Background: Complaints of glare, halos, and disturbances of night vision after photorefractive keratectomy (PRK) probably result from changes in the corneal aberration structure induced by the laser ablation procedure. The purpose of this article is to characterize changes in the corneal aberration structure after PRK and to demonstrate the effect of pupil dilation on these changes. Methods: Videokeratographs obtained preoperatively (n = 112) and at 1 (n = 94), 3 (n = 103), 6 (n = 91), 12 (n = 60), 18 (n = 53), and 24 (n = 44) months postoperatively from 112 eyes of 89 patients who had undergone PRK for myopia were analyzed. The data were used to calculate the wavefront variance of the cornea for both small (3-mm) and large (7-mm) pupils. Results: For both the 3- and 7-mm pupil, coma-like aberrations increased significantly from preoperative values to 1-month postoperative values (P,.05 and P,.001, respectively); for 7-mm pupils, the postoperative values never returned to preoperative values (P,.001, 24 months). For the 3-mm pupil, spherical-like aberrations decreased significantly 1 month after surgery (P,.001), and never returned to preoperative values. For the 7-mm pupil, spherical-like aberrations increased significantly 1 month after surgery (P,.001) and did not return to preoperative values. Opening the pupil from 3 to 7 mm increased spherical-like aberrations only 7-fold before PRK. After PRK, however, pupillary dilation caused a 300-fold increase in this type of aberration. For both pupil sizes at all times after PRK, the magnitude of the surgically induced aberration correlated with the amount of the attempted correction (P,.001, r 2 = 0.6 at 1 month for a 7-mm pupil). Conclusions: Photorefractive keratectomy increases the wavefront variance of the cornea; PRK changes the relative contribution of coma-like and spherical-like aberrations; after PRK, the diameter of the entrance pupil greatly affects the amount and character of the aberrations; and the magnitude of the aberration increases with the attempted correction. Clinical Relevance: Quantitative characterization of irregular astigmatism with the measurement of aberration structures following corneal surgery and the correlation of these data with visual performance in clinical trials provide the basis for understanding patient complaints and for improving surgical approaches. Our analysis shows that, whereas induced aberrations are minimal for simulated daytime vision (3-mm pupil), the increase in aberrations measured for simulated night vision (7-mm pupil) supports the use of large treatment zones to reduce visual disturbances such as glare and halos.

/pdf/effect-of-pupillary-dilation-on-corneal-optical-aberrations-1asiwoil11.pdf

Effect of pupillary dilation on corneal optical aberrations after Photorefractive keratectomy

The present invention discloses methods of obtaining ophthalmic lens capable of reducing the aberrations of the eye comprising the steps of characterizing at least one corneal surface as a mathematical model, calculating the resulting aberrations of said corneal surface(s) by employing said mathematical model, selecting the optical power of the intraocular lens. From this information, an ophthalmic lens is modeled so a wavefront arriving from an optical system comprising said lens and corneal model obtains reduced aberrations in the eye. Also disclosed are ophthalmic lenses as obtained by the methods which are capable reducing aberrations of the eye.

Methods of obtaining ophthalmic lenses providing the eye with reduced aberrations

A procedure to calculate the wave aberration of the human cornea from its surface shape measured by videokeratography is presented. The wave aberration was calculated as the difference in optical path between the marginal rays and the chief ray refracted at the surface, for both on- and off-axis objects. The corneal shape elevation map was obtained from videokeratography and fitted to a Zernike polynomial expansion through a Gram–Schmidt orthogonalization. The wave aberration was obtained also as a Zernike polynomial representation. The accuracy of the procedure was analyzed. For calibrated reference surface elevations, a root-mean-square error (RMSE) of 1 to 2 μm for an aperture 4–6 mm in diameter was obtained, and the RMSE associated with the experimental errors and with the fitting method was 0.2 μm. The procedure permits estimation of the corneal wave aberration from videokeratoscopic data with an accuracy of 0.05–0.2 μm for a pupil 4–6 mm in diameter, rendering the method adequate for many applications.

