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.

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.].

Spherical Aberration Customization to Extend the Depth of Focus With a Clinical Adaptive Optics Visual Simulator.

PURPOSE: To evaluate the use of the VAO adaptive optics visual simulator (Voptica SL, Murcia, Spain) for customization of spherical aberration to increase depth of focus. METHODS: Through-focus visual acuity with both high- and low-contrast letters from +1.00 to -3.00 diopters (D) was measured in 17 dilated eyes with three different induced amounts of spherical aberration for a 4.5-mm pupil diameter: control (0 µm), -0.15 µm, and -0.30 µm. RESULTS: The defocus curves followed the same behavior with both values of contrast, but the visual acuity was 0.2 logMAR lower with low contrast. The mean values of high-contrast logMAR visual acuity at far, intermediate (67 cm), and near (40 cm) were -0.10, 0.11, and 0.37 for control, 0.04, 0.00, and 0.15 for -0.15 µm, and 0.23, 0.00, and 0.06 for -0.30 µm conditions. The 95% confidence interval ranged from ±0.14 to ±0.45 logMAR and the middle 50% of the distribution was approximately 0.2 logMAR. CONCLUSIONS: Negative values of spherical aberration extend the depth of focus in different ways depending on each patient. The VAO is a new instrument that allows the visual customization of spherical aberration to enhance depth of focus. [J Refract Surg. 2020;36(4):223-229.].

One-year follow-up of changes in refraction and aberrations induced by corneal incision.

PURPOSE: To evaluate the surgically induced changes in refraction (sphere and astigmatism) and higher order aberrations by corneal incision for one year. SETTING: University Hospital "Virgen de la Arrixaca", Murcia, Spain. DESIGN: Retrospective interventional case series. METHODS: Corneal power, astigmatism and higher order aberrations (HOA) were calculated from corneal topography measured in 27 eyes prior to surgery and at 2 weeks, 1, 2, 3 and 6 months and 1 year following cataract surgery with 3.2-mm corneal incision. At every stage, optical changes were calculated as the difference between pre- and post-surgery data (in each follow-up) using the formulas of obliquely crossed cylinders for the refraction and Zernikes coefficients for HOA. RESULTS: At 2 weeks after surgery the mean corneal values of induced sphere, cylinder and the root mean square (RMS) of HOA were +0.54±0.27 D, -0.77±0.32 D and 0.15 microns respectively. These parameters decreased significantly (p-values between 0 and 0.01) at 3 months to +0.33±0.27 D sphere, -0.50±0.24 D cylinder and 0.10±0.05 microns HOA and were stable at the next follow-ups. Induced spherical equivalent was around zero at all visits. The changes in HOA were mainly due to trefoil aberration. CONCLUSIONS: Linear corneal incisions do not change the spherical power but can induce significant values of astigmatism and trefoil aberration in the cornea. However, these changes revert fully or partially to preoperative values by the third month after surgery and remain stable with time.

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.].

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.

Optical Measurement of Straylight in Eyes With Cataract.

PURPOSE: To measure straylight in a cohort of patients with cataract using a novel optical instrument and to correlate optical straylight values with clinical grade of cataracts and psychophysical straylight values. METHODS: Measurements were performed on 53 eyes of 44 patients with cataract admitted to the ophthalmology service of the university hospital in Murcia, Spain, and 9 young volunteers with no known ophthalmic pathology. Lens opacities were classified according to the Lens Opacities Classification System Ill (LOCS III) under slit-lamp examination. Intraocular straylight was additionally assessed psychophysically using the C-Quant straylight meter (Oculus Optikgeräte GmbH, Wetzlar, Germany). RESULTS: Optical measurements of the logarithm of the straylight parameter ranged from 1.01 to 2.01 (mean: 1.43 ± 0.244) in patients with cataract and 0.80 to 1.08 (mean: 0.92 ± 0.104) in healthy young volunteers. Straylight differed by a statistically significant amount among different LOCS III groups (P < .05). Moreover, the optically measured straylight parameter was positively correlated to the psychophysically estimated value (r = 0.803, P < .05). CONCLUSIONS: A new compact optical instrument suitable for clinical measurements of straylight in the human eye has been developed. Optically measured straylight values were highly correlated to those that were obtained psychophysically. Optical measurement of straylight can be used for the objective classification of cataract opacities based on their optical impact. [J Refract Surg. 2016;32(12):846-850.].

Relationship between induced spherical aberration and depth of focus after hyperopic LASIK in presbyopic patients.

