The blur horopter: Retinal conjugate surface in binocular viewing.

From measurements of wavefront aberrations in 16 emmetropic eyes, we calculated where objects in the world create best-focused images across the central 27\(^\circ\) (diameter) of the retina. This is the retinal conjugate surface. We calculated how the surface changes as the eye accommodates from near to far and found that it mostly maintains its shape. The conjugate surface is pitched top-back, meaning that the upper visual field is relatively hyperopic compared to the lower field. We extended the measurements of best image quality into the binocular domain by considering how the retinal conjugate surfaces for the two eyes overlap in binocular viewing. We call this binocular extension the blur horopter. We show that in combining the two images with possibly different sharpness, the visual system creates a larger depth of field of apparently sharp images than occurs with monocular viewing. We examined similarities between the blur horopter and its analog in binocular vision: the binocular horopter. We compared these horopters to the statistics of the natural visual environment. The binocular horopter and scene statistics are strikingly similar. The blur horopter and natural statistics are qualitatively, but not quantitatively, similar. Finally, we used the measurements to refine what is commonly referred to as the zone of clear single binocular vision.

Resolution acuity across the visual field for mesopic and scotopic illumination.

We investigated the classical question of why visual acuity decreases with decreasing retinal illuminance by holding retinal eccentricity fixed while illumination varied. Our results indicate that acuity is largely independent of illuminance at any given retinal location, which suggests that under classical free-viewing conditions acuity improves as illumination increases from rod threshold to rod saturation because the retinal location of the stimulus is permitted to migrate from a peripheral location of maximum sensitivity but poor acuity to the foveal location of maximum acuity but poor sensitivity. Comparison with anatomical sampling density of retinal neurons suggests that mesopic acuity at all eccentricities and scotopic acuity for eccentricities beyond about 20° is limited by the spacing of midget ganglion cells. In central retina, however, scotopic acuity is further limited by spatial filtering due to spatial summation within the large, overlapping receptive fields of the A-II class of amacrine cells interposed in the rod pathway between rod bipolars and midget ganglion cells. Our results offer a mechanistic interpretation of the clinical metrics for low-luminance visual dysfunction used to monitor progression of retinal disease.

Combining optical and neural components in physiological visual image quality metrics as functions of luminance and age.

Visual image quality metrics combine comprehensive descriptions of ocular optics (from wavefront error) with a measure of the neural processing of the visual system (neural contrast sensitivity). To improve the ability of these metrics to track real-world changes in visual performance and to investigate the roles and interactions of those optical and neural components in foveal visual image quality as functions of age and target luminance, models of neural contrast sensitivity were constructed from the literature as functions of (1) retinal illuminance (Trolands, td), and (2) retinal illuminance and age. These models were then incorporated into calculation of the visual Strehl ratio (VSX). Best-corrected VSX values were determined at physiological pupil sizes over target luminances of 104 to 10-3 cd/m2 for 146 eyes spanning six decades of age. Optical and neural components of the metrics interact and contribute to visual image quality in three ways. At target luminances resulting in >900 td at physiological pupil size, neural processing is constant, and only aberrations (that change as pupil size changes with luminance) affect the metric. At low mesopic luminances below where pupil size asymptotes to maximum, optics are constant (maximum pupil), and only the neural component changes with luminance. Between these two levels, both optical and neural components of the metrics are affected by changes in target luminance. The model that accounted for both retinal illuminance and age allowed VSX, termed VSX(td,a), to best track visual acuity trends (measured at 160 and 200 cd/m2) as a function of age (20s through 70s) from the literature. Best-corrected VSX(td,a) decreased by 2.24 log units between maximum and minimum target luminances in the youngest eyes and by 2.58 log units in the oldest. The decrease due to age was more gradual at high target luminances (0.70 log units) and more pronounced as target luminance decreased (1.04 log units).

Ricco's law and absolute threshold for foveal detection of black holes.

