Miriam Velasco-Ocana

Full OCT anterior segment biometry: an application in cataract surgery.

In vivo three-dimensional (3-D) anterior segment biometry before and after cataract surgery was analyzed by using custom high-resolution high-speed anterior segment spectral domain Optical Coherence Tomography (OCT). The system was provided with custom algorithms for denoising, segmentation, full distortion correction (fan and optical) and merging of the anterior segment volumes (cornea, iris, and crystalline lens or IOL), to provide fully quantitative data of the anterior segment of the eye. The method was tested on an in vitro artificial eye with known surfaces geometry at different orientations and demonstrated on an aging cataract patient in vivo. Biometric parameters CCT, ACD/ILP, CLT/ILT Tilt and decentration are retrieved with a very high degree of accuracy. IOL was placed 400 μm behind the natural crystalline lens, The IOL was aligned with a similar orientation of the natural lens (2.47 deg superiorly), but slightly lower amounts (0.77 deg superiorly). The IOL was decentered superiorly (0.39 mm) and nasally (0.26 mm).

OCT-based crystalline lens topography in accommodating eyes

Custom Spectral Domain Optical Coherence Tomography (SD-OCT) provided with automatic quantification and distortion correction algorithms was used to measure anterior and posterior crystalline lens surface elevation in accommodating eyes and to evaluate relationships between anterior segment surfaces. Nine young eyes were measured at different accommodative demands. Anterior and posterior lens radii of curvature decreased at a rate of 0.78 ± 0.18 and 0.13 ± 0.07 mm/D, anterior chamber depth decreased at 0.04 ± 0.01 mm/D and lens thickness increased at 0.04 ± 0.01 mm/D with accommodation. Three-dimensional surface elevations were estimated by subtracting best fitting spheres. In the relaxed state, the spherical term accounted for most of the surface irregularity in the anterior lens (47%) and astigmatism (70%) in the posterior lens. However, in accommodated lenses astigmatism was the predominant surface irregularity (90%) in the anterior lens. The RMS of high-order irregularities of the posterior lens surface was statistically significantly higher than that of the anterior lens surface (x2.02, p<0.0001). There was significant negative correlation in vertical coma (Z3 (-1)) and oblique trefoil (Z3 (-3)) between lens surfaces. The astigmatic angle showed high degree of alignment between corneal surfaces, moderate between corneal and anterior lens surface (~27 deg), but differed by ~80 deg between the anterior and posterior lens surfaces (including relative anterior/posterior lens astigmatic angle shifts (10-20 deg).

Optical coherence tomography based estimates of crystalline lens volume, equatorial diameter, and plane position

PURPOSE Measurement of crystalline lens geometry in vivo is critical to optimize performance of state-of-the-art cataract surgery. We used custom-developed quantitative anterior segment optical coherence tomography (OCT) and developed dedicated algorithms to estimate lens volume (VOL), equatorial diameter (DIA), and equatorial plane position (EPP). METHODS The method was validated ex vivo in 27 human donor (19-71 years of age) lenses, which were imaged in three-dimensions by OCT. In vivo conditions were simulated assuming that only the information within a given pupil size (PS) was available. A parametric model was used to estimate the whole lens shape from PS-limited data. The accuracy of the estimated lens VOL, DIA, and EPP was evaluated by comparing estimates from the whole lens data and PS-limited data ex vivo. The method was demonstrated in vivo using 2 young eyes during accommodation and 2 cataract eyes. RESULTS Crystalline lens VOL was estimated within 96% accuracy (average estimation error across lenses ± standard deviation: 9.30 ± 7.49 mm3). Average estimation errors in EPP were below 40 ± 32 μm, and below 0.26 ± 0.22 mm in DIA. Changes in lens VOL with accommodation were not statistically significant (2-way ANOVA, P = 0.35). In young eyes, DIA decreased and EPP increased statistically significantly with accommodation (P < 0.001) by 0.14 mm and 0.13 mm, respectively, on average across subjects. In cataract eyes, VOL = 205.5 mm3, DIA = 9.57 mm, and EPP = 2.15 mm on average. CONCLUSIONS Quantitative OCT with dedicated image processing algorithms allows estimation of human crystalline lens volume, diameter, and equatorial lens position, as validated from ex vivo measurements, where entire lens images are available.

OCT-based full crystalline lens shape change during accommodation in vivo

The full shape of the accommodating crystalline lens was estimated using custom three-dimensional (3-D) spectral OCT and image processing algorithms. Automatic segmentation and distortion correction were used to construct 3-D models of the lens region visible through the pupil. The lens peripheral region was estimated with a trained and validated parametric model. Nineteen young eyes were measured at 0-6 D accommodative demands in 1.5 D steps. Lens volume, surface area, diameter, and equatorial plane position were automatically quantified. Lens diameter & surface area correlated negatively and equatorial plane position positively with accommodation response. Lens volume remained constant and surface area decreased with accommodation, indicating that the lens material is incompressible and the capsular bag elastic.