OBJECTIVE: To evaluate to what extent the modification of corneal asphericity to induce spherical aberration (SA) can improve the depth of focus and to determine whether preoperative adaptive optics assessment (Voptica SL) can predict an optimal SA value for each patient. DESIGN: Comparative, prospective clinical trial with paired eye control. PARTICIPANTS: Patients ≥45 years old who are hyperopic from +1.00 to +2.50 diopters (D), with eyes suitable for LASIK surgery. INTERVENTION: Bilateral hyperopic LASIK surgery using a 200-Hz Allegretto excimer laser. The dominant eye was operated using a conventional profile. The nondominant eye was programmed with an aspheric ablation profile and -0.75 D monovision. MAIN OUTCOME MEASURES: Primary outcome was the correlation between postoperative SA and depth of focus, defined as the pseudo-accommodation value (PAV = [1/reading distance {m}] - minimum addition [D]). Main secondary outcome was the comparison of depth of focus between patients with an induced SA close to the optimal one (group 1), patients with an induced SA far from the optimal one (group 2), and patients for whom SA induction did not increase the depth of focus (control group). RESULTS: We included 76 patients. Between preoperative and postoperative assessment, the mean increase of distance-corrected PAV for near vision was +0.25±0.64 D (P < 0.001) for dominant eyes and +0.63±0.55 D (P < 0.001) for nondominant eyes. As the level of negative or positive postoperative SA increased, PAV for intermediate and near vision increased. Among the 37 eyes that followed the preoperative adaptive optics assessment, the mean PAV increase at near was significantly higher (P < 0.05) in group 1 (0.93±0.50 D) than in group 2 (0.46±0.42 D) and than in the control group (0.35±0.32 D). The mean optimal SA value determined by the dynamic simulation procedure to optimize the depth of focus was -0.18±0.13 µm at 4.5 mm. CONCLUSIONS: Aspheric hyperopic LASIK can increase the depth of focus without impairing far vision, but this benefit would be maximal and reproducible if we could define and achieve an optimal SA value determined by preoperative assessment using an adaptive optics instrument.

Refractive accuracy with light-adjustable intraocular lenses.

PURPOSE: To evaluate efficacy, predictability, and stability of refractive treatments using light-adjustable intraocular lenses (IOLs). SETTING: University Hospital Virgen de la Arrixaca, Murcia, Spain. DESIGN: Prospective nonrandomized clinical trial. METHODS: Eyes with a light-adjustable IOL (LAL) were treated with spatial intensity profiles to correct refractive errors. The effective changes in refraction in the light-adjustable IOL after every treatment were estimated by subtracting those in the whole eye and the cornea, which were measured with a Hartmann-Shack sensor and a corneal topographer, respectively. The refractive changes in the whole eye and light-adjustable IOL, manifest refraction, and visual acuity were obtained after every light treatment and at the 3-, 6-, and 12-month follow-ups. RESULTS: The study enrolled 53 eyes (49 patients). Each tested light spatial pattern (5 spherical; 3 astigmatic) produced a different refractive change (P<.01). The combination of 2 light adjustments induced a maximum change in spherical power of the light-adjustable IOL of between -1.98 diopters (D) and +2.30 D and in astigmatism of up to -2.68 D with axis errors below 9 degrees. Intersubject variability (standard deviation) ranged between 0.10 D and 0.40 D. The 2 required lock-in procedures induced a small myopic shift (range +0.01 to +0.57 D) that depended on previous adjustments. CONCLUSIONS: Light-adjustable IOL implantation achieved accurate refractive outcomes (around emmetropia) with good uncorrected distance visual acuity, which remained stable over time. Further refinements in nomograms and in the treatment's protocol would improve the predictability of refractive and visual outcomes with these IOLs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Minimum amount of astigmatism that should be corrected.

PURPOSE: To evaluate how small amounts of astigmatism affect visual acuity and the minimum astigmatism values that should be corrected to achieve maximum visual performance. SETTING: Optics Laboratory, University of Murcia, Murcia, Spain. DESIGN: Case series. METHODS: A wavefront sensor was used to measure astigmatism and higher-order aberrations (HOAs) in normal young eyes with astigmatism ranging from 0.0 to 0.5 diopter (D). Astigmatism was corrected for natural pupil diameters using a purpose-designed cross-cylinder device. Visual acuity was measured for high-contrast and low-contrast stimuli at best subjective focus with the natural and corrected astigmatism. From the aberrations, optical image-quality metrics were calculated for 3 conditions: natural astigmatism, corrected astigmatism, and astigmatism only (with all HOAs removed). RESULTS: The study evaluated 54 eyes. There was no significant correlation between the amount of astigmatism and visual acuity. The correction of astigmatism improved visual acuity for only high-contrast letters from 0.3 D, but with a high variability between subjects. Low-contrast visual acuity changed randomly as astigmatism was corrected. The correction of astigmatism increased the mean image-quality values; however, there was no significant correlation with visual performance. The deterioration in image quality given by astigmatism higher than 0.3 D was limited by HOAs. CONCLUSIONS: In most subjects, astigmatism less than 0.5 D did not degrade visual acuity. This suggests that under clinical conditions, the visual benefit of precise correction of astigmatism less than 0.5 D would be limited.

