Study of the tear topography dynamics using a lateral shearing interferometer

Biometry study of foveal isoplanatic patch variation for adaptive optics retinal imaging

The change in ocular wavefront aberrations with visual angle determines the isoplanatic patch, defined as the largest field of view over which diffraction-limited retinal imaging can be achieved. Here, we study how the isoplanatic patch at the foveal center varies across 32 schematic eyes, each individualized with optical biometry estimates of corneal and crystalline lens surface topography, assuming a homogeneous refractive index for the crystalline lens. The foveal isoplanatic patches were calculated using real ray tracing through 2, 4, 6 and 8 mm pupil diameters for wavelengths of 400-1200 nm, simulating five adaptive optics (AO) strategies. Three of these strategies, used in flood illumination, point-scanning, and line-scanning ophthalmoscopes, apply the same wavefront correction across the entire field of view, resulting in almost identical isoplanatic patches. Two time-division multiplexing (TDM) strategies are proposed to increase the isoplanatic patch of AO scanning ophthalmoscopes through field-varying wavefront correction. Results revealed substantial variation in isoplanatic patch size across eyes (40-500%), indicating that the field of view in AO ophthalmoscopes should be adjusted for each eye. The median isoplanatic patch size decreases with increasing pupil diameter, coarsely following a power law. No statistically significant correlations were found between isoplanatic patch size and axial length. The foveal isoplanatic patch increases linearly with wavelength, primarily due to its wavelength-dependent definition (wavefront root-mean-squared, RMS <λ/14), rather than aberration chromatism. Additionally, ray tracing reveals that in strongly ametropic eyes, induced aberrations can result in wavefront RMS errors as large as λ/3 for an 8-mm pupil, with implications for wavefront sensing, open-loop ophthalmic AO, spectacle prescription and refractive surgery.

The impact of exposure on the magnitude of astigmatism formed within the precorneal tear film over the central optical zone of the cornea in ocular surface disease

PURPOSE

To estimate the astigmatic power and axis of the tear film over the central optical zone of the cornea by vector analysis of topographic data, in ocular surface disease (OSD) and controls, during blink suppression.

METHODS

Video-keratoscopic images were captured on opening the eyes after a single blink 5, 10 & 15 s later during blink suppression in OSD patients (mixed aetiology, group 1 age 20 - 50 years, n = 12, group 2 > 50 years, n = 38) and controls (group 3, n = 19). The SimK and axis values were used to calculate the astigmatism (power and axis) that formed in the precorneal tear film during each period. Data were aggregated into 3 periods; T0-T5 (between 0 & 5 s after the blink), T5-T10 (5 & 10 s later, T10-T15 (between 10 & 15 s later).

RESULTS

Mean (± SD, 95%CI) astigmatic power (DC) formed in the tear film over each period was respectively : Group 1, -0.81 DC (0.99, -1.44 to -0.17), -2.65 DC(1.36, -3.52 to -1.79), -1.37 DC (2.15, -2.73 to -0.01). Group 2, -0.33 DC (0.38, -0.45 to -0.20), -0.57 DC (0.97, -0.91 to -0.24) -0.96 DC (2.10, -1.68 to -0.24), Group 3, -0.57 DC (0.55 -0.76 to -0.38), -0.56 DC (0.57, -0.76 to -0.37), -0.31 DC (0.44, -0.46 to -0.16). Changes were significant in groups 1 (p = 0.013) & 3 (p = 0.033) but not in 2 (p = 0.078). Intergroup differences were significant at all periods (p < 0.05). Significant correlations were detected following vector analysis, e.g Group2 between the astigmatism formed during T5-T10 (y) and ocular surface astigmatism at 5 s was y = 0.281x - 0.834 (r = 0.328, n = 38, p < 0.05). In all three groups apparent changes in the axes of astigmatism were not significant (p > 0.05).

CONCLUSIONS

Changes in the precorneal tear film after blinking are predominately astigmatic indicating that changes in the central region of the tear film following the natural blink are quasi-orthogonal.

Tear film stability assessment by corneal reflex image degradation

Tear film stability assessment is one of the main tests in dry eye diagnosis. However, to date, no test methodology has been adopted as the gold standard due to several reasons, such as the methods being invasive, subjective, or unfeasible for the clinical environment. In this paper, a method that overcomes the above-mentioned limitations for tear film stability measurements is presented, and is based on the degradation of corneal reflex images caused by breakups. The experimental setup, which is based on recording the corneal reflex image or the first Purkinje image, is described, as well as the method used to determine tear film stability by means of the associated breakup time (BUT) using corneal reflex image degradation. Images obtained through simulations of the experimental setup are also shown. Moreover, BUT measurements performed using both the conventional fluorescein method and the proposed method in nine healthy adults are presented. Both the experimental and simulation images show corneal reflex image degradation due to the appearance of breakups in the tear film, highlighting the potential of the method to assess tear film stability. We have shown that the corneal reflex image degrades when the tear film breaks up and, thus, the proposed method can be used to assess tear film stability.

