Head-mounted adaptive optics visual simulator.

Adaptive optics visual simulation is a powerful tool for vision testing and evaluation. However, the existing instruments either have fixed tabletop configurations or, being wearable, only offer the correction of defocus. This paper proposes a novel head-mounted adaptive optics visual simulator that can measure and modify complex ocular aberrations in real-time. The prototype is composed of two optical modules, one for the objective assessment of aberrations and the second for wavefront modulation, all of which are integrated into a wearable headset. The device incorporates a microdisplay for stimulus generation, a liquid crystal on silicon (LCoS) spatial light modulator for wavefront manipulation, and a Hartmann-Shack wavefront sensor. Miniature optical components and optical path folding structures, together with in-house 3D printed mounts and housing, were adapted to realize the compact size. The system was calibrated by characterizing and compensating the internal aberrations of the visual relay. The performance of the prototype was analyzed by evaluating the measurement and compensation of low-order and higher-order aberrations induced through trial lenses and phase masks in an artificial eye. The defocus curves for a simulated bifocal diffractive lens were evaluated in real eyes. The results show high accuracy while measuring and compensating for the induced defocus, astigmatism, and higher-order aberrations, whereas the MTF analysis shows post-correction resolution of up to 37.5 cycles/degree (VA 1.25). Moreover, the subjective test results show the defocus curves closely matched to a commercial desktop visual simulator.

Inverted meniscus intraocular lens as a better optical surrogate of the crystalline lens.

Current intraocular lenses (IOLs) are designed to substitute the cataractous crystalline lens, optimizing focus at the fovea. However, the common biconvex design overlooks off-axis performance, leading to a reduced optical quality in the periphery of the retina in pseudophakic patients compared to the normal phakic eye. In this work, we designed an IOL to provide better peripheral optical quality, closer in that respect to the natural lens, using ray-tracing simulations in eye models. The resulting design was a concave-convex inverted meniscus IOL with aspheric surfaces. The curvature radius of the posterior surface was smaller than that of the anterior surface by a factor that depended on the IOL power. The lenses were manufactured and evaluated in a custom-built artificial eye. Images of a point source and of extended targets were directly recorded at various field angles with both standard and the new IOLs. This type of IOL produces superior image quality in the whole visual field, being a better surrogate for the crystalline lens than the commonly used thin biconvex intraocular lenses.

Instrument for fast whole-field peripheral refraction in the human eye.

An instrument for fast and objective measurement of the peripheral refraction in the human eye is presented. The apparatus permits the automatic estimation of both defocus and astigmatism at any retinal eccentricity by scanning a near infrared beam. The design includes a Hartmann-Shack wavefront sensor and a steering mirror, which operate in combination with a compounded eyepiece for wide field operation. The basic scanning protocol allows the estimation of refraction in a circular retinal patch of 50 deg diameter (±25 from central fixation) in 3 sec. Combined with additional fixation points, wider retinal fields can be sampled to achieve a whole field. The instrument underwent calibration and testing, and its performance for real eyes was assessed in 11 subjects of varying age and refraction. The results show high repeatability and precision. The instrument provides a new tool for the investigation of peripheral optics in the human eye.

Peripheral Refraction and Contrast Detection Sensitivity in Pseudophakic Patients Implanted With a New Meniscus Intraocular Lens.

