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.

Refractive state and accommodation in the eyes of free-swimming versus restrained juvenile lemon sharks (Negaprion brevirostris).

Optical measurements of the refractive state of the eyes of various shark species typically have depicted sharks as hyperopic (far-sighted) with little evidence of accommodation (i.e. the ability to change focus for visualizing objects at different distances from the eye). In this study, we used infrared video retinoscopy to measure the refractive state in juvenile lemon sharks (Negaprion brevirostris). This technique allows dynamic measurement of refractive state in free-swimming animals as they pass by an aquarium window. We found that unrestrained lemon sharks are focused emmetropically relative to a 1-m distant photorefractor for the lateral visual field. However, when restrained either right side up or upside down (the latter inducing tonic immobility), the sharks become increasingly hyperopic, an artifact also reported in some other vertebrates. In addition, unrestrained lemon sharks display small amplitude accommodative excursions. Thus, refractive state measurements on restrained sharks in general may not reflect the natural, resting state of the shark eye, but rather, an induced hyperopia and lack of accommodative function. Such an artifact may be present in other vertebrate species, underscoring the need to obtain measurements of refractive state in unrestrained animals.

How large is the optic disc? Systematic errors in fundus cameras and topographers.

PURPOSE: To determine whether or not there are systematic differences in the areas of optic discs as measured by different machines using different measurement algorithms and whether racial or gender differences exist in optic disc area measurements. METHODS: We examined the results of twenty-three published studies on the size of normal optic discs of various patient populations. Studies differed in the type of instrument and method used to measure optic disc area, and the number, age, race and gender of subjects examined. Noticing that different machines exhibited statistically significant systematic differences in optic disc sizes of comparable populations, we computed a "normalization" factor for each machine based on these mean differences. Applying this normalization factor to the results, we then re-examined the differences between racial and gender groups. RESULTS: By comparing the results of mean optic disc areas of different racial groups made with different machines, and normalizing results according to those of the Zeiss fundus camera, we found the normalization factors for the following machines to be, Zeiss fundus camera: 1 (by definition), Rodenstock Optic Disc Analyzer (RODA): 1.51, Topcon fundus camera: 1.04, Heidelberg Retina Tomograph (HRT): 1.15 and TopSS scanning laser ophthalmoscope: 1.29. That is, to bring the results of area measurements made with a RODA machine in line with those made with a Zeiss fundus camera, one should multiply the former by the factor 1.51. Using the normalized results, we confirmed the findings of previous authors that the optic disc areas of black subjects were statistically significantly larger than those of white subjects (n-weighted mean effect = 0.556 +/- 0.142 S.E., n = 5). Further, the meta-analysis of various racial populations from five studies shows that males have significantly larger discs than females (n-weighted mean effect = 0.151 +/- .055 S.E., n = 9). CONCLUSION: Different machines and techniques give different results when populations of similar racial composition are measured. We recommend applying the above normalizing factors when comparing studies that employ different instruments.

Laboratory, clinical, and kindergarten test of a new eccentric infrared photorefractor (PowerRefractor).

PURPOSE: Photorefraction is a convenient way to determine refractive state from a distance. It is, therefore, useful for measuring infants and noncooperative subjects. However, its reliability (or precision) and accuracy (or validity) has been questioned. In a study in subjects without cycloplegia, we have tested whether, after complete automatization, eccentric photorefraction at a 1-m distance can be as reliable as a common autorefractor. METHODS: In a laboratory study of 15 student subjects without the use of cycloplegia (30 eyes, refractive errors ranging from -6 D to +6 D), age 25 to 31 years, the photorefractive measurements were compared with spectacle prescriptions. In a clinical study, photorefraction, autorefraction, and subjective refraction were performed in 40 patients without cycloplegia (refractive errors ranging from -4 D to +4 D), most of them with various ocular pathologies. Subjective refractions were obtained by an experienced clinical ophthalmologist but were not accessible to the examiner who used the two refractors. Visual acuity was 20/20 or better except for five subjects. Ages ranged from 6 to 75 years. In the kindergarten screening study, 108 children aged 3 to 6 years were screened for refractive errors. RESULTS: In the laboratory study, it was found that the mean difference between spectacle prescription and PowerRefractor measurements was < 0.6 D for spheres and below 0.4 D for cylinders. In the clinical study, data were obtained by all three procedures in 78 eyes. The photorefractor and the autorefractor performed similarly for spheres (mean absolute dioptric difference between refractor and subjective measure: 0.593 D and 0.696 D) and cylinders (mean absolute dioptric differences: 0.399 D and 0.389 D). However, the photorefractor was superior with regard to the measurement of the magnitude and axis of astigmatism (mean weighted difference between objective and subjective axis 0.644 D and 0.769 D, respectively). In the kindergarten study, it was found that the PowerRefractor was very convenient to handle. The autorefractor measured more myopic refractions than the PowerRefractor (mean of the left eyes 0.11 +/- 1.1 D vs. 0.62 +/- 0.53 D, p < 0.001). There was no indication that the PowerRefractor failed to detect hyperopia, because all but one child with more than 2 D of hyperopia measured with autorefractor (n = 7) was also hyperopic with the PowerRefractor. Furthermore, presenting an interesting fixation target at a 3-m distance did not cause more hyperopic refractions, indicating that the camera of the PowerRefractor at a 1-m distance was not a significant stimulus to accommodation. CONCLUSIONS: The PowerRefractor was shown to have comparable or slightly better reliability and accuracy than a modern autorefractor; however, it has major advantages over current autorefractors in that it is faster, measures both eyes at once, and gives interpupillary distance, pupil size, and information on the alignment of the eyes at the same time.

