Multi-modal and multi-scale clinical retinal imaging system with pupil and retinal tracking.

We present a compact multi-modal and multi-scale retinal imaging instrument with an angiographic functional extension for clinical use. The system integrates scanning laser ophthalmoscopy (SLO), optical coherence tomography (OCT) and OCT angiography (OCTA) imaging modalities and provides multi-scale fields of view. For high resolution, and high lateral resolution in particular, cellular imaging correction of aberrations by adaptive optics (AO) is employed. The entire instrument has a compact design and the scanning head is mounted on motorized translation stages that enable 3D self-alignment with respect to the subject's eye by tracking the pupil position. Retinal tracking, based on the information provided by SLO, is incorporated in the instrument to compensate for retinal motion during OCT imaging. The imaging capabilities of the multi-modal and multi-scale instrument were tested by imaging healthy volunteers and patients.

Comparing Measurements of Vascular Diameter Using Adaptative Optics Imaging and Conventional Fundus Imaging.

The aim of this prospective study was to compare retinal vascular diameter measurements taken from standard fundus images and adaptive optics (AO) images. We analysed retinal images of twenty healthy subjects with 45-degree funduscopic colour photographs (CR-2 Canon fundus camera, Canon™) and adaptive optics (AO) fundus images (rtx1 camera, Imagine Eyes®). Diameters were measured using three software applications: the VAMPIRE (Vessel Assessment and Measurement Platform for Images of the REtina) annotation tool, IVAN (Interactive Vessel ANalyzer) for funduscopic colour photographs, and AO_Detect_Artery™ for AO images. For the arterial diameters, the mean difference between AO_Detect_Artery™ and IVAN was 9.1 µm (-27.4 to 9.2 µm, p = 0.005) and the measurements were significantly correlated (r = 0.79). The mean difference between AO_Detect_Artery™ and VAMPIRE annotation tool was 3.8 µm (-34.4 to 26.8 µm, p = 0.16) and the measurements were poorly correlated (r = 0.12). For the venous diameters, the mean difference between the AO_Detect_Artery™ and IVAN was 3.9 µm (-40.9 to 41.9 µm, p = 0.35) and the measurements were highly correlated (r = 0.83). The mean difference between the AO_Detect_Artery™ and VAMPIRE annotation tool was 0.4 µm (-17.44 to 25.3 µm, p = 0.91) and the correlations were moderate (r = 0.41). We found that the VAMPIRE annotation tool, an entirely manual software, is accurate for the measurement of arterial and venular diameters, but the correlation with AO measurements is poor. On the contrary, IVAN, a semi-automatic software tool, presents slightly greater differences with AO imaging, but the correlation is stronger. Data from arteries should be considered with caution, since IVAN seems to significantly under-estimate arterial diameters.

Enhanced visual acuity and image perception following correction of highly aberrated eyes using an adaptive optics visual simulator.

PURPOSE: To evaluate the changes in visual acuity and visual perception generated by correcting higher order aberrations in highly aberrated eyes using a large-stroke adaptive optics visual simulator. METHODS: A crx1 Adaptive Optics Visual Simulator (Imagine Eyes) was used to correct and modify the wavefront aberrations in 12 keratoconic eyes and 8 symptomatic postoperative refractive surgery (LASIK) eyes. After measuring ocular aberrations, the device was programmed to compensate for the eye's wavefront error from the second order to the fifth order (6-mm pupil). Visual acuity was assessed through the adaptive optics system using computer-generated ETDRS opto-types and the Freiburg Visual Acuity and Contrast Test. RESULTS: Mean higher order aberration root-mean-square (RMS) errors in the keratoconus and symptomatic LASIK eyes were 1.88+/-0.99 microm and 1.62+/-0.79 microm (6-mm pupil), respectively. The visual simulator correction of the higher order aberrations present in the keratoconus eyes improved their visual acuity by a mean of 2 lines when compared to their best spherocylinder correction (mean decimal visual acuity with spherocylindrical correction was 0.31+/-0.18 and improved to 0.44+/-0.23 with higher order aberration correction). In the symptomatic LASIK eyes, the mean decimal visual acuity with spherocylindrical correction improved from 0.54+/-0.16 to 0.71+/-0.13 with higher order aberration correction. The visual perception of ETDRS letters was improved when correcting higher order aberrations. CONCLUSIONS: The adaptive optics visual simulator can effectively measure and compensate for higher order aberrations (second to fifth order), which are associated with diminished visual acuity and perception in highly aberrated eyes. The adaptive optics technology may be of clinical benefit when counseling patients with highly aberrated eyes regarding their maximum subjective potential for vision correction.

Expanding depth of focus by modifying higher-order aberrations induced by an adaptive optics visual simulator.