Corneal wave aberration from videokeratography: accuracy and limitations of the procedure.

The present invention provides a method for designing and making a customized ophthalmic lens, such as a contact lens or an intraocular lens, capable of correcting high-order aberrations of an eye. The posterior surface of the customized contact lens is designed to accommodate the corneal topography of an eye. The design of the customized ophthalmic lens is evaluated and optimized in an optimizing routine using a computational model eye that reproduces the aberrations and corneal topography of an eye. The present invention also provides a system and method for characterizing the optical metrology of a customized ophthalmic lens that is designed to correct aberrations of an eye. Furthermore, the present invention provides a business model and method for placing an order for a pair of customized ophthalmic lenses.

Automatic lens design and manufacturing system

A method of designing a multifocal ophthalmic lens with one base focus and at least one additional focus, capable of reducing aberrations of the eye for at least one of the foci after its implantation, comprising the steps of: (i) characterizing at least one corneal surface as a mathematical model; (ii) calculating the resulting aberrations of said corneal surface(s) by employing said mathematical model; (iii) modeling the multifocal ophthalmic lens such that a wavefront arriving from an optical system comprising said lens and said at least one corneal surface obtains reduced aberrations for at least one of the foci. There is also disclosed a method of selecting a multifocal intraocular lens, a method of designing a multifocal ophthalmic lens based on corneal data from a group of patients, and a multifocal ophthalmic lens.

Multifocal ophthalmic lens

PURPOSE We compared the accuracy of the Computed Anatomy TMS-1 (1.41), the EyeSys Laboratories Corneal Analysis System (2.1), and the Visioptic EH-270 (3.0) videokeratoscopes in measuring toric surfaces. These non-rotationally symmetric aspheric surfaces served as models of corneal astigmatism. METHODS Precision diamond-turned toric surfaces modeling 0.00 diopter (D) to 7.00 D of astigmatism were fabricated. A three-dimensional contact profiler was developed to calibrate the aspheric surfaces. Videokeratoscopic data taken at "best focus" were compared to the theoretical shape to quantify device measurement errors. RESULTS The Computed Anatomy system measurement accuracy shows no statistically significant correlation between measurement error and surface toricity (r2 0.96, p < 0.001 and the Visioptic system (0.03 D error per D of astigmatism, r2 = 0.88, p < 0.001). CONCLUSIONS This study found systematic performance differences among the three machines. Under ideal alignment conditions, the Computed Anatomy TMS-1 is more accurate at detecting astigmatism. The EyeSys Laboratories Corneal Analysis System apparently underestimates the amount of surface astigmatism because of excessive data smoothing. The Visioptic EH-270 errors are primarily in the central zones and may be due to ring localization errors.

Comparison of three videokeratoscopes in measurement of toric test surfaces.

Purpose To demonstrate the potential use of subpixel image processing methods to perform automated Hirschberg measurements of strabismic deviations using relatively inexpensive personal computer hardware; to determine if the method might allow screening for strabismus using full-face video images obtained from a distance of 1 meter. Methods Strabismic deviations ( Results In 10 normal subjects, there was a statistically significant linear correlation of Hirschberg horizontal reflex deviation with asymmetric fixation pseudo-esotropia (0.85 > or = r2 > or = 0.99, P Conclusions The Hirschberg test is used manually to detect strabismus in infants and children but requires a highly skilled examiner. The image processing method described here requires no operator interpretation and may make the test more applicable. The results suggest that this technology may be appropriate for a screening instrument.

Videographic Hirschberg measurement of simulated strabismic deviations.

Visual Acuity Modeling Using Optical Raytracing of Schematic Eyes

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Papers

Comparison of three videokeratoscopes in measurement of toric test surfaces.

Videographic Hirschberg measurement of simulated strabismic deviations.

Visual Acuity Modeling Using Optical Raytracing of Schematic Eyes