Visual detection of small black objects surrounded by a light background depends on background luminance, pupil size, optical blur, and object size. Holding pupil and optics fixed, we measured the minimum background luminance needed for foveal detection of small black targets as a function of target size. For all three observers, absolute threshold varied inversely with target area when disk diameter subtended less than 10' of visual angle. For target diameter ≥10', threshold remained constant at about 0.3 Td, which was also the absolute threshold for detecting light spots 10' or larger in diameter on a black background. These results are consistent with Ricco's law of spatial summation: a "black hole" is just detectable when the background luminance is sufficiently high for its absence inside the Ricco area to reduce 555 nm photon flux by 7500 photons/s, which is the same change needed to detect light spots on a black surround. These results can be accounted for by a differential pair of Ricco detectors, each about the size of the receptive field center of magocellular retinal ganglion cells when projected into object space through the eye's weakly aberrated optical system. Statistical analysis of the model suggests the quantum fluctuations due to internal, biological noise (i.e., "scotons") are a greater handicap than the photon fluctuations inherent in the light stimulus at absolute foveal threshold.

Psychophysical study of the optical origin of starbursts.

Starbursts seen around small bright lights at night have been attributed to optical scatter, diffraction, or aberrations. We manipulated pupil aperture and aberrations to investigate the entopic appearance of perceived starbursts. The impact of circular, annular, and wedge-shaped pupil apertures, and spherical aberration sign and magnitude were used to identify pupil sub-apertures responsible for each radial perceived starburst line. Local intensity distributions within the starbursts mapped onto unique sub-regions of the pupil of both phakic and pseudophakic eyes, consistent with the hypothesis that ocular aberrations are the cause of starbursts. In paraxially focused eyes, the size of starbursts is predicted by the amount of spherical aberration, and starburst orientation is either the same or 180 deg rotated from the pupil region that creates each starburst line. No starbursts are seen when the pupil diameter is smaller than 3 mm. Replacing the eye's natural lens with a radially symmetric and optically homogeneous intraocular lens reduced the observed number of starbursts by 50%. Geometrical optics modeling including the measured aberrations of an individual eye can reveal point spread function structure that captures some of the key elements of the entopic perceptions.

Small Text on Product Labels Poses a Special Challenge for Emerging Presbyopes.

SIGNIFICANCE: Approximately 10% of the lowercase text on nonprescription drug labels is smaller than the 1 mm required by the Food and Drug Administration. The small size, combined with the progressive decline in accommodative amplitude and gain, poses a reading challenge for middle-aged emerging presbyopes. PURPOSE: The purpose of this study was to evaluate the impact of progressing presbyopia and near adds on the ability of middle-aged patients to read small text routinely encountered on product labels. METHODS: Geometrical optics was used to determine the impact of changing viewing distance, accommodation, and pupil size on retinal blur size. We photographed 261 consumer product labels in grocery, personal care, and nonprescription (over-the-counter) drug categories and used character recognition software to identify and size 255,298 printed letters. We computed the impact of viewing distance on the ratio of blur to letter detail and used published blur ratios of ≤4 and ≤2 to identify the conditions that allowed for letter recognition and proficient reading, respectively. RESULTS: Median/mode lowercase letter heights (in millimeters) were 1.39/1.16, 1.29/1.15, and 1.18/1.01, respectively, for groceries, personal care, and over-the-counter drug categories. Despite the increased angular subtense of approaching letters, blur ratios generally increased with reduced viewing distance because of increased defocus. Increased viewing distance decreased blur, but small (e.g., 1 mm) letters became too small to read proficiently (angular size <10 arcminutes) for distances beyond 37 cm. With larger pupils, blur ratios were too large to support proficient reading when accommodative amplitude dropped to ≤3 diopters. An add power sufficient to bring the far point closer than 37 cm was required to proficiently read small text. CONCLUSIONS: Product labels, especially nonprescription drug packages, typically use fonts that are too small to be read proficiently by unaided emmetropes with emerging presbyopia. This problem can be ameliorated by correction of presbyopia at an earlier age and with higher add powers.

