Objective refraction from aberrometry: theory

Implementation of Kiosk-Type System Based on Gaze Tracking for Objective Visual Function Examination

To demonstrate that the near-point-of-convergence (npc) examination is performed subjectively, the visual fixation and four-prism diopter (Δ) base-out (BO) examinations can be conducted with a kiosk-type objective examination method based on gaze tracking, and can be compared with the existing method. Objective examination equipment was used to verify effectiveness. Fifteen adult men and women in their 20s and 30s (26.87 ± 3.31 years) with visual acuity of 0.8 (logMAR: 0.1, Snellen: 20/25(6/7.5)) or higher (corrected vision in the case of ametropia) underwent the npc, visual fixation, and 4 Δ BO examinations based on the existing examination method followed by the gaze-tracking-based kiosk-type examination method. Three examinations were performed, and a comparative analysis was conducted. The gaze tracking method used a method of extracting eye feature points, and it was judged that the ocular moved when the movement of 30 eye feature points at the edge of the iris was detected. In the comparison between the existing method and the kiosk-type method, there were no statistically significant differences in npc, visual fixation, and 4 Δ BO examinations. Npc examinations were performed extensively by the existing subjective method, however, it seems that these can be conducted objectively using the kiosk-type method. Visual fixation and 4 Δ BO examinations require high-examination proficiency because finely moving ocular movements need to be observed, but it is judged that examinations can be performed more easily and accurately when combined with the kiosk-type method. The symmetrical characteristics between the two test results are expected to serve as a basis for using the kiosk-type examination method in clinical practice.

Advancing Digital Workflows for Refractive Error Measurements

Advancements in clinical measurement of refractive errors should lead to faster and more reliable measurements of such errors. The study investigated different aspects of advancements and the agreement of the spherocylindrical prescriptions obtained with an objective method of measurement ("Aberrometry" (AR)) and two methods of subjective refinements ("Wavefront Refraction" (WR) and "Standard Refraction" (StdR)). One hundred adults aged 20-78 years participated in the course of the study. Bland-Altman analysis of the right eye measurement of the spherocylindrical refractive error (M) identified mean differences (±95% limits of agreement) between the different types of measurements of +0.36 D (±0.76 D) for WR vs. AR (t-test: p < 0.001), +0.35 D (± 0.84 D) for StdR vs. AR (t-test: p < 0.001), and 0.0 D (± 0.65 D) for StdR vs. WR (t-test: p < 0.001). Monocular visual acuity was 0.0 logMAR in 96% of the tested eyes, when refractive errors were corrected with measurements from AR, indicating that only small differences between the different types of prescriptions are present.

Morphology, topography, and optics of the orthokeratology cornea

The goal of this work was to objectively characterize the external morphology, topography, and optics of the cornea after orthokeratology (ortho-k). A number of 24 patients between the ages of 17 and 30 years (median=24  years) were fitted with Corneal Refractive Therapy® contact lenses to correct myopia between −2.00 and −5.00 diopters (D) (median=−3.41  D). A classification algorithm was applied to conduct an automatic segmentation based on the mean local curvature. As a result, three zones (optical zone, transition zone, and peripheral zone) were delimited. Topographical analysis was provided through global and zonal fit to a general ellipsoid. Ray trace on partially customized eye models provided wave aberrations and retinal image quality. Monozone topographic description of the ortho-k cornea loses accuracy when compared with zonal description. Primary (C40) and secondary (C60) spherical aberration (SA) coefficients for a 5-mm pupil increased 3.68 and 19 times, respectively, after the treatments. The OZ area showed a strong correlation with C40 (r=−0.49, p<0.05) and a very strong correlation with C60 (r=0.78, p<0.01). The OZ, as well as the TZ, areas did not correlate with baseline refraction. The increase in the eye’s positive SA after ortho-k is the major factor responsible for the decreased retinal optical quality of the unaccommodated eye.

Unbiased estimation of refractive state of aberrated eyes

We seek unbiased methods for estimating the target vergence required to maximize visual acuity based on wavefront aberration measurements. Experiments were designed to minimize the impact of confounding factors that have hampered previous research. Objective wavefront refractions and subjective acuity refractions were obtained for the same monochromatic wavelength. Accommodation and pupil fluctuations were eliminated by cycloplegia. Unbiased subjective refractions that maximize visual acuity for high contrast letters were performed with a computer controlled forced choice staircase procedure, using 0.125 diopter steps of defocus. All experiments were performed for two pupil diameters (3mm and 6mm). As reported in the literature, subjective refractive error does not change appreciably when the pupil dilates. For 3mm pupils most metrics yielded objective refractions that were about 0.1D more hyperopic than subjective acuity refractions. When pupil diameter increased to 6mm, this bias changed in the myopic direction and the variability between metrics also increased. These inaccuracies were small compared to the precision of the measurements, which implies that most metrics provided unbiased estimates of refractive state for medium and large pupils. Thus a variety of image quality metrics may be used to determine ocular refractive state for monochromatic (635nm) light, thereby achieving accurate results without the need for empirical correction factors.

Direct and inverse discrete Zernike transform

An invertible discrete Zernike transform, DZT is proposed and implemented. Three types of non-redundant samplings, random, hybrid (perturbed deterministic) and deterministic (spiral) are shown to provide completeness of the resulting sampled Zernike polynomial expansion. When completeness is guaranteed, then we can obtain an orthonormal basis, and hence the inversion only requires transposition of the matrix formed by the basis vectors (modes). The discrete Zernike modes are given for different sampling patterns and number of samples. The DZT has been implemented showing better performance, numerical stability and robustness than the standard Zernike expansion in numerical simulations. Non-redundant (critical) sampling along with an invertible transformation can be useful in a wide variety of applications.