PURPOSE: To evaluate the impact of higher-order aberrations on depth of focus using an adaptive optics visual simulator. SETTING: Refractive Surgery Department, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA. METHODS: An adaptive optics simulator was used to optically introduce individual aberrations in eyes of subjects with a 6.0 mm pupil under cycloplegia (coma and trefoil, magnitudes +/-0.3 microm; spherical aberration, magnitudes +/-0.3, +/-0.6, +/-0.9 microm). A through-focus response curve was assessed by recording the percentage of Sloan letters at a fixed size identified at various target distances. The subject's ocular depth of focus and center of focus were computed as the half-maximum width and the midpoint of the through-focus response curve. RESULTS: The dominant eyes of 10 subjects were evaluated. The simulation of positive or negative spherical aberration had the effect of enhancing depth of focus and resulted in linearly shifting of the center of focus by 2.6 diopters (D)/microm of error. This increase in depth of focus reached a maximum of approximately 2.0 D with 0.6 microm of spherical aberration and became smaller when the aberration was increased to 0.9 microm. Trefoil and coma appeared to neither shift the center of focus nor significantly modify the depth of focus. CONCLUSION: The introduction of both positive and negative spherical aberration using adaptive optics technology significantly shifted and expanded the subject's overall depth of focus; simulating coma or trefoil did not produce such effects.

Effects of Zernike wavefront aberrations on visual acuity measured using electromagnetic adaptive optics technology.

PURPOSE: This study measured the changes in visual acuity induced by individual Zernike ocular aberrations of various root-mean-square (RMS) magnitudes. METHODS: A crx1 Adaptive Optics Visual Simulator (Imagine Eyes) was used to modify the wavefront aberrations in nine eyes. After measuring ocular aberrations, the device was programmed to compensate for the eye's wavefront error up to the 4th order and successively apply different individual Zernike aberrations using a 5-mm pupil. The generated aberrations included defocus, astigmatism, coma, trefoil, and spherical aberration at a level of 0.1, 0.3, and 0.9 microm. Monocular visual acuity was assessed using computer-generated Landolt-C optotypes. RESULTS: Correction of the patients' aberrations improved visual acuity by a mean of 1 line (-0.1 logMAR) compared to best sphero-cylinder correction. Aberrations of 0.1 microm RMS resulted in a limited decrease in visual acuity (mean +0.05 logMAR), whereas aberrations of 0.3 microm RMS induced significant visual acuity losses with a mean reduction of 1.5 lines (+0.15 logMAR). Larger aberrations of 0.9 microm RMS resulted in greater visual acuity losses that were more pronounced with spherical aberration (+0.64 logMAR) and defocus (+0.62 logMAR), whereas trefoil (+0.22 logMAR) was found to be better tolerated. CONCLUSIONS: The electromagnetic adaptive optics visual simulator effectively corrected and generated wavefront aberrations up to the 4th order. Custom wavefront correction significantly improved visual acuity compared to best-spectacle correction. Symmetric aberrations (eg, defocus and spherical aberration) were more detrimental to visual performance.

Assessment of just-noticeable differences for refractive errors and spherical aberration using visual simulation.

PURPOSE: The aim of this study was to evaluate the threshold levels of aberration change that a typical reference eye is able to detect. METHODS: The method involved simulation of the foveal vision of a typical eye in polychromatic light through optics affected by different levels of the various chosen monochromatic aberrations. The reference eye had the following monochromatic wavefront characteristics based on the aberrations of a population of young adults: no spherical defocus, astigmatism -0.37D oriented at 0 degrees celsius, coma -0.17 D/mm oriented at 270 degrees celsius, and spherical aberration -0.12 D/mm. Average amounts of longitudinal and transverse chromatic aberration were assumed, and allowance was made for the Stiles-Crawford effect. The pupil diameter of the simulated eye was kept fixed at 6 mm. Three observers each compared, 100 times, a simulated image as seen through the standard reference eye with a variant "aberrated" image. The varying parameter was the value of a chosen additional aberration affecting the variant image in the reference eye. The test was repeated for varying amounts of spherical defocus, astigmatic defocus, and spherical aberration. For each of these aberrations and each observer, the discrimination probability as a function of the aberration level in the variant image was determined. The just-noticeable difference in aberration (JNDA) was derived from each discrimination curve as the difference between the aberrations corresponding to discrimination probabilities of 75% and 25%. The JNDA values obtained were expressed in the form of root mean square (RMS) wavefront error thresholds. RESULTS: It was found that 0.04 microm of RMS aberration should be considered as the threshold of just-noticeable image change, in good agreement with the Maréchal criterion. CONCLUSIONS: The results imply that in normal viewing conditions (e.g., a 3-mm pupil size), optical corrections should be in the range of +/-0.15 D in sphere and cylinder from the target prescription if perceptible change in the quality of the perceived images is to be avoided. The design of conventional soft contact lenses of high negative power or positive power should aim to produce -0.07 D/mm of spherical aberration, with a tolerated interval between -0.15 to +0.01 D/mm for a 6-mm pupil size.

A method for simulation of foveal vision during wear of corrective lenses.