Calculation of the geometrical point-spread function from wavefront aberrations.

PURPOSE: This report uses the principles of geometrical optics to compute the optical point-spread function (PSF) from the wavefront error function. METHOD: Step 1 uses Prentice's rule to determine the spatial form of the PSF established by tracing a field of rays from the eye's exit pupil to the retina. Ray vergence is related to the slope of the wavefront error function, which enables the mapping of light rays to produce a retinal 'spot diagram'. Step 2 completes the PSF by assigning an irradiance value to each ray in the spot diagram. RESULTS AND CONCLUSIONS: Spot irradiance is inversely proportional to the Gaussian curvature (i.e. the product of principal curvatures) of each local region of wavefront error surface centered on the corresponding ray. The Gaussian curvature, in turn, may be computed as the determinant of the vergence error matrix associated with each point on the wavefront error surface. Elements of the vergence error matrix consist of sums and differences of the local power vector components M, J0 and J45 . This method is shown to be equivalent to published derivations of the geometric PSF using the Jacobian of the ray mapping function and equivalent also to the Hessian of the wavefront error function. Examples are presented for the familiar cases of spherical and astigmatic blur as well as for higher order aberrations and the formation of caustics in the retinal image.

Customized models of ocular aberrations across the visual field during accommodation.

We aimed to create individual eye models that accurately reproduce the empirical measurements of wave-front aberrations across the visual field at different accommodative states, thus providing a mechanistic explanation for the changes in the eye's aberration structure due to accommodation. Structural parameters of a generic eye model were optimized using optical design software to account for published measurements of wave-front aberrations measured for 19 individuals at 37 test locations over the central 30°-diameter visual field at eight levels of accommodative demand. Biometric data for individual eyes were used as starting values and normative data were used to constrain optimizations to anatomically reasonable values. Customizations of the accommodating eye model accurately accounted for ocular aberrations over the central 30° of visual field with an averaged root mean square fitting error typically below 0.2 µm at any given field location. Optimized structural parameters of the eye models were anatomically reasonable and changed in the expected way when accommodating. Accuracy for representing spherical aberration was significantly improved by relaxing anatomical constraints on the anterior surface of the lens to compensate for not including gradient-index media. Use of the model to compute pan-retinal image quality revealed large penalties of accommodative lag for activating photoreceptor responses to the retinal image.

What is a troland?

Trolands are a widely used measure of retinal illuminance in vision science and visual optics, but disagreements exist for the definition and interpretation of this photometric unit. The purpose of this communication is to resolve the confusion by providing a sound conceptual basis for interpreting trolands as a measure of angular flux density incident upon the retina. Using a simplified optical analysis, we show that the troland value of an extended source is the intensity in micro-candelas of an equivalent point source located at the eye's posterior nodal point that produces the same illuminance in the retinal image as does the extended source. This optical interpretation of trolands reveals that total light flux in the image of an extended object is the product of the troland value of the source and the solid angle subtended by the source at the first nodal point, independent of eye size.

Normative best-corrected values of the visual image quality metric VSX as a function of age and pupil size.

The visual image quality metric the visual Strehl ratio (VSX) combines a comprehensive description of the optics of an eye (wavefront error) with an estimate of the photopic neural processing of the visual system, and has been shown to be predictive of subjective best focus and well correlated with change in visual performance. Best-corrected visual image quality was determined for 146 eyes, and the quantitative relation of VSX, age, and pupil size is presented, including 95% confidence interval norms for age groups between 20 and 80 years and pupil diameters from 3 to 7 mm. These norms were validated using an independently collected population of wavefront error measurements. The best visual image quality was found in young eyes at smaller pupil sizes. Increasing pupil size caused a more rapid decrease in VSX than increasing age. These objectively determined benchmarks represent the best theoretical levels of visual image quality achievable with a sphere, cylinder, and axis correction in normal eyes and can be used to evaluate both traditional and wavefront-guided optical corrections provided by refractive surgery, contact lenses, and spectacles.

