Harilaos Ginis

The effect of ocular aberrations on steady-state errors of accommodative response

It is well accepted that the accommodation system is characterized by steady-state errors in focus. The purpose of this study was to correlate these errors with changes in ocular wavefront aberration and corresponding image quality when accommodating. A wavefront analyzing system, the Complete Ophthalmic Analysis System (COAS), was used in conjunction with a Badal optometer to allow continuous recording of the aberration structure of the eye for a range of accommodative demands (up to 8 D). Fifty consecutive recordings from seven subjects were taken. Monocular accommodative response was calculated as (i) the equivalent refraction minimizing wavefront error and (ii) the defocus needed to optimize the modulation transfer function at high spatial frequencies. Previously reported changes in ocular aberrations with accommodation (e.g., the shift of spherical aberration to negative values) were confirmed. Increased accommodation errors for near targets (lags) were evident for all subjects, although their magnitude showed a significant intersubject variability. It is concluded that the one-to-one stimulus/response slope in accommodation function should not always be considered as ideal, because higher order aberrations, especially changes of spherical aberration, may influence the actual accommodative demand. Fluctuations may serve to preserve image quality when errors of accommodation are moderate, by temporarily searching for the best focus.

Epi-LASIK: Preliminary clinical results of an alternative surface ablation procedure

Purpose: To evaluate the clinical results of epi‐LASIK, a new surface ablation surgical technique for the treatment of low myopia. Setting: Vardinoyannion Eye Institute of Crete, University of Crete, Greece. Methods: Forty‐four eyes of 31 patients had epi‐LASIK for the correction of low myopia. Mean preoperative spherical equivalent was 3.71 diopters (D) ± 1.2 (SD) (range −1.75 to −7.00 D) and the mean baseline logMAR best spectacle‐corrected visual acuity was −0.01 ± 0.06 (range 0.10 to −0.10). All the epithelial separations were performed with the Centurion epikeratome (CIBA Surgical). The enrolled patients were followed daily until the epithelial healing was complete as well as at 1‐ and 3‐month intervals. On the operative day, patients filled out a questionnaire grading visual performance and pain score of treated eyes every 2 hours for a total of 5 records. Results: The mean epithelial healing time was 4.86 ± 0.56 days (range 3 to 5 days). The mean logMAR uncorrected visual acuity on the day of reepithelization was 0.19 ± 0.09 (range 0.40 to 0.10). At 1 month, the mean was spherical equivalent of the treated eyes (N = 44), −0.3 ± 0.6 D (range −1.0 to 0.87 D), and at 3 months it was (N = 37), −0.10 ± 0.4 D (range −0.75 to 0.75 D); 97% of eyes had clear corneas or trace haze 3 months after treatment. Conclusions: Preliminary clinical results suggest that epi‐LASIK is a safe and efficient method for the correction of low myopia. Further studies will establish this method as an alternative surface ablation procedure.

Variability of wavefront aberration measurements in small pupil sizes using a clinical Shack-Hartmann aberrometer

BackgroundRecently, instruments for the measurement of wavefront aberration in the living human eye have been widely available for clinical applications. Despite the extensive background experience on wavefront sensing for research purposes, the information derived from such instrumentation in a clinical setting should not be considered a priori precise. We report on the variability of such an instrument at two different pupil sizes.MethodsA clinical aberrometer (COAS Wavefront Scienses, Ltd) based on the Shack-Hartmann principle was employed in this study. Fifty consecutive measurements were perfomed on each right eye of four subjects. We compared the variance of individual Zernike expansion coefficients as determined by the aberrometer with the variance of coefficients calculated using a mathematical method for scaling the expansion coefficients to reconstruct wavefront aberration for a reduced-size pupil.ResultsWavefront aberration exhibits a marked variance of the order of 0.45 microns near the edge of the pupil whereas the central part appears to be measured more consistently. Dispersion of Zernike expansion coefficients was lower when calculated by the scaling method for a pupil diameter of 3 mm as compared to the one introduced when only the central 3 mm of the Shack – Hartmann image was evaluated. Signal-to-noise ratio was lower for higher order aberrations than for low order coefficients corresponding to the sphero-cylindrical error. For each subject a number of Zernike expansion coefficients was below noise level and should not be considered trustworthy.ConclusionWavefront aberration data used in clinical care should not be extracted from a single measurement, which represents only a static snapshot of a dynamically changing aberration pattern. This observation must be taken into account in order to prevent ambiguous conclusions in clinical practice and especially in refractive surgery.