Full 3-D OCT-based pseudophakic custom computer eye model

We compared measured wave aberrations in pseudophakic eyes implanted with aspheric intraocular lenses (IOLs) with simulated aberrations from numerical ray tracing on customized computer eye models, built using quantitative 3-D OCT-based patient-specific ocular geometry. Experimental and simulated aberrations show high correlation (R = 0.93; p<0.0001) and similarity (RMS for high order aberrations discrepancies within 23.58%). This study shows that full OCT-based pseudophakic custom computer eye models allow understanding the relative contribution of optical geometrical and surgically-related factors to image quality, and are an excellent tool for characterizing and improving cataract surgery.

Portable simultaneous vision device to simulate multifocal corrections

Multifocal lenses are increasingly used solutions for presbyopia, the age-related loss of crystalline lens focus ability. These lenses work by the principle of simultaneous vision, superimposing focused and defocused images on the retina. Providing the experience of simultaneous vision to a patient before permanent implantation of a multifocal lens is a recognized unmet need to increase the patient’s confidence and optimize the lens selection. We developed a hand-held, see-through multifocal vision simulator based on temporal multiplexing of a tunable lens. The device was calibrated and validated using focimetry and Hartmann–Shack aberrometry revealing high reproducibility of the through-focus multifocal energy distribution and high optical quality. We measured visual acuity and perceptual quality on nine cyclopeged patients with three monofocal, two bifocal, and two trifocal corrections with different far/intermediate/near energy distributions simulated using the device. Visual performance and perceptual quality with multifocal corrections varied across patients, although they were more uniform across distances than monofocal corrections. Among the bifocal and trifocal designs, a trifocal with more energy at far was the most frequently identified as providing better quality. The simultaneous vision simulator proved a promising compact tool to study visual performance with multifocal corrections and to select the lens design best suited for each patient, alternative to costly and bulky adaptive optics based devices.

Impact of astigmatism and high-order aberrations on subjective best focus.

We studied the role of native astigmatism and ocular aberrations on best-focus setting and its shift upon induction of astigmatism in 42 subjects (emmetropes, myopes, hyperopes, with-the-rule [WTR] and against-the-rule [ATR] myopic astigmats). Stimuli were presented in a custom-developed adaptive optics simulator, allowing correction for native aberrations and astigmatism induction (+1 D; 6-mm pupil). Best-focus search consisted on randomized-step interleaved staircase method. Each subject searched best focus for four different images, and four different conditions (with/without aberration correction, with/without astigmatism induction). The presence of aberrations induced a significant shift in subjective best focus (0.4 D; p < 0.01), significantly correlated (p = 0.005) with the best-focus shift predicted from optical simulations. The induction of astigmatism produced a statistically significant shift of the best-focus setting in all groups under natural aberrations (p = 0.001), and in emmetropes and in WTR astigmats under corrected aberrations (p < 0.0001). Best-focus shift upon induced astigmatism was significantly different across groups, both for natural aberrations and AO-correction (p < 0.0001). Best focus shifted in opposite directions in WTR and ATR astigmats upon induction of astigmatism, symmetrically with respect to the best-focus shift in nonastigmatic myopes. The shifts are consistent with a bias towards vertical and horizontal retinal blur in WTR and ATR astigmats, respectively, indicating adaptation to native astigmatism.

Three-dimensional OCT based Guinea pig eye model: Relating morphology and optics

Custom Spectral Optical Coherence Tomography (SOCT) provided with automatic quantification and distortion correction algorithms was used to measure the 3-D morphology in guinea pig eyes (n = 8, 30 days; n = 5, 40 days). Animals were measured awake in vivo under cyclopegia. Measurements showed low intraocular variability (<4% in corneal and anterior lens radii and <8% in the posterior lens radii, <1% interocular distances). The repeatability of the surface elevation was less than 2 µm. Surface astigmatism was the individual dominant term in all surfaces. Higher-order RMS surface elevation was largest in the posterior lens. Individual surface elevation Zernike terms correlated significantly across corneal and anterior lens surfaces. Higher-order-aberrations (except spherical aberration) were comparable with those predicted by OCT-based eye models.

Changes in anterior segment 3-D geometry in normal and myopic guinea pig eyes

We quantified anterior-segment geometry in both control and lens-treated eyes of a guinea pig model in vivo, using custom-developed optical coherence tomography. Myopic eyes showed longer axial-lengths, thinner corneas, longer anterior-chamber-depth and steeper anterior lens.