PURPOSE: To evaluate peripheral refraction and contrast detection sensitivity in pseudophakic patients implanted with a new type of inverted meniscus intraocular lens (IOL) (Art25; Voptica SL) that was designed to provide better peripheral optics. METHODS: One month after cataract surgery, in 87 eyes implanted with the Art25 IOL, peripheral contrast detection sensitivity was measured psychophysically at 40° visual angle, both horizontally and vertically, and compared with a control group of 51 eyes implanted with standard biconvex IOLs. Thirty-one eyes with the Art25 IOL and 28 eyes from the control group were randomly selected to also measure peripheral refraction using a scanning Hartmann-Shack wavefront sensor along 80° in the horizontal meridian. RESULTS: Most patients achieved emmetropia and good visual acuity, and no significant adverse events were observed after cataract surgery with Art25 IOLs. Peripheral contrast detection sensitivity was significantly better (P < .01) in the group with the Art25 IOL in both directions (7.78 ± 3.24 vs 5.74 ± 2.60 vertical, 10.98 ± 5.09 vs 7.47 ± 3.96 horizontal), which was in agreement with the optical quality improvement in the periphery due to a reduction of defocus (1.97 and 1.21 diopters [D] at 40° temporal and nasal sides) and astigmatism (1.17 and 0.37 D at 40° temporal and nasal sides) that was statistically significant (P < .01) from 20° of eccentricity. CONCLUSIONS: Patients implanted with a new inverted meniscus IOL present a reduced amount of peripheral defocus and astigmatism compared to patients implanted with standard biconvex IOLs. This improvement in optical quality leads to better contrast detection sensitivity measured at 40° of eccentricity. [J Refract Surg. 2022;38(4):229-234.].

Binocular dynamics of accommodation, convergence, and pupil size in myopes.

The purpose of this work is to study the dynamics of the accommodative response as a function of the subject's refractive error, as a first step in determining whether an anomalous accommodative function could affect emmetropization or trigger myopia progression. A secondary goal was to establish potential relationships between the speed of accommodation and other parameters in the accommodation process. Parameters related to the speed and amplitude of accommodation, convergence, miosis, and change in high-order aberrations were measured during the accommodative process for 2.8 D demand in 18 young healthy subjects (mean age 25.0 ± 4.7 years) with a range of refractive errors between 0 and -7.5 D (spherical equivalent). Measurements were performed in real time (25 Hz) with an open-view binocular Hartmann-Shack (HS) sensor using a GPU-based processing unit. Correlation coefficients were calculated between refractive error and each computed variable. Additionally, the speed of accommodation was correlated with all the other parameters in the study. Correlation coefficients with refractive error had non-zero values for several parameters of the accommodative response but p-values were higher than 0.05 except in two cases: with pupil miosis speed (R = -0.49, p = 0.041) and with lag of accommodation (R = -0.57, p = 0.014). Additionally, correlation values with p-value < 0.05 were found between accommodation speed and convergence duration (R = 0.57, p = 0.014), convergence speed (R = 0.48, p = 0.044), and pupil miosis amplitude (R = 0.47, p = 0.049). We did not find strong evidence of a link between myopia and altered dynamics of the accommodation process. Only miosis speed was found to be correlated to refractive error with p < 0.05, being slower for myopes. On the other hand, increased lag of accommodation tends to be associated to larger refractive errors. Additionally, our data suggests that the faster the accommodation, the faster and longer the convergence and the larger the pupil miosis.

Phase-only modulation with two vertical aligned liquid crystal devices.

Spatial Light Modulators (SLMs) are widely used in several fields of optics such as adaptive optics. SLMs based on Liquid Crystal (LC) devices allow a dynamic and easy representation of two-dimensional phase maps. A drawback of these devices is their elevated cost, preventing a massive use of the technology. We present a more affordable approach based on the serial arrangement of vertical aligned LC devices, with characteristics of phase modulation similar to a widely used parallel aligned LC device. We discuss the peculiarities of the approach, the performance and some potential areas of applications.

Assessment of subjective refraction with a clinical adaptive optics visual simulator.