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.

Diurnal illumination patterns affect the development of the chick eye.

Exposure to continuous illumination disrupts normal ocular development in young chicks, causing severe corneal flattening, shallow anterior chambers and progressive hyperopia ('constant light (CL) effects'). We have studied the minimum requirements of a diurnal light cycle to prevent CL effects. (1) Seven groups of 10 chicks were reared under a 0 (constant light, CL), or 1, 2, 3,4, 6, or 12/12 h (normal) light-dark cycles. It was found that CL effects were prevented if the dark period was 4 h or longer. Below 4 h, the effects were dose-dependent and inversely correlated with the amplitude of the Fourier component of illumination at 1 cycle per day (CPD). (2) Three groups of 20 chicks were exposed to 4 h of darkness distributed differently over 24 h to vary the amplitude of the Fourier component at 1 CPD. It was found that complete suppression of the CL effects required that the 4 h of darkness were given in one block and at the same time each day. Our results show that normal ocular development in the chick requires a minimum of 4 h darkness per day, provided at the same time of the day without interruption, and suggest that the light-dark cycle interacts with a linear or weakly nonlinear oscillating system.

Modulation of constant light effects on the eye by ciliary ganglionectomy and optic nerve section.

Our previous studies have shown that an environment of constant light (CL) can lead to development of high degree of hyperopia in newborn chicks by inducing severe corneal flattening, and compensatory growth of the vitreous chamber. We wish to know whether the abnormal eye growth and progressive hyperopia under CL conditions is accomplished by a mechanism that uses the visual processing pathways of the central nervous system (CNS) or by a mechanism located in the eye. Thirty white leghorn chicks (Cornell K-strain) were raised under 12 h light/12 h dark (12L/12D) for either optic nerve section (ONS) or ciliary ganglion section (CGS). Another 30 chicks were raised under CL for ONS or CGS. Refractive states and corneal curvatures were measured by infrared (IR) photoretinoscopy and IR keratometry, respectively. The axial lengths of the ocular components were measured by A-scan ultrasonography. Both ONS and CGS surgery produced dilated pupils and accommodative paralysis. Four weeks after surgery, CGS eyes exhibited a hyperopic defocus, flatter cornea, and shorter vitreous chamber depth under both CL and normal conditions, whereas ONS eyes showed a smaller radius of corneal curvature and shallow vitreous chamber only in the normal light cycle group. CGS eyes of CL chicks showed significantly deeper vitreous chambers than did fellow control eyes. Our results indicate that optic nerve section does not seem to influence CL effects. Thus, local mechanisms may play a major role in the ocular development of chicks. The ciliary nerve is necessary for the normal corneal and anterior chamber growth, and prevents CL effects. The progressively increasing vitreous chamber depth under CL may be influenced by both local and central mechanisms.

Prism induced accommodation in infants 3 to 6 months of age.

Convergence-accommodation, one of several cross-linkages in the oculomotor system is manifested by opening the accommodative feedback loop and increasing the vergence input. We elicited this response in human infants aged 3-6 months by placing a 15 delta prism (base-out) before one eye while they viewed a diffuse patch of light. Accommodation was measured and ocular alignment was confirmed with a video photorefractor. The convergence-accommodation response is therefore present during a time when blur driven accommodation and disparity vergence are maturing. The gain of convergence-accommodation (expressed as the stimulus CA/C ratio) appeared to be greater for infants than adults.

Stability analysis of two linear accommodation and convergence models.

