the measurement path. The system consists of a Hartmann-Shack wave-front sensor and a Xe-white-light lamp in combination with a set of interference filters used to sequentially select the measurement wavelength. To show the capabilities of the system and its reliability for measuring at different wavelengths, the ocular aberrations were measured in three subjects at 440, 488, 532, 633 and 694 nm, basically covering the whole visible spectrum. Even for the shortest wavelengths, the illumination level was always several orders of magnitude below the safety limits. The longitudinal chromatic aberration estimates and the wavelength dependence of coma and spherical aberration, as examples of higher-order aberration terms, were compared to the predictions of a chromatic eye model, with good agreement. To our knowledge, this is the first report of a device to objectively determine the spectral fluctuations in the ocular wavefront.

Perceived brightness with small apertures.

PURPOSE: To quantify the relative perceived brightness when viewing through a small aperture as that used by presbyopic patients with small-aperture corneal inlays or intraocular lenses with an embedded aperture. SETTING: Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain. DESIGN: Prospective case series. METHODS: The relative perceived brightness when 2 apertures (3.0 mm and 1.6 mm diameters) were presented monocularly to the participant was determined. With equal transmittances in both apertures, a flickering effect caused by the different retinal illuminance for each condition is perceived. The participant's task was to modify the transmittance of the 3.0 mm pupil until the flickering was minimized. This transmittance value indicates the relative perceived brightness reduction. The measurements were performed under 3 average luminance levels. RESULTS: The perceived relative luminance measured ranged between 38.5% and 46.9%. This represents an increase in brightness perception with a small aperture of 1.24 and 1.51, respectively, compared with what would be expected. This trend was consistent for all the participants in the study. CONCLUSIONS: The perceived brightness with a small aperture was less pronounced than what would be predicted by the reduction in retinal illuminance. Under real visual conditions, this effect could be even more significant because binocular effects and temporal adaptation might further increase the perceived brightness with the small aperture.

Volumetric macro- and micro-scale assessment of crystalline lens opacities in cataract patients using long-depth-range swept source optical coherence tomography.

We demonstrate an optimized optical platform for the three-dimensional (3-D) visualization of crystalline lens opacities in vivo in the eyes of patients with different types and grades of cataracts. We developed a prototype long-depth-range swept source optical coherence tomography (SS-OCT) instrument operating at the speed of 50 kA-scans/second and at the central wavelength of 1 µm to perform high-resolution imaging of the whole anterior segment of the eye. Volumetric data sets of cataractous eyes were acquired and processed to obtain contrast-enhanced high-resolution images of lenticular structures and opacifications. The results showed lens micro- and macro-scale features related to possible cataract development such as cortical spokes, water clefts and enhanced scattering in the lens nucleus. The results demonstrate also the ability of this SS-OCT imaging to locate and characterize opacities quantitatively. The instrument might be a useful tool in the high-resolution preoperative evaluation of crystalline lens opacities in cataract patients.

Three-Dimensional Cataract Crystalline Lens Imaging With Swept-Source Optical Coherence Tomography.

Purpose: To image, describe, and characterize different features visible in the crystalline lens of older adults with and without cataract when imaged three-dimensionally with a swept-source optical coherence tomography (SS-OCT) system. Methods: We used a new SS-OCT laboratory prototype designed to enhance the visualization of the crystalline lens and imaged the entire anterior segment of both eyes in two groups of participants: patients scheduled to undergo cataract surgery, n = 17, age range 36 to 91 years old, and volunteers without visual complains, n = 14, age range 20 to 81 years old. Pre-cataract surgery patients were also clinically graded according to the Lens Opacification Classification System III. The three-dimensional location and shape of the visible opacities were compared with the clinical grading. Results: Hypo- and hyperreflective features were visible in the lens of all pre-cataract surgery patients and in some of the older adults in the volunteer group. When the clinical examination revealed cortical or subcapsular cataracts, hyperreflective features were visible either in the cortex parallel to the surfaces of the lens or in the posterior pole. Other type of opacities that appeared as hyporeflective localized features were identified in the cortex of the lens. The OCT signal in the nucleus of the crystalline lens correlated with the nuclear cataract clinical grade. Conclusions: A dedicated OCT is a useful tool to study in vivo the subtle opacities in the cataractous crystalline lens, revealing its position and size three-dimensionally. The use of these images allows obtaining more detailed information on the age-related changes leading to cataract.

Liquid crystal Adaptive Optics Visual Simulator: Application to testing and design of ophthalmic optical elements.

The concept of Adaptive Optics Visual Simulation applies to the use of an Adaptive Optics system to manipulate ocular aberrations in order to perform visual testing through a modified optics. It can be of interest both to study the visual system and to design new ophthalmic optical elements. In this work, we describe an apparatus based on a liquid crystal programmable phase modulator and explore its capabilities as a tool in the early stages of the design of ophthalmic optical elements with increased depth of field for presbyopic subjects. To illustrate the potential of the instrument, we analyze the performance of two phase profiles obtained by a hybrid optimization procedure. The liquid crystal Adaptive Optics Visual Simulator can be used to experimentally record the point spread function for different vergences in order to objectively measure depth of focus, to perform different psychophysical experiments through the phase profile in order to measure its impact on visual performance, and to study the interaction with the eye's particular aberrations. This approach could save several steps in current procedures of ophthalmic optical design and eventually lead to improved solutions.