Darren E. Koenig

Wavefront-guided scleral lens correction in keratoconus.

Purpose To examine the performance of state-of-the-art wavefront-guided scleral contact lenses (wfgSCLs) on a sample of keratoconic eyes, with emphasis on performance quantified with visual quality metrics, and to provide a detailed discussion of the process used to design, manufacture, and evaluate wfgSCLs. Methods Fourteen eyes of seven subjects with keratoconus were enrolled and a wfgSCL was designed for each eye. High-contrast visual acuity and visual quality metrics were used to assess the on-eye performance of the lenses. Results The wfgSCL provided statistically lower levels of both lower-order root mean square (RMS) (p < 0.001) and higher-order RMS (HORMS) (p < 0.02) than an intermediate spherical equivalent scleral contact lens. The wfgSCL provided lower levels of lower-order RMS than a normal group of well-corrected observers (p << 0.001). However, the wfgSCL does not provide less HORMS than the normal group (p = 0.41). Of the 14 eyes studied, 10 successfully reached the exit criteria, achieving residual HORMS wavefront error less than or within 1 SD of the levels experienced by normal, age-matched subjects. In addition, measures of visual image quality (logVSX, logNS, and logLIB) for the 10 eyes were well distributed within the range of values seen in normal eyes. However, visual performance as measured by high-contrast acuity did not reach normal, age-matched levels, which is in agreement with prior results associated with the acute application of wavefront correction to keratoconic eyes. Conclusions Wavefront-guided scleral contact lenses are capable of optically compensating for the deleterious effects of higher-order aberration concomitant with the disease and can provide visual image quality equivalent to that seen in normal eyes. Longer-duration studies are needed to assess whether the visual system of the highly aberrated eye wearing a wfgSCL is capable of producing visual performance levels typical of the normal population.

Do color appearance judgments interfere with detection of small threshold stimuli

The application of adaptive optics to vision science creates the potential to directly probe the link between the retinal mosaic and visual perception. However, interrogation on a cellular level requires small, threshold stimuli and therefore an implicit detection model. Unfortunately the parameters governing detection at cone threshold are poorly constrained, and whether or not appearance judgments interact with detectability under these conditions is unknown. We tested the assumption that subjects can report stimulus appearance without compromising sensitivity by having four subjects rate either detection certainty, color appearance, or both, for small, brief, monochromatic (580 nm) point stimuli presented to the dark adapted fovea. Reporting color, either alone or in conjunction with detection certainty, did not impair detection. Sensitivity actually increased in the simultaneous reporting task, while color reports were effectively unaltered. These results suggest that 1. color mechanisms contain information relevant for detection at cone threshold, 2. subjects cannot voluntarily make full use of this information in a simple detection task, and 3. simultaneous reporting is a viable method of investigating multiple stimulus attributes for small threshold stimuli.

A Comparison of Three Methods to Increase Scleral Contact Lens On-Eye Stability.

Purpose: To quantify on-eye rotational and translational stability of three scleral contact lens stabilization methods and to model the variation in visual acuity when these movements occur in a wavefront-guided correction for highly aberrated eyes. Methods: Three lens stabilization methods were integrated into the posterior periphery of a scleral contact lens designed at the Visual Optics Institute. For comparison, a lens with no stabilization method (rotationally symmetric posterior periphery) was designed. The lenses were manufactured and lens movements were quantified on 8 eyes as the average SD of the observed translations and rotations over 60 min of wear. In addition, the predicted changes in acuity for five eyes with keratoconus wearing a simulated wavefront-guided correction (full correction through the fifth order) were modeled using the measured movements. Results: For each lens design, no significant differences in the translation and rotation were found between left and right eyes, and lenses behaved similarly on all subjects. All three designs with peripheral stability modifications exhibited no statistically significant differences in translation and rotation distributions of lens movement and were statistically more stable than the spherical lens in rotation. When the measured movements were used to simulate variation in visual performance, the 3 lenses with integrated stability methods showed a predicted average loss in acuity from the perfectly aligned condition of approximately 0.06 logMAR (3 letters), compared with the loss of over 0.14 logMAR (7 letters) for the lens with the spherical periphery. Conclusion: All three stabilization methods provided superior stability, as compared with the spherical lens design. Simulations of the optical and visual performance suggest that all three stabilization designs can provide desirable results when used in the delivery of a wavefront-guided correction for a highly aberrated eye.

Detecting Significant Change in Wavefront Error: How long does it take?

Purpose:  Measurement noise in ocular wavefront sensing limits detection of statistically significant change in high‐order wavefront error (HO WFE). Consequently, measurement noise is problematic when trying to detect progressive change in HO WFE. Our aims were to determine the necessary amount of time to detect age‐related change in HO WFE given measurement variability and HO WFE composition and magnitude; and to minimise the length of time necessary to detect change.

Factors accounting for the 4-year change in acuity in patients between 50 and 80 years.

Purpose It is well known that acuity slowly decreases in the later decades of life. We wish to determine the extent by which 4-year longitudinal acuity changes can be accounted for by changes in optical quality, or combination of optical quality metrics and of age between 50 and 80 years. Methods High-contrast logMAR acuity, 35 image quality metrics, 4 intraocular scatter metrics, and 4 Lens Opacification Classification System III metrics and entry age were measured on one eye of each of the 148 subjects. Acuity change between baseline and the last visit was regressed against change in each metric for all eyes and a faster changing subset of 50 eyes with a gain or loss of four or more letters. Results Average change across 148 subjects was a 1.6 ± 4 letter loss (t148 = 4.31, p < 0.001) and loss for the faster changing subset was 3.4 ± 6.1 letters (t50 = 2.73, p = 0.008). The multiple-regression model for faster changing eyes included change in point spread function entropy, posterior subcapsular cataract, and trefoil and baseline age (sequential r2 adjusted values of 0.19, 0.27, 0.32, and 0.34, respectively; p = 1.48 × 10−4 for the full four-factor model). The same variables entered the multiple-regression model for the full 148 data set where most of the acuity measurements were within test-retest error and accounted for less of the variance (r2 adjusted = 0.15, p = 2.37 × 10−5). Conclusions Despite being near noise levels for the measurement of acuity, change in optical quality metrics was the most important factor in eyes that lost or gained four or more letters of acuity. These findings should be generalizable given that our 4-year acuity change is essentially identical to other studies and indicate that these optical quality markers can be used to help identify those on a faster track to an acuity change.

Adaptive optics without altering visual perception.

Adaptive optics combined with visual psychophysics creates the potential to study the relationship between visual function and the retina at the cellular scale. This potential is hampered, however, by visual interference from the wavefront-sensing beacon used during correction. For example, we have previously shown that even a dim, visible beacon can alter stimulus perception (Hofer et al., 2012). Here we describe a simple strategy employing a longer wavelength (980nm) beacon that, in conjunction with appropriate restriction on timing and placement, allowed us to perform psychophysics when dark adapted without altering visual perception. The method was verified by comparing detection and color appearance of foveally presented small spot stimuli with and without the wavefront beacon present in 5 subjects. As an important caution, we found that significant perceptual interference can occur even with a subliminal beacon when additional measures are not taken to limit exposure. Consequently, the lack of perceptual interference should be verified for a given system, and not assumed based on invisibility of the beacon.