PURPOSE: To perform time domain stability analysis on two widely accepted linear models of accommodation and convergence. METHODS: For each model, the governing differential equations were used to compute the system matrix. The system matrices were used to calculate the respective trace and determinant from which eigen-vectors and eigenvalues were quantified. These characteristic numbers fully identified and classified the fixed points of each model and, thus, their stability. RESULTS: Controller gains, time constants, and accommodation and convergence cross-links determined model stability. Accommodation and convergence cross-links have the greatest influence on stability. A model-specific transition between stabilities was identified as the product of these cross-links, AC.CA(CRITICAL). For each model, three types of fixed points are described and displayed graphically: stable node, line of nonisolated fixed points, and saddle. CONCLUSION: We demonstrated the stability analysis of a two-dimensional linear system, working only in the time domain. The benefit of time-domain stability analysis is that it can be extended to nonlinear systems when frequency domain analysis techniques fail. Given that we live in a fundamentally nonlinear world and that the use and application of computational models is extensive, this is a valuable and important tool.

Accommodation in the cuttlefish (Sepia officinalis).

We have studied natural accommodation in the eye of six specimens of cuttlefish (Sepia officinalis) as they were fed with fish and shrimp. Using infrared photoretinoscopy, we observed (1) that the resting refractive state of the cuttlefish was emmetropic or slightly hyperopic, (2) that accommodation took place only a fraction of a second before a strike and (3) that accommodation focused selectively only in the frontal visual field while no change in refraction could be measured in the lateral field of view. Accommodation was bilateral and amounted to approximately 5 diopters (the reciprocal of the focal length expressed in meters). Simultaneously, the eyes converged. It appears that, as in most teleost fishes, accommodation in the cuttlefish involves a movement of the crystalline lens perpendicular to the axis of the eye. In histological sections, we observed the position and arrangement of the ciliary muscles, confirming earlier anatomical descriptions, and developed a model of how accommodation could be achieved.

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.

A true neuronal consensual pupillary reflex in chicks.

The existence of a true neuronal consensual pupillary reflex (CPR) in birds has long been debated. In this century Noll (Noll, A. (1915). Archiv für Physiologie (Leipzig), 350-372.) claimed to observe a neuronal CPR in a pigeon, but this was contradicted by Levine (Levine, J. (1955). Science, 122, 699.), who observed a direct transillumination effect (Durchleuchtungs-effekt) due to the retinas of the two eyes of the pigeon being in close apposition. To determine if a neuronal CPR exists, we transected the optic nerves of 28 chicks and observed and videotaped the direct and indirect pupillary responses. Twenty-one of the chicks exhibited no direct response in the operated eye but did exhibit an indirect pupillary response. The non-operated eye showed a direct but no indirect response. These results conclusively demonstrate for the first time that a true neuronal CPR does exist in chickens.

Measurement of the eye's near infrared wave-front aberration using the objective crossed-cylinder aberroscope technique.

We used the crossed-cylinder aberroscope technique to obtain the near infrared (784 nm) wave-front aberration of the human eye. We compared the results with those obtained under the same conditions using red light (633 nm). Other than the greater retinal scattering of the near infrared light, third- and fourth-order wave-front aberrations are similar in both wavelengths. Values of the calculated near infrared point spread function show a typical half-height width of around 2 arcmin, which is in good agreement with previous work.

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.

An extension of an accommodation and convergence model of emmetropization to include the effects of illumination intensity.

The Flitcroft (1998) emmetropization model incorporates a classical model of accommodation and convergence with blur-driven feedback control of eye growth. We have modified this model by incorporating the effects of illumination (with or without extensive near work) on accommodation, vergence, pupil diameter and emmetropization. In addition to replicating Flitcroft's results, we show that (1) decreased illumination and (2) a low convergence accommodation/convergence (CAC) ratio exacerbate the progression of near-work-induced myopia. Our model further indicates that prescription of negative lenses, under these conditions, augments the advancement of myopia.

Generation of third-order spherical and coma aberrations by use of radically symmetrical fourth-order lenses.

We have extended the method of Alvarez [J. Am. Optom. Assoc. 49, 24 (1978)] to generate a variable magnitude of third-order spherical and/or coma aberration by using a combination of fourth-order plates with a magnification system. The technique, based on the crossed-cylinder aberroscope, is used to measure the wave-front aberration generated by the plates. The method has been applied to correct the third-order spherical aberration generated by an artificial eye as well as the coma produced by a progressive addition ophthalmic lens. The simplicity of the method and its relatively low cost make it attractive for partial correction of the aberrations of the eye.