Alexander Leube

The Influence of Induced Astigmatism on the Depth of Focus.

Purpose To evaluate whether an induced astigmatism influences the subjective depth of focus. Methods Fifty-one participants aged 18 to 35 years and with a mean spherical equivalent refractive error of −0.51 ± 2.35 DS participated in the study. The accommodation was blocked with three drops of 1% cyclopentolate. Refractive errors were corrected after subjective refraction with a 4-mm artificial pupil. To evaluate the depth of focus (DoF), defocus curves with a spherical range of ±1.5 DS were assessed. The DoF was calculated as the horizontal distance at a threshold level of +0.1 logMAR from the maximum visual acuity (VA). Defocus curves were estimated binocularly during distance (500 cm) and a near vision (40 cm) for two induced axis (ATR in 0° and WTR in 90°) and for a fixed amount of astigmatic defocus of −0.5 DC. Results The mean natural DoF was 0.885 ± 0.316 D for far vision and 0.940 ± 0.400 D for near vision. With induced astigmatism, the DoF for far vision was significantly increased to 1.095 ± 0.421 D (p = 0.006, ANOVA) for the WTR astigmatism but not for the ATR astigmatism (1.030 ± 0.395 D; p = 0.164, ANOVA). The induced WTR astigmatism enhanced the DoF for near vision significantly to 1.144 ± 0.338 D (p = 0.04, ANOVA), and DoF with induced ATR astigmatism (0.953 ± 0.318 D) was not significantly different (p = 1.00, ANOVA). ATR-astigmatism reduced VA by +0.08 ± 0.08 logMAR (p < 0.01, t-test). Conclusions With an induced WTR astigmatism of −0.5 DC, the DoF can be enhanced in the near viewing distance with a marginal loss in binocular VA. The approach of using induced WTR astigmatism can lead to novel optical treatments for presbyopia.

TuebingenCSTest – a useful method to assess the contrast sensitivity function

Since contrast sensitivity (CS) relies on the accuracy of stimulus presentation, the reliability of the psychophysical procedure and observers attention, the measurement of the CS-function is critical and therefore, a useful threshold contrast measurement was developed. The Tuebingen Contrast Sensitivity Test (TueCST) includes an adaptive staircase procedure and a 16-bit gray-level resolution. In order to validate the CS measurements with the TueCST, measurements were compared with existing tests by inter-test repeatability, test-retest reliability and time. The novel design enables an accurate presentation of the spatial frequency and higher precision, inter-test repeatability and test-retest reliability compared to other existing tests.

Steps towards Smarter Solutions in Optometry and Ophthalmology-Inter-Device Agreement of Subjective Methods to Assess the Refractive Errors of the Eye.

Purpose: To investigate the inter-device agreement and mean differences between a newly developed digital phoropter and the two standard methods (trial frame and manual phoropter). Methods: Refractive errors of two groups of participants were measured by two examiners (examiner 1 (E1): 36 subjects; examiner 2 (E2): 38 subjects). Refractive errors were assessed using a trial frame, a manual phoropter and a digital phoropter. Inter-device agreement regarding the measurement of refractive errors was analyzed for differences in terms of the power vector components (spherical equivalent (SE) and the cylindrical power vector components J0 and J45) between the used methods. Intraclass correlation coefficients (ICC’s) were calculated to evaluate correlations between the used methods. Results: Analyzing the variances between the three methods for SE, J0 and J45 using a two-way ANOVA showed no significant differences between the methods (SE: p = 0.13, J0: p = 0.58 and J45: p = 0.96) for examiner 1 and for examiner 2 (SE: p = 0.88, J0: p = 0.95 and J45: p = 1). Mean differences and ±95% Limits of Agreement for each pair of inter-device agreement regarding the SE for both examiners were as follows: Trial frame vs. digital phoropter: +0.10 D ± 0.56 D (E1) and +0.19 D ± 0.60 D (E2), manual phoropter vs. trial frame: −0.04 D ± 0.59 D (E1) and −0.12 D ± 0.49 D (E2) and for manual vs. digital phoropter: +0.06 D ± 0.65 D (E1) and +0.08 D ± 0.45 D (E2). ICCs revealed high correlations between all methods for both examiner (p < 0.001). The time to assess the subjective refraction was significantly smaller with the digital phoropter (examiner 1: p < 0.001; examiner 2: p < 0.001). Conclusion: “All used subjective methods show a good agreement between each other terms of ICC (>0.9). Assessing refractive errors using different subjective methods, results in similar mean differences and 95% limits of agreement, when compared to those reported in studies comparing subjective refraction non-cylcoplegic retinoscopy or autorefraction”.

Individual neural transfer function affects the prediction of subjective depth of focus

Attempts to accurately predict the depth of focus (DoF) based on objective metrics have failed so far. We investigated the effect of the individual neural transfer function (iNTF) on the quality of the prediction of the subjective DoF from objective wavefront measures. Subjective DoF was assessed in 22 participants using subjective through focus curves of visual acuity (VA). Objective defocus curves were calculated for visual Strehl metrics of the optical (VSOTFa) and the modulation transfer function as well as the point spread function. DoF was computed for residual lower order aberrations (rLoA) and incorporation of iNTF. Correlations between subjective and objective DoF did not reach significance, when a) standard metrics were used and b) rLoA were considered (rmax = 0.33, pall > 0.05). By incorporating the iNTF of the individuals in the calculation of the objective DoF from the VSOTFa metric, a moderate statistically significant correlation was found (r = 0.43, p < 0.01, Pearson). The iNTF of the individual’s eye is fundamental for the prediction of subjective DoF using the VSOTFa metric. Individualized predictions could aid future application in the correction of refractive errors like presbyopia using intraocular lenses.

Axis-free correction of astigmatism using bifocal soft contact lenses

PURPOSE Pilot study to investigate the feasibility of an axis-free correction approach of regular astigmatism using soft, bifocal contact lenses (CL). METHODS The investigation covers an optical simulation and a pilot study for the assessment of visual performance (over refraction OR, monocular visual acuity VA). The power of the two zones was adjusted according to the power of the astigmatic meridians, individually. Subjective performance was assessed in 30 participants with a mean horizontal cylindrical component of J0=- 0.65±1.29 D (cylinder from -0.75 to -4.00 DC). OR and VA were measured directly after fitting the CL, after one hour and after 5days (3FUP). RESULTS Evaluating the modulation transfer function, CL increased the Strehl ratio by 10% and the transferred spatial frequency was improved from 6.6 cpd to 21.3 cpd. Analysis of Sturms interval revealed a residual astigmatism of DAst=0.73 D. OR revealed a statistically significant reduction of spherical error between baseline and all follow up (ΔM=-2.14 D, p<0.001) and between the J0 from baseline to 3FUP (ΔJ0=-0.46 D, p=0.04). Wearing the CL for 5days did not result in a significant difference of VA (ΔVA3FUP=+0.01 logMAR, p=0.99). CONCLUSION Axis-free correction of astigmatism using bifocal CL resulted in reasonable performance based on computer simulation. Participants showed no clinically reduced visual acuity or contrast sensitivity. Further clinical studies are needed to show if this approach provides a good alternative to conventional astigmatic correction.