Robert Rosén

Influence of Optical Defocus on Peripheral Vision

PURPOSE Peripheral optical corrections are often thought to give few visual benefits beyond improved detection acuity. However, patients with central visual field loss seem to benefit from peripheral correction, and animal studies suggest a role for peripheral vision in the development of myopia. This study was conducted to bridge this gap by systematically studying the sensitivity to optical defocus in a wide range of peripheral visual tasks. METHODS The spatial frequency threshold for detection and resolution in high and low contrast with stationary and drifting gratings were measured off-axis (20° nasal visual field) in five subjects with a peripheral optical correction that was varied systematically ±4 D. RESULTS All visual tasks, except high-contrast resolution, were sensitive to optical defocus, particularly low-contrast resolution with an increase of up to 0.227 logMAR/D. The two myopic subjects exhibited a very low sensitivity to defocus by negative lenses for low-contrast tasks, whereas all subjects were equally affected by myopic defocus. Contrary to expectations, drifting gratings made little difference overall. CONCLUSIONS Optical defocus as low as 1 D has a large impact on most peripheral visual tasks, with high-contrast resolution being the exception. Since the everyday visual scenery consists of objects at different contrast levels, it is understandable that persons with central visual field loss are helped by correction of peripheral refractive errors. The asymmetry in sensitivity to peripheral optical defocus in low-contrast tasks that was experienced by the myopic subjects in this study merits further investigation.

Evaluating the peripheral optical effect of multifocal contact lenses

Multifocal soft contact lenses have been used to decrease the progression of myopia, presumably by inducing relative peripheral myopia at the same time as the central image is focused on the fovea. The aim of this study was to investigate how the peripheral optical effect of commercially available multifocal soft contact lenses can be evaluated from objective wavefront measurements.

Sign-dependent sensitivity to peripheral defocus for myopes due to aberrations.

PURPOSE Animal studies suggest that the periphery of the eye plays a major role in emmetropization. It is also known that human myopes tend to have relative peripheral hyperopia compared to the foveal refraction. This study investigated peripheral sensitivity to defocus in human subjects, specifically whether myopes are less sensitive to negative than to positive defocus. METHODS Sensitivity to defocus (logMAR/D) in the 20° nasal visual field was determined in 16 emmetropes (6 males and 10 females, mean spherical equivalent -0.03 ± 0.13 D, age 30 ± 10 years) and 16 myopes (3 males and 13 females, mean spherical equivalent -3.25 ± 2 D, age 25 ± 6 years) using the slope of through-focus low-contrast resolution (10%) acuity measurements. Peripheral wavefront measurements at the same angle were obtained from 13 of the myopes and 9 of the emmetropes, from which the objective depth of field was calculated by assessing the area under the modulation transfer function (MTF) with added defocus. The difference in depth of field between negative and positive defocus was taken as the asymmetry in depth of field. RESULTS Myopes were significantly less sensitive to negative than to positive defocus (median difference in sensitivity 0.06 logMAR/D, P = 0.023). This was not the case for emmetropes (median difference -0.01 logMAR/D, P = 0.382). The difference in sensitivity between positive and negative defocus was significantly larger for myopes compared to emmetropes (P = 0.031). The correlation between this difference in sensitivity and objective asymmetry in depth of field due to aberrations was significant for the whole group (R(2) = 0.18, P = 0.02) and stronger for myopes (R(2) = 0.8, P < 0.01). CONCLUSIONS We have shown that myopes, in general, are less sensitive to negative than to positive defocus, which can be linked to their aberrations. This finding is consistent with a previously proposed model of eye growth that is driven by the difference between tangential and radial peripheral blur.

Resolution of static and dynamic stimuli in the peripheral visual field

In a clinical setting, emphasis is given to foveal visual function, and tests generally only utilize static stimuli. In this study, we measured static (SVA) and dynamic visual acuity (DVA) in the central and peripheral visual field on healthy, young emmetropic subjects using stationary and drifting Gabor patches. There were no differences between SVA and DVA in the peripheral visual field; however, SVA was superior to DVA in the fovea for both velocities tested. In addition, there was a clear naso-temporal asymmetry for both SVA and DVA for isoeccentric locations in the visual field beyond 10° eccentricity. The lack of difference in visual acuity between static and dynamic stimuli found in this study may reflect the use of drift-motion as opposed to displacement motion used in previous studies.

Benefit of Adaptive Optics Aberration Correction at Preferred Retinal Locus

Purpose. To investigate the effect of eccentric refractive correction and full aberration correction on both high- and low-contrast grating resolution at the preferred retinal locus (PRL) of a single low-vision subject with a long-standing central scotoma. Methods. The subject was a 68-year-old women with bilateral absolute central scotoma due to Stargardt disease. She developed a single PRL located 25° nasally of the damaged macula in her left eye, this being the better of the two eyes. High- (100%) and low-contrast (25 and 10%) grating resolution acuity was evaluated using four different correction conditions. The first two corrections were solely refractive error corrections, namely, habitual spectacle correction and full spherocylindrical correction. The latter two corrections were two versions of adaptive optics corrections of all aberrations, namely, habitual spectacle correction with aberration correction and full spherocylindrical refractive correction with aberration correction. Results. The mean high-contrast (100%) resolution acuity with her habitual correction was 1.06 logMAR, which improved to 1.00 logMAR with full spherocylindrical correction. Under the same conditions, low-contrast (25%) acuity improved from 1.30 to 1.14 logMAR. With adaptive optics aberration correction, the high-contrast resolution acuities improved to 0.89/0.92 logMAR and the low-contrast acuities improved to 1.04/1.06 logMAR under both correction modalities. The low-contrast (10%) resolution acuity was 1.34 logMAR with adaptive optics aberration correction; however, with purely refractive error corrections, she was unable to identify the orientation of the gratings. Conclusions. Correction of all aberrations using adaptive optics improves both high- and low-contrast resolution acuity at the PRL of a single low-vision subject with long-standing absolute central scotoma.