Two-dimensional simulation of eccentric photorefraction images for ametropes: factors influencing the measurement.

PURPOSE: Eccentric photorefraction and Purkinje image tracking are used to estimate refractive state and eye position simultaneously. Beyond vision screening, they provide insight into typical and atypical visual development. Systematic analysis of the effect of refractive error and spectacles on photorefraction data is needed to gauge the accuracy and precision of the technique. METHODS: Simulation of two-dimensional, double-pass eccentric photorefraction was performed (Zemax). The inward pass included appropriate light sources, lenses and a single surface pupil plane eye model to create an extended retinal image that served as the source for the outward pass. Refractive state, as computed from the luminance gradient in the image of the pupil captured by the model's camera, was evaluated for a range of refractive errors (-15D to +15D), pupil sizes (3 mm to 7 mm) and two sets of higher-order monochromatic aberrations. Instrument calibration was simulated using -8D to +8D trial lenses at the spectacle plane for: (1) vertex distances from 3 mm to 23 mm, (2) uncorrected and corrected hyperopic refractive errors of +4D and +7D, and (3) uncorrected and corrected astigmatism of 4D at four different axes. Empirical calibration of a commercial photorefractor was also compared with a wavefront aberrometer for human eyes. RESULTS: The pupil luminance gradient varied linearly with refractive state for defocus less than approximately 4D (5 mm pupil). For larger errors, the gradient magnitude saturated and then reduced, leading to under-estimation of refractive state. Additional inaccuracy (up to 1D for 8D of defocus) resulted from spectacle magnification in the pupil image, which would reduce precision in situations where vertex distance is variable. The empirical calibration revealed a constant offset between the two clinical instruments. CONCLUSIONS: Computational modelling demonstrates the principles and limitations of photorefraction to help users avoid potential measurement errors. Factors that could cause clinically significant errors in photorefraction estimates include high refractive error, vertex distance and magnification effects of a spectacle lens, increased higher-order monochromatic aberrations, and changes in primary spherical aberration with accommodation. The impact of these errors increases with increasing defocus.

Interaction of aberrations, diffraction, and quantal fluctuations determine the impact of pupil size on visual quality.

Our purpose is to develop a computational approach that jointly assesses the impact of stimulus luminance and pupil size on visual quality. We compared traditional optical measures of image quality and those that incorporate the impact of retinal illuminance dependent neural contrast sensitivity. Visually weighted image quality was calculated for a presbyopic model eye with representative levels of chromatic and monochromatic aberrations as pupil diameter was varied from 7 to 1 mm, stimulus luminance varied from 2000 to 0.1 cd/m2, and defocus varied from 0 to -2 diopters. The model included the effects of quantal fluctuations on neural contrast sensitivity. We tested the model's predictions for five cycles per degree gratings by measuring contrast sensitivity at 5 cyc/deg. Unlike the traditional Strehl ratio and the visually weighted area under the modulation transfer function, the visual Strehl ratio derived from the optical transfer function was able to capture the combined impact of optics and quantal noise on visual quality. In a well-focused eye, provided retinal illuminance is held constant as pupil size varies, visual image quality scales approximately as the square root of illuminance because of quantum fluctuations, but optimum pupil size is essentially independent of retinal illuminance and quantum fluctuations. Conversely, when stimulus luminance is held constant (and therefore illuminance varies with pupil size), optimum pupil size increases as luminance decreases, thereby compensating partially for increased quantum fluctuations. However, in the presence of -1 and -2 diopters of defocus and at high photopic levels where Weber's law operates, optical aberrations and diffraction dominate image quality and pupil optimization. Similar behavior was observed in human observers viewing sinusoidal gratings. Optimum pupil size increases as stimulus luminance drops for the well-focused eye, and the benefits of small pupils for improving defocused image quality remain throughout the photopic and mesopic ranges. However, restricting pupils to <2 mm will cause significant reductions in the best focus vision at low photopic and mesopic luminances.