PURPOSE: To clinically validate an adaptive optics visual simulator (VAO) that measures subjective refraction and visual acuity. SETTING: Optics Laboratory, University of Murcia, Murcia, Spain. DESIGN: Prospective case series. METHODS: Using the adaptive optics visual simulator, 2 examiners measured the subjective refraction and visual acuity in healthy eyes of volunteers; 1 examiner also used a trial frame as a gold standard. The interexaminer reproducibility and agreement with the gold standard were estimated using the following statistical parameters: limits of agreement from Bland-Altman analysis, significance between differences (P value), and intraclass correlation coefficient (ICC). RESULTS: Seventy-six eyes of 38 volunteers were measured. Interexaminer reproducibility for subjective refraction was excellent (ICC ≥0.96; P > .05), with low 95% confidence interval (CI) values for the power vectors M (spherical equivalent of the given refractive error), J0 (Jackson cross-cylinder, axes at 180 degrees and 90 degrees), and J45 (Jackson cross-cylinder, axes at 45 degrees and 135 degrees) (±0.51 diopter [D], ±0.14 D, and ±0.14 D, respectively). No significant differences in subjective refraction and visual acuity were found between the visual simulator and gold standard (P > .05), with 95% CIs for M, J0, and J45 (subjective refraction) of ±0.67 D, ±0.14 D, and ±0.16 D, respectively, and a ±0.10 logarithm of the minimum angle of resolution (visual acuity). CONCLUSION: Subjective refraction results using the adaptive optics visual simulator agreed with those of the gold standard and can be used as the baseline for visual simulation of any optical corneal profile or intraocular lens design for refractive surgery patients.

Chromatic aberration control with liquid crystal spatial phase modulators.

The chromatic behavior of diffractive optical elements, exhibiting 2π-wrapped phase profiles, implemented into liquid crystal spatial light modulators (LC-SLM) is described. A wrapped phase map is only equivalent to the original continuous profile for the design wavelength while at other wavelengths there are unwanted phase jumps and the profile does not correspond to a pure defocus. For those conditions the wrapped profile behaves as a multiple order lens (multi-focal lens). The optical power dispersion for each order is linearly proportional to the wavelength, while the energy of each order depends on the design wavelength and the material dispersion. For practical purposes, for most of the visible range only first order (main defocus) is relevant but two other orders may also be considered depending on the actual PSF of the system. As an application, we demonstrate that the longitudinal chromatic aberration of the eye can be compensated by the diffractive lens dispersion when the appropriate defocus is programmed into the SLM.

Interferometric method for phase calibration in liquid crystal spatial light modulators using a self-generated diffraction-grating.

An auto-referenced interferometric method for calibrating phase modulation of parallel-aligned liquid crystal (PAL) spatial light modulators (SLM) is described. The method is experimentally straightforward, robust, and requires solely of a collimated beam, with no need of additional optics. This method uses the SLM itself to create a tilted plane wave and a reference wave which mutually interfere. These waves are codified by means of a binary diffraction grating and a uniformly distributed gray level area (piston) into the SLM surface. Phase shift for each gray level addressed to the piston section can then be evaluated. Phase modulation on the SLM can also be retrieved with the proposed method over spatially resolved portions of the surface. Phase information obtained with this novel method is compared to other well established calibration procedures, requiring extra elements and more elaborated optical set-ups. The results show a good agreement with previous methods. The advantages of the new method include high mechanical stability, faster performance, and a significantly easier practical implementation.

Night myopia is reduced in binocular vision.

Night myopia, which is a shift in refraction with light level, has been widely studied but still lacks a complete understanding. We used a new infrared open-view binocular Hartmann-Shack wave front sensor to quantify night myopia under monocular and natural binocular viewing conditions. Both eyes' accommodative response, aberrations, pupil diameter, and convergence were simultaneously measured at light levels ranging from photopic to scotopic conditions to total darkness. For monocular vision, reducing the stimulus luminance resulted in a progression of the accommodative state that tends toward the subject's dark focus or tonic accommodation and a change in convergence following the induced accommodative error. Most subjects presented a myopic shift of accommodation that was mitigated in binocular vision. The impact of spherical aberration on the focus shift was relatively small. Our results in monocular conditions support the hypothesis that night myopia has an accommodative origin as the eye progressively changes its accommodation state with decreasing luminance toward its resting state in total darkness. On the other hand, binocularity restrains night myopia, possibly by using fusional convergence as an additional accommodative cue, thus reducing the potential impact of night myopia on vision at low light levels.

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.

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 open-view instrument to measure aberrations and pupillary dynamics.