Extended depth of focus with induced spherical aberration in light-adjustable intraocular lenses.

PURPOSE: To evaluate the quality of vision and depth of focus induced by controlled amounts of negative spherical aberration in patients implanted bilaterally with light-adjustable intraocular lenses. DESIGN: Prospective, nonrandomized clinical trial. METHODS: Seventeen patients were implanted and treated with appropriate spatial irradiance light profiles. One eye was set for emmetropia, and the fellow eye received an additional aspheric light treatment to induce controlled amounts of negative spherical aberration. We used a Hartmann-Shack sensor to measure the eye's refraction and aberrations for a 4-mm pupil diameter. Decimal visual acuity (VA) was measured using a micro-display placed at 10 m, 60 cm, 40 cm, and 30 cm. RESULTS: Eyes treated with aspheric profiles were divided into 2 groups depending on the final amount of induced negative spherical aberration: low [-0.05, -0.10 µm] and high [-0.13, -0.23 µm]. In both groups, the mean uncorrected decimal VA at 60 cm was over 0.90. In the first group, distance VA was 0.97 ± 0.16, but in the second group it was lower (0.76 ± 0.16). As expected, the VA for nearer distances is higher in the eyes with a larger magnitude of spherical aberration (P value < .01): 0.94 ± 0.10 and 0.73 ± 0.16 at 40 and 30 cm, respectively, in comparison with 0.71 ± 0.15 and 0.50 ± 0.14. Binocular summation with the fellow eye, adjusted for emmetropia, produces an excellent binocular distance VA (>1.10) in both groups. CONCLUSIONS: Controlled amounts of negative spherical aberration and defocus can be induced in eyes implanted with adjustable intraocular lenses to enhance near vision.

Impact of positive coupling of the eye's trefoil and coma in retinal image quality and visual acuity.

When the eye's higher-order aberrations are measured and reported, as important as the magnitude of each individual term are the possible combinations between them, which may change the overall retinal image quality and therefore visual performance. We have evaluated the relationships among different aberration terms in the human eye-coma, trefoil, and spherical aberration-and their effects on both retinal image quality and visual acuity (VA). In a group of normal young subjects with normal to excellent vision, we measured the eye's aberrations and high contrast VA under natural conditions after carefully correcting defocus and astigmatism. Among the different combinations of aberration terms, we only found a significant negative correlation (r2=0.30) between the vertical coefficients of trefoil C(3,-3) and coma C(3,-1). This is a positive coupling that produces a better retinal image quality than any of the other possible combinations of these terms. However, this improvement in image quality is limited by the presence of other aberrations. Only in a few eyes that presented the larger values of coupled vertical trefoil and coma appeared a significant improvement of image quality. Although we did not find a clear correction between the coma-trefoil vertical coupling and VA, most eyes with large amounts of aberrations (RMS>0.4 µm) have these terms coupled, keeping decimal acuity around 1.2 or higher.

Effect of corneal aberrations on intraocular lens power calculations.

PURPOSE: To use ray tracing to determine the influence of corneal aberrations on the prediction of the optimum intraocular lens (IOL) power for implantation in normal eyes and eyes with previous laser in situ keratomileusis (LASIK). SETTING: Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. DESIGN: Case series. METHODS: The optimum IOL power was calculated by ray tracing using a patient-customized eye model in cataract surgery cases. The calculation can be performed with or without inclusion of the patient's corneal aberrations. Standard predictions were also generated using current state-of-the-art IOL power calculation techniques. The results for all predictions were compared with the optimum IOL power after cataract surgery. RESULTS: For patients without previous LASIK (n = 18), the standard approaches and the ray-tracing procedure gave a similar mean absolute residual error and variance. The incorporation of corneal aberrations did not improve the accuracy of the ray-tracing prediction in these cases. For post-LASIK patients (n = 10), the ray-tracing prediction incorporating corneal aberrations generated the most accurate results. The difference between the prediction with and without considering corneal aberrations correlated with the amount of corneal spherical aberration (r(2) = 0.82), resulting in a difference of up to 3.00 diopters in IOL power in some cases. CONCLUSIONS: Ray tracing using patient-customized eye models was a robust procedure for IOL power calculation. The incorporation of corneal aberrations is crucial in post-LASIK eyes, primarily because of the elevated corneal spherical aberration. FINANCIAL DISCLOSURE: Mrs. Canovas and Dr. Artal hold a provisional patent application on the ray-tracing procedure. Mrs. Canovas is an employee of Abbott Medical Optics Groningen B.V. No other author has a financial or proprietary interest in any material or method mentioned.

