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.

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.

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.

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.

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.].

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.

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.

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.

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.

Minimum change in spherical aberration that can be perceived.

It is important to know the visual sensitivity to optical blur from both a basic science perspective and a practical point of view. Of particular interest is the sensitivity to blur induced by spherical aberration because it is being used to increase depth of focus as a component of a presbyopic solution. Using a flicker detection-based procedure implemented on an adaptive optics visual simulator, we measured the spherical aberration thresholds that produce just-noticeable differences in perceived image quality. The thresholds were measured for positive and negative values of spherical aberration, for best focus and + 0.5 D and + 1.0 D of defocus. At best focus, the SA thresholds were 0.20 ± 0.01 µm and -0.17 ± 0.03 µm for positive and negative spherical aberration respectively (referred to a 6-mm pupil). These experimental values may be useful in setting spherical aberration permissible levels in different ophthalmic techniques.

Location of achromatizing pupil position and first Purkinje reflection in a normal population.

PURPOSE: Quality of vision in patients who have undergone corneal refractive surgery depends upon the optimal centration of the procedures used. The center of the pupil is used as a reference point in some corneal ablation procedures. The achromatic axis would be a more sensible option from an optical point of view, but it is not as readily detectable. As an alternative, other refractive techniques, like the small aperture corneal inlay for presbyopia correction, use the corneal reflex (first Purkinje image). To assess the relative position of these two marks, we developed a new instrument to simultaneously measure both the first Purkinje image (PI) and the intersection of the achromatic axis with the pupil plane. METHODS: The apparatus records images of the pupil and the PI when illuminated with a circle of infrared light-emitting diodes. A second optical path allows determination of the achromatic axis by using a subjective method. Both the positions of the PI and the achromatic axis intersection are determined simultaneously. RESULTS: A series of data were obtained in 48 eyes. The mean location of the achromatic point relative to the PI was [x = -0.05 ± 0.15 mm; y = 0.09 ± 0.18 mm]. Considered individually, in 55% of eyes, the distance between locations is less than 0.2 mm, and in 95% of eyes, distances are less than 0.4 mm. CONCLUSIONS: On average, achromatic axis crossing of the pupil and PI locations coincides within measurement errors. Although there was some intersubject variability, differences in location were less than 0.6 mm in all measured eyes.

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.

Comparison of binocular through-focus visual acuity with monovision and a small aperture inlay.

Corneal small aperture inlays provide extended depth of focus as a solution to presbyopia. As this procedure is becoming more popular, it is interesting to compare its performance with traditional approaches, such as monovision. Here, binocular visual acuity was measured as a function of object vergence in three subjects by using a binocular adaptive optics vision analyzer. Visual acuity was measured at two luminance levels (photopic and mesopic) under several optical conditions: 1) natural vision (4 mm pupils, best corrected distance vision), 2) pure-defocus monovision ( + 1.25 D add in the nondominant eye), 3) small aperture monovision (1.6 mm pupil in the nondominant eye), and 4) combined small aperture and defocus monovision (1.6 mm pupil and a + 0.75 D add in the nondominant eye). Visual simulations of a small aperture corneal inlay suggest that the device extends DOF as effectively as traditional monovision in photopic light, in both cases at the cost of binocular summation. However, individual factors, such as aperture centration or sensitivity to mesopic conditions should be considered to assure adequate visual outcomes.

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).

Impact on stereo-acuity of two presbyopia correction approaches: monovision and small aperture inlay.

Some of the different currently applied approaches that correct presbyopia may reduce stereovision. In this work, stereo-acuity was measured for two methods: (1) monovision and (2) small aperture inlay in one eye. When performing the experiment, a prototype of a binocular adaptive optics vision analyzer was employed. The system allowed simultaneous measurement and manipulation of the optics in both eyes of a subject. The apparatus incorporated two programmable spatial light modulators: one phase-only device using liquid crystal on silicon technology for wavefront manipulation and one intensity modulator for controlling the exit pupils. The prototype was also equipped with a stimulus generator for creating retinal disparity based on two micro-displays. The three-needle test was programmed for characterizing stereo-acuity. Subjects underwent a two-alternative forced-choice test. The following cases were tested for the stimulus placed at distance: (a) natural vision; (b) 1.5 D monovision; (c) 0.75 D monovision; (d) natural vision and small pupil; (e) 0.75 D monovision and small pupil. In all cases the standard pupil diameter was 4 mm and the small pupil diameter was 1.6 mm. The use of a small aperture significantly reduced the negative impact of monovision on stereopsis. The results of the experiment suggest that combining micro-monovision with a small aperture, which is currently being implemented as a corneal inlay, can yield values of stereoacuity close to those attained under normal binocular vision.

Disruption of the retinal parafoveal capillary network in type 2 diabetes before the onset of diabetic retinopathy.

PURPOSE: To establish, using adaptive optics scanning laser ophthalmoscopy (AOSLO), that the retinal parafoveal capillary network is altered before the onset of diabetic retinopathy in adult patients with type 2 diabetes. METHODS: AOSLO videos were acquired in the parafoveal region of one eye from control subjects and from patients with type 2 diabetes and no retinopathy. Detailed images of the parafoveal capillary network were generated with custom motion contrast enhancement algorithms. The combination of AOSLO images and videos enabled the simultaneous assessment of several features of the parafoveal capillary network. Arteriovenous (AV) channels were identified by finding the least tortuous capillary channels connecting terminal arterioles to postcapillary venules. Measures of capillary dropout and capillary hemodynamics were also quantified. RESULTS: The average tortuosity of AV channels was 26% higher in patients with type 2 diabetes when compared with controls, even though there were no signs of diabetic retinopathy in any of the eyes that were assessed (P < 0.05). In addition, the metrics of capillary dropout showed small changes (between 3% and 7%), leukocyte speed 14% lower, and pulsatility 25% higher, but none of these differences was statistically significant. CONCLUSIONS: It is often difficult to find consistent changes in the retinal microvasculature due to large intersubject variability. However, with a novel application of AOSLO imaging, it is possible to visualize parafoveal capillaries and identify AV channels noninvasively. AV channels are disrupted in type 2 diabetes, even before the onset of diabetic retinopathy.