The wide-angle point spread function of the human eye reconstructed by a new optical method

The point spread function (PSF) of the human eye spans over a wide angular distribution where the central part is associated mostly to optical aberrations while the peripheral zones are associated to light scattering. There is a plethora of optical methods for the direct and indirect measurements of the central part of the PSF as a result of monochromatic and polychromatic aberrations. The impact of the spatial characteristics of this central part of the PSF on the retinal image quality and visual function has been extensively analyzed and documented both by optical and psychophysical methods. However, the more peripheral areas of the PSF in the living human eye, ranging from about 1 to 10 degrees of eccentricity, have been investigated only psychophysically. We report here a new optical method for the accurate reconstruction of the wide-angle PSF in the living human eye up to 8 degrees. The methodology consists of projecting disks of uniform radiance on the retina, recording the images after reflection and double pass through the eyes optics and performing a proper analysis of the images. Examples of application of the technique in real eyes with different amount of scatter artificially induced are presented. This procedure allows the direct, accurate, and in vivo measurement of the effect of intraocular scattering and may be a step toward the comprehensive optical evaluation of the optics of the living human eye.

Corneal Biomechanical Properties from Two-Dimensional Corneal Flap Extensiometry: Application to UV-Riboflavin Cross-Linking

PURPOSE Corneal biomechanical properties are usually measured by strip extensiometry or inflation methods. We developed a two-dimensional (2D) flap extensiometry technique, combining the advantages of both methods, and applied it to measure the effect of UV-Riboflavin cross-linking (CXL). METHODS Corneal flaps (13 pig/8 rabbit) from the de-epithelialized anterior stroma (96 μm) were mounted on a custom chamber, consisting of a BK7 lens, a reflective retina, and two reservoirs (filled with Riboflavin and silicone oil). Stretching the corneal flap during five pressure increase/decrease cycles (0-30 mm Hg) changed the refractive power of the system, whose Zernike aberrations were monitored with a ray-tracing aberrometer. Porcine flaps were used to test the system. Rabbits were treated with CXL unilaterally in vivo following standard clinical procedures. Flaps were measured 1 month postoperatively. An analytical model allowed estimating Youngs modulus from the change in surface (strain) and pressure (stress). Confocal microscopy examination was performed before, and at different times after CXL. RESULTS Flap curvature changed with increased function of IOP in pig flaps (23.4 × 10⁻³ D/mm Hg). In rabbit flaps curvature changed significantly less in 1 month post CXL (P = 0.026) than in untreated corneas [17.0 vs. 6.36 millidiopter (mD)/mm Hg]. Youngs modulus was 2.29 megapascals (MPa) in porcine corneas, 1.98 MPa in untreated rabbit corneas, and 4.83 MPa in 1 month post CXL rabbit corneas. At the same time, highly reflective structures were observed in the rabbit midstroma after treatment. CONCLUSIONS 2D flap extensiometry allows estimating corneal elasticity in vitro. The measurements are spatially resolved in depth, minimize the effects of corneal hydration, and preserve the integrity of the cornea. The method proved the efficacy of CXL in increasing corneal rigidity after 1 month in rabbits.

Influence of ablation parameters on refractive changes after phototherapeutic keratectomy.

PURPOSE The aim of the current study was to control the hypothetical effects of decreased laser energy delivered to the peripheral cornea during phototherapeutic keratectomy (PTK) and provide quantitative calculation of induced low and high order aberrations. METHODS We employed a model eye to simulate the refractive effect of homogeneous laser corneal irradiation, as in PTK, for different laser fluences (range 125 to 225 mJ/cm2) and treatment depths up to 200 microm. RESULTS The hyperopic shift induced by the relatively lower energy delivered at the peripheral ablation zone during PTK was proportional to the treatment depth and inversely proportional to the energy fluence. The hyperopic shift calculated using the above ablation parameters was lower compared to previously reported clinical results. Higher order wavefront aberration (total root mean square) changes were of minimal significance for treatment depths up to 200 microm. CONCLUSIONS After PTK, a hyperopic shift cannot be attributed to the energy delivery method alone. Modification of laser energy delivery algorithms may only minimize PTK-induced hyperopia.

Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of axial length.

