Intrasession repeatability of pupil size measurements under different light levels provided by a multidiagnostic device in healthy eyes.

BACKGROUND: The measurement of the pupillary function is an indispensable test in some eye examinations, being necessary the evaluation of the precision of instruments performing such measures. The aim of this study was to evaluate the intrasession repeatability of pupil size measurements provided by a multidiagnostic platform in a large sample of healthy eyes. METHODS: This prospective study enrolled 100 healthy eyes of 100 patients, with ages ranging from 23 to 65 years old. Repeated pupil size measures under photopic (P, 220 lx), mesopic (M, 160 lx), low mesopic (L, 70 lx), and scotopic conditions (S, 1 lx) were obtained with the VX120 system (Visionix-Luneau Technologies, Chartres, France) after a complete eye exam. Likewise, pupil size was also measured once in the fellow eye in a total of 75 eyes. The level of intrasession variability as well as differences between fellow eyes were evaluated. RESULTS: Most of differences between repeated measures did not exceed 0.5 mm (82% of S and 100% of P below this value). No significant differences between these repeated measures were found for S (p = 0.099) and L (p = 0.751). However, statistically significant differences were found between repeated measures for M (p = 0.002) and P (p = 0.003). The analysis of clinical relevance of differences between pairs (Passing-Bablok) only confirmed the clinical relevance of differences between the first and second repeated measurement of M. Concerning the comparative analysis between fellow eyes, no statistically significant differences in pupil size were found between right and left eyes in any light condition evaluated (p ≥ 0.227). CONCLUSIONS: The VX120 system can provide consistent measurements of pupil size under scotopic, low mesopic and photopic conditions, with a relative limitation under mesopic conditions.

Intrasession repeatability of ocular anatomical measurements obtained with a multidiagnostic device in healthy eyes.

BACKGROUND: To evaluate the intrasession repeatability of anterior chamber depth (ACD), central (CCT) and peripheral corneal thickness (PCT), white-to-white diameter (WTW), and irido-corneal angle (IA) measurements obtained with a multidiagnostic device in healthy eyes. METHODS: A total of 107 eyes of 107 patients ranging in age from 23 to 65 years were examined with the VX120 system (Visionix-Luneau Technologies). Three consecutive measurements were obtained with this device to assess the intrasession repeatability of ACD, CCT, PCT at different nasal and temporal locations, WTW, and nasal and temporal IA. Data analysis included the calculation of within-subject standard deviation (Sw), intrasubject precision (1.96xSw), coefficient of variation (CV) and intraclass correlation coefficient (ICC). RESULTS: The Sw and CV for ACD was 0.03 mm and 1.16%, respectively, with an ICC of 0.992. The Sw values for central and peripheral pachymetric measurements were below 9 µm, with CV of less than 1.6% and ICC of 0.976 or higher. For IA measurements, Sw values of 0.84 or lower were found, with a CV between 1 and 2%, and an ICC of more than 0.970. The Sw for WTW was 0.24 mm and the CV was 1.95%. No statistically significant correlations were found between any anatomical parameter evaluated and their Sw and CV values associated (-0.220 ≤ r ≤ 0.204, p ≥ 0.125). CONCLUSIONS: The VX120 system is able to provide repeatable measurements of anatomical parameters in healthy eyes. Inter-observer repeatability should be evaluated in future studies.

Analysis and comparison of monofocal, extended depth of focus and trifocal intraocular lens profiles.

To test the feasibility of using profilometers to extract information about IOL surfaces design. A standard monofocal IOL (Tecnis 1), a monofocal IOL that provided some depth of focus (Eyhance), an extended depth of focus IOL based on refractive optics (Mini Well) and a trifocal IOL based on diffractive optics were used in this study (Tecnis Synergy). The surface topography of the IOLs was measured by using a multimode optical profilometer. Posterior surface of Tecnis 1 IOL was spherical and the anterior surface aspherical. In the Eyhance IOL, posterior surface was spherical and anterior surface did not fit to any of our reference surfaces, indicating a higher order aspheric surface design. In the Mini Well Ready IOL, a best-fit sphere surface was obtained for the second surface and a high order aspherical surface design was deduced for the first surface. The anterior surface of the Synergy IOL was aspherical and the base curve of the diffractive structure fitted very well to a spherical surface. To consider an aspheric surface as possible best-fit surface provided more information than if only best-fit spherical surface was considered. The high order aspheric surface designs employed in the IOLs studied presented differences, regarding best-fit asphere surface, higher than 1 micron. These differences were correlated with the generation of spherical aberration complex profiles (with Zernike terms higher than 4th order) and with the production of distinct amounts of depth of focus. This method was also useful to deduce the base curve of diffractive surfaces.