Wide-field retinal optical coherence tomography with wavefront sensorless adaptive optics for enhanced imaging of targeted regions

The peripheral retina of the human eye offers a unique opportunity for assessment and monitoring of ocular diseases. We have developed a novel wide-field (>70°) optical coherence tomography system (WF-OCT) equipped with wavefront sensorless adaptive optics (WSAO) for enhancing the visualization of smaller (<25°) targeted regions in the peripheral retina. We iterated the WSAO algorithm at the speed of individual OCT B-scans (~20 ms) by using raw spectral interferograms to calculate the optimization metric. Our WSAO approach with a 3 mm beam diameter permitted primarily low- but also high- order peripheral wavefront correction in less than 10 seconds. In preliminary imaging studies in five normal human subjects, we quantified statistically significant changes with WSAO correction, corresponding to a 10.4% improvement in average pixel brightness (signal) and 7.0% improvement in high frequency content (resolution) when visualizing 1 mm (~3.5°) B-scans of the peripheral (>23°) retina. We demonstrated the ability of our WF-OCT system to acquire non wavefront-corrected wide-field images rapidly, which could then be used to locate regions of interest, zoom into targeted features, and visualize the same region at different time points. A pilot clinical study was conducted on seven healthy volunteers and two subjects with prodromal Alzheimer's disease which illustrated the capability to image Drusen-like pathologies as far as 32.5° from the fovea in un-averaged volume scans. This work suggests that the proposed combination of WF-OCT and WSAO may find applications in the diagnosis and treatment of ocular, and potentially neurodegenerative, diseases of the peripheral retina, including diabetes and Alzheimer's disease.

Dynamics and function of the tear film in relation to the blink cycle

Great strides have recently been made in quantitative measurements of tear film thickness and thinning, mathematical modeling thereof and linking these to sensory perception. This paper summarizes recent progress in these areas and reports on new results. The complete blink cycle is used as a framework that attempts to unify the results that are currently available. Understanding of tear film dynamics is aided by combining information from different imaging methods, including fluorescence, retroillumination and a new high-speed stroboscopic imaging system developed for studying the tear film during the blink cycle. During the downstroke of the blink, lipid is compressed as a thick layer just under the upper lid which is often released as a narrow thick band of lipid at the beginning of the upstroke. "Rippling" of the tear film/air interface due to motion of the tear film over the corneal surface, somewhat like the flow of water in a shallow stream over a rocky streambed, was observed during lid motion and treated theoretically here. New mathematical predictions of tear film osmolarity over the exposed ocular surface and in tear breakup are presented; the latter is closely linked to new in vivo observations. Models include the effects of evaporation, osmotic flow through the cornea and conjunctiva, quenching of fluorescence, tangential flow of aqueous tears and diffusion of tear solutes and fluorescein. These and other combinations of experiment and theory increase our understanding of the fluid dynamics of the tear film and its potential impact on the ocular surface.

Are the fluctuations in dynamic anterior surface aberrations of the human eye chaotic?

The purpose of the study is to measure chaos in dynamic anterior surface aberrations and examine how it varies between the eyes of an individual. Noninvasive tear breakup time and dynamic corneal surface aberrations were measured for two open-eye intervals of 15 s. The maximal Lyapunov exponent (MLE) was calculated to test the nature of the fluctuations of the dynamic anterior surface aberrations. The average MLE for total higher-order aberration (HOA) was found to be small (+0.0102±0.0072) μm/s. No significant difference in MLE was found between the eyes for HOA (t-test; p=0.131). Data analysis was carried out for individual Zernike coefficients, including vertical prism as it gives a direct measure of the thickness of the tear film over time. The results show that the amount of chaos was small for each Zernike coefficient and not significantly correlated between the eyes.

Fourier fringe analysis and its application to metrology of extreme physical phenomena: a review [Invited]

The paper reviews a technique for fringe analysis referred to as Fourier fringe analysis (FFA) or the Fourier transform method, with a particular focus on its application to metrology of extreme physical phenomena. Examples include the measurement of extremely small magnetic fields with subfluxon sensitivity by electron wave interferometry, subnanometer wavefront evaluation of projection optics for extreme UV lithography, the detection of sub-Ångstrom distortion of a crystal lattice, and the measurement of ultrashort optical pulses in the femotsecond to attosecond range, which show how the advantages of FFA are exploited in these cutting edge applications.

Future directions in non-invasive measurements of tear film surface kinetics

PURPOSE

To review the methods for dynamic, non-invasive, and objective assessment of tear film surface quality and to outline their current state-of-the-art and their future potential.

METHODS

Among the methods available, high-speed videokeratoscopy, lateral shearing interferometry, and dynamic wavefront sensing are being considered.

RESULTS

The principles of operations, their advantages and disadvantages, and limitations of each method are being outlined. The possible future directions of each method are also discussed.

CONCLUSIONS

To gain a better understanding of tear film, its structure and function, it is essential to combine macroimaging technologies with those focusing on tear film microstructure. In this way, one can envisage a clinical device that could help, in future, early diagnosis of dry eye syndrome and development of better materials for contact lenses and eye lubricants.