Compensation of corneal oblique astigmatism by internal optics: a theoretical analysis.

PURPOSE: Oblique astigmatism is a prominent optical aberration of peripheral vision caused by oblique incidence of rays striking the refracting surfaces of the cornea and crystalline lens. We inquired whether oblique astigmatism from these two sources should be expected, theoretically, to have the same or opposite signs across the visual field at various states of accommodation. METHODS: Oblique astigmatism was computed across the central visual field for a rotationally-symmetric schematic-eye using optical design software. Accommodative state was varied by altering the apical radius of curvature and separation of the biconvex lens's two aspheric surfaces in a manner consistent with published biometry. Oblique astigmatism was evaluated separately for the whole eye, the cornea, and the isolated lens over a wide range of surface curvatures and asphericity values associated with the accommodating lens. We also computed internal oblique astigmatism by subtracting corneal oblique astigmatism from whole-eye oblique astigmatism. RESULTS: A visual field map of oblique astigmatism for the cornea in the Navarro model follows the classic, textbook description of radially-oriented axes everywhere in the field. Despite large changes in surface properties during accommodation, intrinsic astigmatism of the isolated human lens for collimated light is also radially oriented and nearly independent of accommodation both in theory and in real eyes. However, the magnitude of ocular oblique astigmatism is smaller than that of the cornea alone, indicating partial compensation by the internal optics. This implies internal oblique astigmatism (which includes wavefront propagation from the posterior surface of the cornea to the anterior surface of the lens and intrinsic lens astigmatism) must have tangentially-oriented axes. This non-classical pattern of tangential axes for internal astigmatism was traced to the influence of corneal power on the angles of incidence of rays striking the internal lens. CONCLUSIONS: Partial compensation of corneal astigmatism by internal optics is due mainly to the highly converging nature of wavefronts incident upon the lens resulting from corneal refraction. The degree of compensation is quadratically dependent on eccentricity but is expected to diminish as the eye accommodates. Neutralising the cornea by index-matching defeats internal compensation, revealing classical, radially-oriented oblique astigmatism in the isolated lens.

Variation of axial and oblique astigmatism with accommodation across the visual field.

In this study we investigated the impact of accommodation on axial and oblique astigmatism along 12 meridians of the central 30° of visual field and explored the compensation of corneal first-surface astigmatism by the remainder of the eye's optical system. Our experimental evidence revealed no systematic effect of accommodation on either axial or oblique astigmatism for two adult populations (myopic and emmetropic eyes). Although a few subjects exhibited systematic changes in axial astigmatism during accommodation, the dioptric value of these changes was much smaller than the amount of accommodation. For most subjects, axial and oblique astigmatism of the whole eye are both less than for the cornea alone, which indicates a compensatory role for internal optics at all accommodative states in both central and peripheral vision. A new method for determining the eye's optical axis based on visual field maps of oblique astigmatism revealed that, on average, the optical axis is 4.8° temporal and 0.39° superior to the foveal line-of-sight in object space, which agrees with previous results obtained by different methodologies and implies that foveal astigmatism includes a small amount of oblique astigmatism (0.06 D on average). Customized optical models of each eye revealed that oblique astigmatism of the corneal first surface is negligible along the pupillary axis for emmetropic and myopic eyes. Individual variation in the eye's optical axis is due in part to misalignment of the corneal and internal components that is consistent with tilting of the crystalline lens relative to the pupillary axis.

Interaction of axial and oblique astigmatism in theoretical and physical eye models.