Comparison of the optical quality vision between real post-LASIK myopic laser surgery and the simulated implantation of a phakic IOL in low myopia.

A phakic intraocular lens (PIOL) of - 4.5 D was characterized from its wavefront aberration profile. A preclinical study was conducted using pre- and post-surgery data from four patients that had undergone myopic laser refractive surgery. All these patients would have needed a PIOL of - 4.5 D. Pre-surgery data were used to simulate the effect of a PIOL implantation. Post myopic refractive surgery data were used to calculate the post-LASIK eye model. Modulation transfer function (MTF), point spread function (PSF) and simulation of optotypes vision were obtained and compared. The PIOL did not worsen the optical quality of the eyes evaluated. High order Aberrations were always higher in the post-LASIK eye model. Optics quality trended to be better in PIOL implantation than post-LASIK surgery as pupil size increased.

The furosemide stress test and computational modeling identify renal damage sites associated with predisposition to acute kidney injury in rats.

Acute kidney injury (AKI) diagnosis relies on plasma creatinine concentration (Crpl), a relatively insensitive, surrogate biomarker of glomerular filtration rate that increases only after significant damage befalls. However, damage in different renal structures may occur without increments in Crpl, a condition known as subclinical AKI. Thus, detection of alterations in other aspects of renal function different from glomerular filtration rate must be included in an integral diagnosis of AKI. With this aim, we adapted to and validated in rats (for preclinical research) the furosemide stress test (FST), a tubular function test hitherto performed only in humans. We also tested its sensitivity in detecting subclinical tubular alterations. In particular, we predisposed rats to AKI with 3 mg/kg cisplatin and subsequently subjected them to a triggering insult (ie, 50 mg/kg/d gentamicin for 6 days) that had no effect on nonpredisposed animals but caused an overt AKI in predisposed rats. The FST was performed immediately before adding the triggering insult. Predisposed animals showed a reduced response to the FST (namely, reduced furosemide-induced diuresis and K+ excretion), whereas nonpredisposed animals showed no alteration, compared to the controls. Computational modeling of epithelial transport of solutes and water along the nephrons applied to experimental data suggested that proximal tubule transport was only minimally reduced, the sodium-chloride symporter was upregulated by 50%, and the renal outer medullary potassium channel was downregulated by 85% in predisposed animals. In conclusion, serial coupling of the FST and computational modeling may be used to detect and localize subclinical tubular alterations.

New method to improve the quality of vision in cataractous keratoconus eyes.

To analyze using optical simulations if the proper use of a segmented intraocular lens (IOL) can improve the visual outcomes compared to the implantation of a spherical monofocal IOL. The wavefront profile of the Mplus (Oculentis) and a monofocal IOLs with the phase transformation introduced by each IOL were calculated using a Hartmann-Shack wavefront sensor. In addition, the wavefront profile of schematic eye models of various keratoconus conditions was obtained and was propagated to the IOLs. The optical performance of such combination was obtained after combining ray tracing and Fourier optics. A pre-clinical validation was also evaluated incorporating clinical data from three different keratoconus eyes of three patients. The implantation of the Mplus IOL can compensate or reduce the overall coma of the eye with keratoconus improving the quality of vision compared with a spherical monofocal IOL due to lower displacements of the retinal image or tilting in keratoconus. All theoretical simulations were confirmed afterwards by mean of a preclinical validation. The use of a standard toric segmented IOL with a proper orientation and selection of the addition can improve the optical quality of the keratoconus eye compared to the use of a monofocal spherical IOL.

Comparative analysis of anterior corneal curvature and astigmatism measurements obtained with three different devices.