Quick contrast sensitivity measurements in the periphery.

Measuring the contrast sensitivity function (CSF) in the periphery of the eye is complicated. The lengthy measurement time precludes all but the most determined subjects. The aim of this study was to implement and evaluate a faster routine based on the quick CSF method (qCSF) but adapted to work in the periphery. Additionally, normative data is presented on neurally limited peripheral CSFs. A peripheral qCSF measurement using 100 trials can be performed in 3 min. The precision and accuracy were tested for three subjects under different conditions (number of trials, peripheral angles, and optical corrections). The precision for estimates of contrast sensitivity at individual spatial frequencies was 0.07 log units when three qCSF measurements of 100 trials each were averaged. Accuracy was estimated by comparing the qCSF results with a more traditional measure of CSF. Average accuracy was 0.08 log units with no systematic error. In the second part of the study, we collected three CSFs of 100 trials for six persons in the 20° nasal, temporal, inferior, and superior visual fields. The measurements were performed in an adaptive optics system running in a continuous closed loop. The Tukey HSD test showed significant differences (p < 0.05) between all fields except between the nasal and the temporal fields. Contrast sensitivity was higher in the horizontal fields, and the inferior field was better than the superior. This modified qCSF method decreases the measurement time significantly and allows otherwise unfeasible studies of the peripheral CSF.

Adaptive optics for peripheral vision

Understanding peripheral optical errors and their impact on vision is important for various applications, e.g. research on myopia development and optical correction of patients with central visual field loss. In this study, we investigated whether correction of higher order aberrations with adaptive optics (AO) improve resolution beyond what is achieved with best peripheral refractive correction. A laboratory AO system was constructed for correcting peripheral aberrations. The peripheral low contrast grating resolution acuity in the 20° nasal visual field of the right eye was evaluated for 12 subjects using three types of correction: refractive correction of sphere and cylinder, static closed loop AO correction and continuous closed loop AO correction. Running AO in continuous closed loop improved acuity compared to refractive correction for most subjects (maximum benefit 0.15 logMAR). The visual improvement from aberration correction was highly correlated with the subjects initial amount of higher order aberrations (p = 0.001, R 2 = 0.72). There was, however, no acuity improvement from static AO correction. In conclusion, correction of peripheral higher order aberrations can improve low contrast resolution, provided refractive errors are corrected and the system runs in continuous closed loop.

Symmetries in peripheral ocular aberrations

A mirror symmetry in the aberrations between the left and right eyes has previously been found foveally, but while a similar symmetry for the peripheral visual field is likely, it has not been investigated. Nevertheless, the peripheral optical quality is often evaluated in only one eye, because it is more time efficient than analyzing the whole visual field of both eyes. This study investigates the correctness of such an approach by measuring the peripheral wavefront aberrations in both eyes of 22 subjects out to ±40° horizontally. The largest aberrations (defocus, astigmatism, and coma) were found to be significantly correlated between the left and right eyes when comparing the same temporal or nasal angle. The slope of the regression line was close to ±1 (within 0.05) for these aberrations, with a negative slope for the horizontally odd aberrations, i.e. the left and right eyes are mirror symmetric. These findings justify that the average result, sampled in one of the two eyes of many subjects, can be generalized to the other eye as well.

Preclinical metrics to predict through-focus visual acuity for pseudophakic patients

This study compares the clinical through-focus visual acuity (VA) in patients implanted with different intraocular lens (IOL) to optical bench testing of the same IOLs to evaluate the suitability of optical metrics of predicting clinical VA. Modulation transfer function and phase transfer function for different spatial frequencies and US Air Force pictures were measured using an optical bench for two monofocal IOLs, three multifocal IOLs and an extended range of vision IOL. Four preclinical metrics were calculated and compared to the clinical through-focus VA collected in three different clinical studies (243 patients in total). All metrics were well correlated (R2≥0.89) with clinical data and may be suitable for predicting through-focus VA in pseudophakic eyes.

Choice of Grating Orientation for Evaluation of Peripheral Vision.

Purpose Peripheral resolution acuity depends on the orientation of the stimuli. However, it is uncertain if such a meridional effect also exists for peripheral detection tasks because they are affected by optical errors. Knowledge of the quantitative differences in acuity for different grating orientations is crucial for choosing the appropriate stimuli for evaluations of peripheral resolution and detection tasks. We assessed resolution and detection thresholds for different grating orientations in the peripheral visual field. Methods Resolution and detection thresholds were evaluated for gratings of four different orientations in eight different visual field meridians in the 20-deg visual field in white light. Detection measurements in monochromatic light (543 nm; bandwidth, 10 nm) were also performed to evaluate the effects of chromatic aberration on the meridional effect. A combination of trial lenses and adaptive optics system was used to correct the monochromatic lower- and higher-order aberrations. Results For both resolution and detection tasks, gratings parallel to the visual field meridian had better threshold compared with the perpendicular gratings, whereas the two oblique gratings had similar thresholds. The parallel and perpendicular grating acuity differences for resolution and detection tasks were 0.16 logMAR and 0.11 logMAD, respectively. Elimination of chromatic errors did not affect the meridional preference in detection acuity. Conclusions Similar to peripheral resolution, detection also shows a meridional effect that appears to have a neural origin. The threshold difference seen for parallel and perpendicular gratings suggests the use of two oblique gratings as stimuli in alternative forced-choice procedures for peripheral vision evaluation to reduce measurement variation.