The interaction between oblique and axial astigmatism was investigated analytically (generalized Coddington's equations) and numerically (ray tracing) for a theoretical eye model with a single refracting surface. A linear vector-summation rule for power vector descriptions of axial and oblique astigmatism was found to account for their interaction over the central 90° diameter of the visual field. This linear summation rule was further validated experimentally using a physical eye model measured with a laboratory scanning aberrometer. We then used the linear summation rule to evaluate the relative contributions of axial and oblique astigmatism to the total astigmatism measured across the central visual field. In the central visual field, axial astigmatism dominates because the oblique astigmatism is negligible near the optical axis. At intermediate eccentricities, axial and oblique astigmatism may have equal magnitude but orthogonal axes, which nullifies total astigmatism at two locations in the visual field. At more peripheral locations, oblique astigmatism dominates axial astigmatism, and the axes of total astigmatism become radially oriented, which is a trait of oblique astigmatism. When eccentricity is specified relative to a foveal line-of-sight that is displaced from the eye's optical axis, asymmetries in the visual field map of total astigmatism can be used to locate the optical axis empirically and to estimate the relative contributions of axial and oblique astigmatism at any retinal location, including the fovea. We anticipate the linear summation rule will benefit many topics in vision science (e.g., peripheral correction, emmetropization, meridional amblyopia) by providing improved understanding of how axial and oblique astigmatism interact to produce net astigmatism.

Uniformity of accommodation across the visual field.

We asked the question: Does accommodation change the eye's focusing power equally over the central visual field in emmetropic and myopic adult eyes? To answer this question we modified our laboratory scanning wavefront aberrometer to rapidly measure ocular refractive state over the central 30° diameter of visual field as a function of foveal accommodative demand. On average, ocular refractive state changed uniformly over the central visual field as the eye accommodated up to 6 D. Visual field maps of accommodative error (relative to a spherical target surface of constant vergence) reveal subtle patterns of deviation on the order of ± 0.5 D that are unique to the individual and relatively invariant to changes in accommodative state. Population mean maps for accommodative error are remarkably uniform across the central visual field, indicating the retina of the hypothetical "average eye" is conjugate to a sphere of constant target vergence for all states of accommodation, even though individual eyes might deviate from the mean due to random variations. No systematic difference between emmetropic and myopic eyes was evident. Since accuracy of accommodation across the central visual field is similar to that measured in the fovea, loss of image quality due to accommodative errors, which potentially drives myopia and may affect many aspects of visual function, will be similar across the central retina.

Neural bandwidth of veridical perception across the visual field.

Neural undersampling of the retinal image limits the range of spatial frequencies that can be represented veridically by the array of retinal ganglion cells conveying visual information from eye to brain. Our goal was to demarcate the neural bandwidth and local anisotropy of veridical perception, unencumbered by optical imperfections of the eye, and to test competing hypotheses that might account for the results. Using monochromatic interference fringes to stimulate the retina with high-contrast sinusoidal gratings, we measured sampling-limited visual resolution along eight meridians from 0° to 50° of eccentricity. The resulting isoacuity contour maps revealed all of the expected features of the human array of retinal ganglion cells. Contours in the radial fringe maps are elongated horizontally, revealing the functional equivalent of the anatomical visual streak, and are extended into nasal retina and superior retina, indicating higher resolution along those meridians. Contours are larger in diameter for radial gratings compared to tangential or oblique gratings, indicating local anisotropy with highest bandwidth for radially oriented gratings. Comparison of these results to anatomical predictions indicates acuity is proportional to the sampling density of retinal ganglion cells everywhere in the retina. These results support the long-standing hypothesis that "pixel density" of the discrete neural image carried by the human optic nerve limits the spatial bandwidth of veridical perception at all retinal locations.

Modelling the effects of secondary spherical aberration on refractive error, image quality and depth of focus.