Optical quality of the eye in subjects with normal and excellent visual acuity.

PURPOSE: To study the relationship between visual acuity (VA) and the eye's optical quality in subjects with normal and excellent spatial vision. VA ranged from decimal values of 1.0 (20/20) to 2.0 (20/10) when defocus and astigmatism were carefully corrected. METHODS: In 60 eyes of young subjects, visual and optical performance with the natural pupil were measured. A forced-choice procedure was used to measure tumbling-E high-contrast VA (HCVA) and low-contrast VA (LCVA). Wavefront aberration (WA) was measured using a Hartmann-Shack sensor. The associated point-spread function (PSF) and modulation transfer function (MTF) were also estimated. High-order aberrations (HOA) and several image quality parameters were represented as a function of VA. Subjects were classified into three groups according to their VA, and average optical parameters were calculated. RESULTS: Coma and trefoil vary between 0 and 0.5 mum, and spherical aberration ranges from -0.40 mum to +0.45 mum, with an average value of approximately zero. LCVA is not correlated with any of the aberration terms. Coma and spherical aberration are not correlated with HCVA. However, eyes with trefoil equal to or higher than 0.25 mum have an HCVA less than 1.5. The average optical quality in eyes with HCVA greater than 1.4 is slightly better than in eyes with normal VA. However, some eyes had relatively poor image quality and excellent VA. CONCLUSIONS: No significant correlations were found between VA measurements and the optical quality of the eye in young subjects with normal or excellent spatial vision. Some subjects with normal degrees of aberrations attained excellent VA.

An analytical model describing aberrations in the progression corridor of progressive addition lenses.

PURPOSE: In the progression corridor of a typical progressive addition lens (PAL) with an addition of 2.5 D, the power changes by roughly 1/8 D/mm. This renders a power difference of some 0.5 D across a typical pupil diameter of 4 mm. Contrary to this fact, PALs do work well in the progression zone. To explain why, we apply a simple model to derive wavefront characteristics in the progression zone and compare it with recent experimental data. METHODS: We consider a simple analytic function to describe the progression zone of a PAL, which has been introduced by Alvarez and other authors. They considered the power change and astigmatism, which are second-order wavefront aberrations. We include third-order aberrations and compare them with spatially resolved wavefront data from Hartmann-Shack-sensor measurements. RESULTS: The higher-order aberrations coma and trefoil are the dominant aberrations besides astigmatism as given by experimental data. According to our model, the third-order aberrations in the transition zone are strongly coupled to the power change and the cubic power of the pupil radius. Their overall contribution according to experimental data is nicely reproduced by our model. The numeric contribution of higher-order aberrations is small and, for practical purposes, the wavefront can be described locally by the second-order components of sphere and astigmatism only. CONCLUSIONS: We propose a simple analytical model to understand the optics in the progression corridor and nearby zones of a PAL. Our model confirms that for typical pupil sizes, all higher-order aberrations, including the dominant modes of coma and trefoil, are small enough to render an undisturbed vision in the progression zone. Therefore, higher-order aberrations have a minimal impact on the optical performance of these lenses.

Visual acuity and optical parameters in progressive-power lenses.