Use of numerical orthogonal transformation for the Zernike analysis of lateral shearing interferograms

A numerical orthogonal transformation method for reconstructing a wavefront by use of Zernike polynomials in lateral shearing interferometry is proposed. The difference fronts data in two perpendicular directions are fitted to numerical orthonormal polynomials instead of Zernike polynomials, and then the orthonormal coefficients are used to evaluate the Zernike coefficients of the original wavefront by use of a numerical shear matrix. Due to the fact that the dimensions of the shear matrix are finite, the high-order terms of the original wavefront above a certain order have to be neglected. One of advantages of the proposed method is that the impact of the neglected high-order terms on the outcomes of the lower-order terms can be decreased, which leads to a more accurate reconstruction result. Another advantage is that the proposed method can be applied to reconstruct a wavefront on an aperture of arbitrary shape from its difference fronts. Theoretical analysis and numerical simulations shows that the proposed method is correct and its reconstruction error is obviously smaller than that of Rimmer-Wyant method.

Lateral shearing interferometry for analysis of tear film surface kinetics

PURPOSE

To date, there have been no measuring techniques available that could clearly identify all phases of tear film surface kinetics in one interblink interval.

METHODS

Using a series of cases, we show that lateral shearing interferometry equipped with a set of robust parameter estimation techniques is able to characterize up to five different phases of tear film surface kinetics that include: (i) initial fast tear film build-up phase, (ii) further slower tear film build-up phase, (iii) tear film stability, (iv) tear film thinning, and (v), after a detected break-up, subsequent tear film deterioration.

RESULTS

Several representative examples are given for estimating tear film surface kinetics in measurements in which the subjects were asked to blink and keep their eyes open as long as they could.

CONCLUSIONS

Lateral shearing interferometry is a noninvasive technique that provides means for temporal characterization of tear film surface kinetics and the opportunity for the analysis of the two-step tear film build-up process.

Examination of tear film smoothness on corneae after refractive surgeries using a noninvasive interferometric method

A lateral shearing interferometer was used to examine the smoothness of the tear film. The information about the distribution and stability of the precorneal tear film is carried out by the wavefront reflected from the surface of tears and coded in interference fringes. Smooth and regular fringes indicate a smooth tear film surface. On corneae after laser in situ keratomileusis (LASIK) or radial keratotomy (RK) surgery, the interference fringes are seldom regular. The fringes are bent on bright lines, which are interpreted as tear film breakups. The high-intensity pattern seems to appear in similar location on the corneal surface after refractive surgery. Our purpose was to extract information about the pattern existing under the interference fringes and calculate its shape reproducibility over time and following eye blinks. A low-pass filter was applied and correlation coefficient was calculated to compare a selected fragment of the template image to each of the following frames in the recorded sequence. High values of the correlation coefficient suggest that irregularities of the corneal epithelium might influence tear film instability and that tear film breakup may be associated with local irregularities of the corneal topography created after the LASIK and RK surgeries.

Lateral shearing interferometer for measuring photoinduced refractive index change in As(2)S(3)

We have built and demonstrated a lateral shearing interferometer as a process engineering and control tool for the fabrication and characterization of direct-laser-written waveguide structures in chalcogenide glasses. Photoinduced change in refractive index of 0.154+/-0.002 was measured for as-deposited amorphous As(2)S(3) thin films at 633 nm with an estimated measurement uncertainty of 1.3% for this air-gap interferometer configuration. The simple design of this interferometer can easily be adapted to other wavelengths including mid- and long-wave infrared regions to measure changes in refractive index or material inhomogeneities in transmissive materials.

Changes in aberrations and retinal image quality due to tear film dynamics

A reliable and objective method to measure aberration changes due to the tear film is essential in improving clinical assessment of the tear film and in vivo retinal imaging. The tear film of 11 subjects are studied by acquiring continuous wavefront measurements in real-time with a customized Shack-Hartmann wavefront sensor. The device has a high resolution lenslet array (190 mum) and a topographer unit with an infrared pupil illuminator (940 nm). A Fourier transform reconstructor algorithm [1] was used to estimate the eyes' wavefront aberrations from slope measurements. Increasing irregularities in the tear film produced observable wavefront variations. The temporal behavior of tear induced aberrations and retinal image quality was evaluated by the root mean squared (RMS) error of the residual wavefront and the volume modulation transfer function (MTF). Similar trends were observed from both metrics. Our analysis demonstrates the applicability of the SH wavefront sensor to assessing the dynamics of the human tear film.

Study of the dynamic aberrations of the human tear film

The dynamic aberrations introduced by the human tear film are studied by measuring the topography of the tear film surface on 14 subjects using a curvature sensing setup. The RMS wavefront error variation of the data obtained is presented showing the non-negligible contribution of the tear film to overall eye aberrations. The tear film wavefronts are decomposed in their constituent Zernike terms, showing stronger contributions from 4th order terms and terms with vertical symmetry, and the temporal behaviour of these aberrations is analysed.