PURPOSE: To examine the role of Zernike secondary spherical aberration and its component terms on refraction, image quality and depth of focus. METHODS: Computational methods were used to define wavefronts with controlled levels of r(6) , r(4) and r(2) terms, and image quality associated with these terms for a range of target vergences. Target vergences that generated maximum image quality were used as an objective measures of refractive error. RESULTS: Unlike primary Zernike spherical aberration, which generates peak image quality with a near paraxial focus, in the absence of other higher order aberrations, peak image quality with secondary spherical aberration is achieved with a near marginal focus. When alone, positive primary and secondary spherical aberration induce small hyperopic shifts in refraction, but in the presence of other higher order aberrations, secondary spherical aberration can induce significant myopic shifts in refractive error, as predicted by the combined lower order r(4) & r(2) component of Z60. The predicted expansion in depth of focus associated with increased primary or secondary spherical aberration is mostly absent if a strict image quality criterion is applied. The expansion of depth of focus observed with a low image quality criterion when opposite sign Z40 and Z60 are combined is primarily due to the elevated r(4) term. CONCLUSIONS: Secondary Zernike spherical aberration can have a significant impact on refractive error, image quality and depth of focus, but mostly due to the lower order components within this polynomial. Our analysis shows that the r(6) term that defines secondary spherical aberration actually narrows rather than expands depth of focus, when in the presence of the r(4) term within Z60. Therefore, a multifocal lens generated with exclusively primary spherical aberration is likely to be more effective than one that includes opposite sign of primary and secondary spherical aberration.

Differences between wavefront and subjective refraction for infrared light.

PURPOSE: To determine the accuracy of objective wavefront refractions for predicting subjective refractions for monochromatic infrared light. METHODS: Objective refractions were obtained with a commercial wavefront aberrometer (COAS, Wavefront Sciences). Subjective refractions were obtained for 30 subjects with a speckle optometer validated against objective Zernike wavefront refractions on a physical model eye (Teel et al., Design and validation of an infrared Badal optometer for laser speckle, Optom Vis Sci 2008;85:834-42). Both instruments used near-infrared (NIR) radiation (835 nm for COAS, 820 nm for the speckle optometer) to avoid correction for ocular chromatic aberration. A 3-mm artificial pupil was used to reduce complications attributed to higher-order ocular aberrations. For comparison with paraxial (Seidel) and minimum root-mean-square (Zernike) wavefront refractions, objective refractions were also determined for a battery of 29 image quality metrics by computing the correcting lens that optimizes retinal image quality. RESULTS: Objective Zernike refractions were more myopic than subjective refractions for 29 of 30 subjects. The population mean discrepancy was -0.26 diopters (D) (SEM = 0.03 D). Paraxial (Seidel) objective refractions tended to be hyperopically biased (mean discrepancy = +0.20 D, SEM = 0.06 D). Refractions based on retinal image quality were myopically biased for 28 of 29 metrics. The mean bias across all 31 measures was -0.24 D (SEM = 0.03). Myopic bias of objective refractions was greater for eyes with brown irises compared with eyes with blue irises. CONCLUSIONS: Our experimental results are consistent with the hypothesis that reflected NIR light captured by the aberrometer originates from scattering sources located posterior to the entrance apertures of cone photoreceptors, near the retinal pigment epithelium. The larger myopic bias for brown eyes suggests that a greater fraction of NIR light is reflected from choroidal melanin in brown eyes compared with blue eyes.

The 2012 Charles Prentice medal lecture: wavefront measurement of refractive state.

Modern efforts to define and measure the refractive state of aberrated eyes have led to new insights about the nature of refractive error, the quality of the retinal image, the interplay of the crystalline lens, and the eye's pupil during accommodation. Our change in mind-set engendered by wavefront concepts has the power to alter our way of thinking about many clinical issues that are fundamentally optical in nature, such as dynamic changes in optical quality of eyes caused by tear film deterioration, outcome assessment of refractive therapies, and myopia progression. The aim of this lecture is to help make advances in these areas of optometric science broadly accessible to educators, clinicians, and patients by explaining in simple terms the underlying optical concepts of wavefront aberrometry.