PURPOSES: The purposes of this study are to explore the effect of astigmatism and high-order aberrations of progressive-power lenses (PPLs) on visual acuity (VA) and to find a good optical metric for evaluating visual performance of PPLs. METHODS: A Hartmann-Shack (HS) wavefront sensor was used to measure PPLs and human eyes either independently or in combination. An additional channel permits the measurement of VA under the same optical conditions. Measurements were taken in six relevant locations of a PPL and in three eyes of different normal subjects. In every case, we obtained the wavefront aberration as Zernike polynomials expansions, the root mean square (RMS) error, and two metrics on point spread function (PSF): Strehl ratio and the common logarithm of the volume under the PSF normalized to one (Log_Vol_PSF). RESULTS: Aberration coupling of the PPL with the eye tends to equalize the retinal image quality between central and peripheral zones of the progressive lenses. In the corridor of the PPL, the combination of small amounts of coma, trefoil, and astigmatism (total RMS 0.1 mum) does not significantly affect VA. The continuous increase of astigmatism from corridor to outside zones reduces moderately the quality of vision. The highest correlations between optical metrics and VA were found for Log_Vol_PSF of the entire system eye plus PPL. CONCLUSIONS: Ocular aberrations reduce optical quality difference between corridor and peripheral zones of PPLs. In the same way, VA through the corridor is similar to that of eyes without a lens and it decreases slowly toward peripheral locations. VA through PPLs is well predicted by the logarithm of metrics directly related with image spread (Log_Vol_PSF or equivalent) of the complete system of the eye with the lens.

Comparison of aberrations in different types of progressive power lenses.

Recently, computer numerically controlled machines have permitted the manufacture of progressive power lenses (PPLs) with different designs. However, the possible differences in optical performance among lens designs are not yet well established. In this work, the spatially resolved aberrations, at 20 relevant locations, of three PPLs with different designs were measured with a Hartmann-Shack wavefront sensor. The wavefront aberration (WA), its root mean square error (RMS) and the point-spread function were obtained. Spatially resolved plots are shown for all aberrations, astigmatism alone, and for higher order aberrations. The average RMS of all zones is also compared, and the standard deviation is used as a parameter to evaluate the level of hard-soft design. We find differences in the spatial distribution of the aberrations but not in the global RMS, indicating that current PPLs are rather similar to a waterbed, with the aberrations being the water: they can be moved but they cannot be eliminated.

Spatially resolved wavefront aberrations of ophthalmic progressive-power lenses in normal viewing conditions.

PURPOSE: To measure the wavefront aberration at different locations in progressive-power lenses (PPL's) isolated and in situ (PPL's plus eye). METHODS: A Hartmann-Shack wavefront sensor was used to measure progressive-power lenses and human eyes either independently or in combination. In each selected zone, the lens was placed and tilted accordingly to simulate natural viewing conditions. We measured 21 relevant locations across an isolated PPL (plano lens of power addition of 2 D). In six of the locations, the wavefront aberration of the eye plus PPL were obtained in two ways: (1) by direct measurement of the system and (2) by adding the individual wavefront aberrations of the eye and the lens for each appropriate zone. In every case, we obtained the wavefront aberration as Zernike polynomials expansions, the root mean square error, the point-spread function, and the Strehl ratio. RESULTS: Along the corridor of the PPL, third-order coma and trefoil, and astigmatism were the dominant aberrations. In areas of the PPL outside the corridor, astigmatism increased, whereas other aberrations remained similar to the lens center. Small differences were found between the direct and calculated methods used to obtain the wavefront aberration of the eye with the lens, and the possible sources of errors were discussed. In some lenses zones, the aberrations of the lens may be compensated by the particular aberrations of the eye, yielding improved optical performance over that present in the lens alone. CONCLUSIONS: We designed and built a wavefront sensor to perform spatially resolved aberration measurements in ophthalmic lenses, in particular in PPL's, either isolated or in combination with the eye. The aberrations appearing in the PPL were compared with those in normal aged eyes.

Correlation between optical and psychophysical parameters as a function of defocus.

PURPOSE: To evaluate how ocular optical image quality and psychophysical estimates of visual performance compare to each other as a function of defocus. METHODS: We measured the optical modulation transfer function using a double-pass apparatus and psychophysical estimates of visual performance: contrast sensitivity function (CSF) and visual acuity. Both sets of data were obtained under the same optical conditions. RESULTS: We measured optical and psychophysical parameters as a function of defocus. We studied the correlation between optical parameters (Strehl ratio and the logarithm of the volume in the double-pass image [log_Vol D-P]) and psychophysical parameters (the area under the fitted CSF represented in a logarithmic scale with the spatial frequency in linear scale [Area CSF-log_lin] and visual acuity) for different values of defocus. CONCLUSIONS: Strehl ratio is well correlated with the psychophysical estimates of the visual performance for moderate amount of defocus (within 1 D), whereas the other parameter (log_Vol D-P) is well correlated for larger ranges of defocus (within 2 D) and for different pupil diameters. These results suggest that optical measurements could be used for clinical testing of ophthalmic optics.