BACKGROUND: The objective of this study was to compare the central corneal curvature and astigmatism measurements obtained with three different systems in healthy eyes and to assess the level of interchangeability between them. METHODS: This was a comparative study examining 30 healthy eyes of 30 patients (age 15-53 years). A complete eye examination was performed in all cases including analysis of anterior corneal curvature and astigmatism with three devices: the colour-LED topography system Cassini (i-Optics) (CAS), the Scheimpflug-based system Pentacam (Oculus Optikgeräte) (PTC) and the optical biometer IOL-Master 500 (Carl Zeiss Meditec) (IOLM). Differences between devices in terms of curvature in the flattest (flat K) and steepest meridians (steep K) as well as in the magnitude (AST) and power vector components of astigmatism (J0 and J45 ) were evaluated. The interchangeability between devices was evaluated with the Bland-Altman method. RESULTS: Statistically significant differences between devices were found in steep K and flat K (p < 0.001). No statistically significant differences between devices were found in AST (p = 0.057) and J0 power vector (p = 0.185). However, differences between devices in J45 did reach statistical significance (p = 0.039). Ranges of agreement for curvature measures ranged from 0.123 (flat K, CAS-PTC) to 0.165 mm (steep K, CAS-PTC). Ranges for the magnitude of astigmatism were 0.868, 1.059 and 0.739 D in CAS-IOLM, PTC-IOLM and CAS-PTC comparisons, respectively. For J0 and J45 , ranges of agreement were below 0.522 D. CONCLUSIONS: Measurements of central corneal curvature and astigmatism obtained with the three devices evaluated cannot be used interchangeably.

A New Approach for the Calculation of Total Corneal Astigmatism Considering the Magnitude and Orientation of Posterior Corneal Astigmatism and Thickness.

PURPOSE: To evaluate a new method of calculation of total corneal astigmatism based on Gaussian optics and the power design of a spherocylindrical lens (C) in the healthy eye and to compare it with keratometric (K) and power vector (PV) methods. METHODS: A total of 92 healthy eyes of 92 patients (age, 17-65 years) were enrolled. Corneal astigmatism was calculated in all cases using K, PV, and our new approach C that considers the contribution of corneal thickness. An evaluation of the interchangeability of our new approach with the other 2 methods was performed using Bland-Altman analysis. RESULTS: Statistically significant differences between methods were found in the magnitude of astigmatism (P < 0.001), with the highest values provided by K. These differences in the magnitude of astigmatism were clinically relevant when K and C were compared [limits of agreement (LoA), -0.40 to 0.62 D), but not for the comparison between PV and C (LoA, -0.03 to 0.01 D). Differences in the axis of astigmatism between methods did not reach statistical significance (P = 0.408). However, they were clinically relevant when comparing K and C (LoA, -5.48 to 15.68 degrees) but not for the comparison between PV and C (LoA, -1.68 to 1.42 degrees). CONCLUSIONS: The use of our new approach for the calculation of total corneal astigmatism provides astigmatic results comparable to the PV method, which suggests that the effect of pachymetry on total corneal astigmatism is minimal in healthy eyes.

Ultrafast beam shaping with high-numerical-aperture microscope objectives.

Ultrafast diffraction results in spatiotemporal un-coupling of the wave field, inducing spectral anomalies and pulse stretching. Localized compensation may be achieved via angular dispersion driven by diffractive optical elements (DOEs). We report on an DOEs-based beam shaper of ultrashort optical pulses with high spatiotemporal resolution. Inspection of the validity of our approach is performed in the single-cycle regime.

In Vitro Aberrometric Assessment of a Multifocal Intraocular Lens and Two Extended Depth of Focus IOLs.

PURPOSE: To analyze the "in vitro" aberrometric pattern of a refractive IOL and two extended depth of focus IOLs. METHODS: A special optical bench with a Shack-Hartmann wavefront sensor (SH) was designed for the measurement. Three presbyopia correction IOLs were analyzed: Mini WELL (MW), TECNIS Symfony ZXR00 (SYM), and Lentis Mplus X LS-313 MF30 (MP). Three different pupil sizes were used for the comparison: 3, 4, and 4.7 mm. RESULTS: MW generated negative primary and positive secondary spherical aberrations (SA) for the apertures of 3 mm (-0.13 and +0.12 µm), 4 mm (-0.12 and +0.08 µm), and 4.7 mm (-0.11 and +0.08 µm), while the SYM only generated negative primary SA for 4 and 4.7 mm apertures (-0.12 µm and -0.20 µm, resp.). The MP induced coma and trefoil for all pupils and showed significant HOAs for apertures of 4 and 4.7 mm. CONCLUSIONS: In an optical bench, the MW induces negative primary and positive secondary SA for all pupils. The SYM aberrations seem to be pupil dependent; it does not produce negative primary SA for 3 mm but increases for higher pupils. Meanwhile, the HOAs for the MW and SYM were not significant. The MP showed in all cases the highest HOAs.