We have designed and built a binocular Hartmann-Shack wave-front sensor using a single microlens array and camera for real-time aberration measurement of both eyes in an open-view configuration. Furthermore, the use of a long wavelength (1050 nm) laser diode makes the illumination source completely invisible, so that measurements can be unobtrusively performed while the subject stares at the visual world under realistic conditions. The setup provides a large dynamic range and simultaneous measurements of convergence, pupil size, accommodation, and aberrations. The open-view design not only offers the possibility of measuring the subject's ocular optics under natural conditions but also allows coupling the device with other existing vision testing instruments and setups, which increases its potential to become a powerful tool for different visual optics studies.

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.

Binocular adaptive optics vision analyzer with full control over the complex pupil functions.

We present a binocular adaptive optics vision analyzer fully capable of controlling both amplitude and phase of the two complex pupil functions in each eye of the subject. A special feature of the instrument is its comparatively simple setup. A single reflective liquid crystal on silicon spatial light modulator working in pure phase modulation generates the phase profiles for both pupils simultaneously. In addition, another liquid crystal spatial light modulator working in transmission operates in pure intensity modulation to produce a large variety of pupil masks for each eye. Subjects perform visual tasks through any predefined variations of the complex pupil function for both eyes. As an example of the system efficiency, we recorded images of the stimuli through the system as they were projected at the subject's retina. This instrument proves to be extremely versatile for designing and testing novel ophthalmic elements and simulating visual outcomes, as well as for further research of binocular vision.

Adaptive optics binocular visual simulator to study stereopsis in the presence of aberrations.

A binocular adaptive optics visual simulator has been devised for the study of stereopsis and of binocular vision in general. The apparatus is capable of manipulating the aberrations of each eye separately while subjects perform visual tests. The correcting device is a liquid-crystal-on-silicon spatial light modulator permitting the control of aberrations in the two eyes of the observer simultaneously in open loop. The apparatus can be operated as an electro-optical binocular phoropter with two micro-displays projecting different scenes to each eye. Stereo-acuity tests (three-needle test and random-dot stereograms) have been programmed for exploring the performance of the instrument. As an example, stereo-acuity has been measured in two subjects in the presence of defocus and/or trefoil, showing a complex relationship between the eye's optical quality and stereopsis. This instrument might serve for a better understanding of the relationship of binocular vision and stereopsis performance and the eye's aberrations.

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.

Binocular adaptive optics visual simulator.

A binocular adaptive optics visual simulator is presented. The instrument allows for measuring and manipulating ocular aberrations of the two eyes simultaneously, while the subject performs visual testing under binocular vision. An important feature of the apparatus consists on the use of a single correcting device and wavefront sensor. Aberrations are controlled by means of a liquid-crystal-on-silicon spatial light modulator, where the two pupils of the subject are projected. Aberrations from the two eyes are measured with a single Hartmann-Shack sensor. As an example of the potential of the apparatus for the study of the impact of the eye's aberrations on binocular vision, results of contrast sensitivity after addition of spherical aberration are presented for one subject. Different binocular combinations of spherical aberration were explored. Results suggest complex binocular interactions in the presence of monochromatic aberrations. The technique and the instrument might contribute to the better understanding of binocular vision and to the search for optimized ophthalmic corrections.

Wave-aberration control with a liquid crystal on silicon (LCOS) spatial phase modulator.

Liquid crystal on Silicon (LCOS) spatial phase modulators offer enhanced possibilities for adaptive optics applications in terms of response velocity and fidelity. Unlike deformable mirrors, they present a capability for reproducing discontinuous phase profiles. This ability also allows an increase in the effective stroke of the device by means of phase wrapping. The latter is only limited by the diffraction related effects that become noticeable as the number of phase cycles increase. In this work we estimated the ranges of generation of the Zernike polynomials as a means for characterizing the performance of the device. Sets of images systematically degraded with the different Zernike polynomials generated using a LCOS phase modulator have been recorded and compared with their theoretical digital counterparts. For each Zernike mode, we have found that image degradation reaches a limit for a certain coefficient value; further increase in the aberration amount has no additional effect in image quality. This behavior is attributed to the intensification of the 0-order diffraction. These results have allowed determining the usable limits of the phase modulator virtually free from diffraction artifacts. The results are particularly important for visual simulation and ophthalmic testing applications, although they are equally interesting for any adaptive optics application with liquid crystal based devices.