PURPOSE: The aim was to simulate the visual appearance of images viewed through corrective lenses having known, arbitrary types and amounts of monochromatic aberration, so that the visual effect of changing the design parameters of the lens could be explored. METHODS: We first calculate the optical response of the eye and any corrective lens using a numerical model eye. We then use this response as a filter, which we convolve with a selected original (unaberrated) image, to obtain an initial simulated retinal image. This image is then deconvolved by a second filter, which is calculated as the optical response of the eye of the observer who views the final image displayed on a video monitor. The originality of our approach to visual simulation is to take the aberrational characteristics of the observer's eye into account in the calculation. We validated our simulation by comparing images degraded by simulated dioptric blur with real defocused images seen through corresponding optical lenses. RESULTS: When using a small (2.5 mm) pupil size and a "typical" observer wavefront aberration model, there was a close resemblance between optical and simulated blurs. Although it was not necessary to consider the measured aberrations of the subject when simulating vision with a small pupil size, this requirement could not be ignored when vision through a larger pupil was simulated. With a 5.7-mm pupil diameter, use of Shack-Hartmann measurements of the ocular aberrations of the individual observers rather than "typical" levels of aberrations for the entire population gave excellent agreement between the effects of simulated and real defocus blur in monochromatic and polychromatic light. A Bland-Altman analysis of the differences between matching simulated and real blurs for a 5.7-mm pupil in polychromatic light with the model including allowance for individual measured aberrations gave mean differences close to zero and 95% confidence limits of about +/-0.25 D over a defocus range of -2.00 to +2.00 D. CONCLUSION: The simulation technique can be expected to be a useful tool to evaluate the potential performance of an eye that wears various designs of corrective lens.

Simulated optical performance of custom wavefront soft contact lenses for keratoconus.

PURPOSE: Outstanding improvements in vision can theoretically be expected using contact lenses that correct monochromatic aberrations of the eye. Imperfections in such correction inherent to contact lenses are lens flexure, translation, rotation, and tear layer effects. The effects of pupil size and accommodation on ocular aberration may cause further difficulties. The purpose of this study was to evaluate whether nonaxisymmetric soft contact lenses could efficiently compensate for higher-order aberrations induced by keratoconus and to what extent rotation and translation of the lens would degrade this perfect correction. METHODS: Height topography data of nine moderate to severe keratoconus corneas were obtained using the Maastricht Shape Topographer. Three-dimensional ray tracing was applied to each elevation topography to calculate aberrations in the form of a phase error mapping. The effect of a nonaxisymmetric soft contact lens tailored to the corneal aberrations was simulated by adding an opposite phase error mapping that would theoretically compensate all corneal-induced optical aberrations of the keratoconus eyes. Translation (0.25, 0.5, 0.75, and 1.0 mm) and rotation (2.5 degrees, 5.0 degrees, 7.5 degrees, and 10 degrees ) mismatches were introduced. The modulation transfer function (MTF) of each eye with each displaced correction and with various pupil sizes (3, 5, and 7 mm) was deduced from the residual phase error mapping. A single performance criterion (mtfA) was calculated as the area under the MTF over a limited spatial frequency range (5 to 15 periods per degree). Finally, the ratio (RmtfA) of corrected mtfA over uncorrected mtfA provided an estimate of the global enhancement in contrast sensitivity with the customized lens. RESULTS: The contrast improvement ratios RmtfA with perfectly located lenses were for an average pupil size of 4.5 mm between 6.5 and 200. For small translation errors (0.25 mm), RmtfA ranged between 2 and 7. The largest lens translation tested (1 mm) often resulted in poorer performance than without correction (RmtfA <1). More than threefold improvements were achieved with any of the angular errors experimented. RmtfA values showed significant variations for pupil diameters between 3 and 7 mm. CONCLUSIONS: Three-dimensional aberration-customized soft contact lenses may drastically improve visual performance in patients with keratoconus. However, such lenses should be well positioned on the cornea. In particular, translation errors should not exceed 0.5 mm. Angular errors appeared to be less critical. It is further questioned whether the visual system is able to adapt to variations in optical performance of the correction in situ due to lens positioning and pupil size.

Aberration generation by contact lenses with aspheric and asymmetric surfaces.

PURPOSE: We explored the potential of aberration correction in the human eye by using a new generation of soft contact lenses with aspheric and asymmetric surfaces. METHODS: Soft contact lens samples were designed with one asymmetrical surface (front) and one spherical (back) to produce predetermined amounts of desired pure defocus, astigmatism, trefoil, coma, and spherical aberration. Contact lens wavefront aberrations were measured ex vivo using a Fizeau-Tolanski interferometer and compared with the in vivo wavefronts obtained by subtracting the aberrations of the eye with and without the contact lenses. These second set of measurements were obtained using a Shack-Hartmann sensor. RESULTS: We found that an aberration-free contact lens sample induced in the eye a small amount of residual aberration. We obtained a good match between the ex vivo and in vivo wavefront measurements for most of the samples of the contact lenses. CONCLUSIONS: The aberrations generated by soft contact lenses on the eye were predictable. Rotations and translations of the contact lenses with respect to correct position on the eye were, however, the main limitation for precise correction of the ocular aberrations.