Intrasession repeatability of refractive and ocular aberrometric measurements obtained using a multidiagnostic device in healthy eyes.

PURPOSE: To evaluate the intrasession repeatability of refractive and ocular aberrometric measurements obtained using a new multidiagnostic device in healthy eyes. PATIENTS AND METHODS: A total of 107 eyes of 107 patients, age ranging from 23 to 65 years, were enrolled in this study. A complete eye examination was performed in all eyes, including an ocular examination using the VX120 system. Three consecutive measurements were obtained using this device to assess the intrasession repeatability of different refractive and ocular aber-rometric parameters. The within-subject standard deviation (Sw), intrasubject precision (1.96×Sw), and intraclass correlation coefficient (ICC) were calculated. RESULTS: Sw and intrasubject precision for refractive data were below 0.12 and 0.20 D, respectively, in all cases. The ICC ranged from 0.947 for the J45 power vector component to 0.997 for the sphere. Concerning aberrometric measurements Sw and intrasubject precision values were below 0.05 µm and 0.10 µm, respectively. Likewise, the ICC ranged from 0.805 for the quadrafoil root mean square to 0.954 for the primary spherical aberration. Poor correlations were found between most of the refractive parameters and their Sw (-0.033≤r≤0.053, p≥0.064). Moderate and significant positive correlations were found between the magnitude of the aberrometric parameters evaluated and their Sw (r≥0.446, p<0.001). CONCLUSION: The new multidiagnostic device evaluated is able to provide consistent measurements of refraction and ocular aberrations in healthy eyes. Future studies should confirm if this consistency is also observed in highly aberrated eyes.

Corneal Topographic and Aberrometric Measurements Obtained with a Multidiagnostic Device in Healthy Eyes: Intrasession Repeatability.

Purpose. To evaluate the intrasession repeatability of corneal curvature, eccentricity, and aberrometric measurements obtained with a multidiagnostic device in healthy eyes. Methods. This study enrolled 107 eyes of 107 patients ranging in age from 23 to 65 years. All of them underwent a complete anterior segment examination with the VX120 system (Visionix-Luneau Technologies, Chartres, France). Three consecutive measurements were obtained. The within-subject standard deviation (Sw ), intrasubject precision (1.96 × Sw ), and intraclass correlation coefficient (ICC) were calculated. Results. All Sw for corneal power measurements were below 0.26 D, with ICC above 0.982. The Sw for corneal astigmatism at different areas (3, 5, and 7 mm) was below 0.21 D, with ICC above 0.913. Concerning the axis of astigmatism, its Sw was below 11.27°, with ICC above 0.975. The Sw and ICC for corneal eccentricity were 0.067 and 0.957, respectively. The Sw and ICC for high-order aberration root mean square (RMS) were 0.048 µm and 0.901, respectively. For 3rd- and 4th-order aberrometric parameters, all Sw were below 0.037 µm and all ICC were higher than 0.84, except for quadrafoil RMS (ICC: 0.689). Conclusions. The multidiagnostic device evaluated is able to provide consistent measurements of corneal power, eccentricity, and third- and fourth-order aberrations in healthy eyes.

Angular spectrum of diffracted wave fields with apochromatic correction.

We report on compensation of diffraction-induced angular dispersion of ultrashort pulses up to a second order. A strategy for chromatic correction profits from high dispersion of kinoform-type zone plates. Ultraflat dispersion curves rely on a saddle point that may be tuned at a prescribed wavelength. Validity of our approach may reach the few-cycles regime.

Isotropic compensation of diffraction-driven angular dispersion.

We report on an optical arrangement capable of compensating angular dispersion of paraxial wave fields developed by diffractive optical elements (DOEs). Schematically, the system is a beam expander in which two phase-only zone plates have been inserted, remaining afocal the coupled system. The DOE, which induces a continuous set of dispersive tilted plane waves, is placed at a specific position within the proposed setup providing an output spectrum with achromatic angular deviation. A directional matching between phase fronts and pulse fronts of output wave packets is demonstrated.