PURPOSE Previous studies have shown a negative correlation between axial length (AL) and pulsatile ocular blood flow (POBF). This relation has been questioned because of the possible confounding effect of ocular volume on ocular rigidity (OR). The purpose of this study was to investigate the relation between AL, as a surrogate parameter for ocular volume, and OR, ocular pulse amplitude (OPA), and POBF. METHODS Eighty-eight cataract patients were enrolled in this study. A computer-controlled device comprising a microdosimetric pump and a pressure sensor was used intraoperatively. The system was connected to the anterior chamber and used to raise the intraocular pressure (IOP) from 15 to 40 mm Hg, by infusing the eye with a saline solution. After each infusion step, the IOP was continuously recorded for 2 seconds. Blood pressure and pulse rate were measured during the procedure. The OR coefficient was calculated from the pressure volume data. OPA and POBF were measured from pressure recordings. RESULTS Median AL was 23.69 (interquartile range 3.53) mm. OR coefficient was 0.0218 (0.0053) μL(-1). A negative correlation between the OR coefficient and AL (ρ = -0.641, P < 0.001) was documented. Increasing AL was associated with decreased OPA (ρ = -0.637, P < 0.001 and ρ = -0.690, P < 0.001) and POBF (ρ = -0.207, P = 0.053 and ρ = -0.238, P = 0.028) at baseline and elevated IOP, respectively. CONCLUSIONS Based on manometric data, increasing AL is associated with decreased OR, OPA, and POBF. These results suggest decreased pulsatility in high myopia and may have implications on ocular pulse studies and the pathophysiology of myopia.

Corneal Hydration Monitored by Laser-induced Breakdown Spectroscopy

BACKGROUND Corneal hydration is an important factor in laser corneal ablation. In photorefractive keratectomy (PRK), corneal ablation rate and final ablation surface quality are strongly dependent on corneal hydration. We used a spectroscopic technique for monitoring corneal hydration during PRK. METHODS Hydroxyethlymethacrylate (HEMA) was employed for corneal hydration modeling. Hydrated HEMA samples were irradiated with a pulsed Nd:YAG laser (1064 nm, 10 mJ/pulse, pulse duration 15 nsec). Successive emission spectra corresponding to different degrees of hydration were recorded on a gated optical multichannel analyzer. The weight of the sample and hence its water content was monitored during the entire procedure with a sensitive balance. One rabbit and one human cornea were used to demonstrate the spectral analogy between the model and corneal tissue. RESULTS The most noticeable dependence on water content of the substrate was that of atomic emission lines of Ca at 393 nm and 396 nm. CONCLUSION Plasma emission spectra exhibited significant dependence on sample hydration. This dependence can be used for estimation of water content of irradiated model material and real cornea.

Wavelength dependence of the ocular straylight.

PURPOSE Ocular straylight is the combined effect of light scattering in the optical media and the diffuse reflectance from the various fundus layers. The aim of this work was to employ an optical technique to measure straylight at different wavelengths and to identify the optimal conditions for visually relevant optical measurements of straylight. METHODS The instrument, based on the double-pass (DP) principle, used a series of uniform disks that were projected onto the retina, allowing the recording of the wide-angle point spread function (PSF) from its peak and up to 7.3° of visual angle. A liquid crystal wavelength tunable filter was used to select six different wavelengths ranging from 500 to 650 nm. The measurements were performed in nine healthy Caucasian subjects. The straylight parameter was analyzed for small (0.5°) and large (6°) angles. RESULTS For small angles, the wavelength dependence of straylight matches the transmittance spectrum of hemoglobin, which suggests that diffuse light from the fundus contributes significantly to the total straylight for wavelengths longer than 600 nm. Eyes with lighter pigmentation exhibited higher straylight at all wavelengths. For larger angles, straylight was less dependent on wavelength and eye pigmentation. CONCLUSIONS Small-angle straylight in the eye is affected by the wavelength-dependent properties of the fundus. At those small angles, measurements using wavelengths near the peak of the spectral sensitivity of the eye might be better correlated with the visual aspects of straylight. However, the impact of fundus reflectance on the values of the straylight parameter at larger angles did not depend on the measuring wavelength.

Compact optical integration instrument to measure intraocular straylight

Optical measurement of straylight in the human eye is a challenging task. Issues such as illumination geometry, detector sensitivity and dynamic range as well as various inherent artifacts must be addressed. We developed a novel instrument based on the principle of double-pass optical integration adapted for fast measurements in a clinical setting. The experimental setup was validated using four different diffusers introduced in front of the eyes of ten subjects. Measurement limitations and future implications of rapid optical measurement of straylight in ophthalmic diagnosis are discussed.