Changes in spherical aberration after various corneal surface ablation techniques

Purpose

The corneal change induced by refractive procedures influence both the postoperative refractive status and the ocular spherical aberration (SA). We evaluated changes in corneal SA after three types of surface ablation: phototherapeutic keratectomy (PTK), myopic photorefractive keratectomy (PRK), and myopic wavefront-guided laser epithelial keratomileusis (LASEK).

Methods

Twenty-six eyes (25 patients) were subjected to PTK 26 eyes (14 patients) to PRK, and 34 eyes (17 patients) to wavefront-guided LASEK. Corneal SA was measured with the iTrace in all patients both preoperatively and 6 months postoperatively.

Results

Six months after surgery, mean corneal SA was -0.173 ± 0.171 µm in the PTK group, 0.672 ± 0.200 µm in the PRK group, and 0.143 ± 0.136 µm in the wavefront-guided LASEK group. The mean difference between the preoperative and postoperative corneal SA (ΔSA) was -0.475 µm in the PTK group, 0.402 µm in the PRK group, and -0.143 µm in the wavefront-guided LASEK group.

Conclusions

Surgically induced changes in corneal SA vary with procedure. The prediction of the pattern of SA change induced by various surface ablation procedures may be helpful for developing future surgical procedures.

Safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK) with a 1000-Hz scanning spot excimer laser

PURPOSE

To evaluate the safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK) with a 1000-Hz scanning spot excimer laser (Concept System 1000; WaveLight GmbH, Erlangen, Germany).

METHODS

LASIK was performed on twenty eyes with myopia or myopic astigmatism (mean spherical equivalent refraction: -3.97±1.72 dioptres (D); mean cylinder: -0.84±0.77 D) using a microkeratome for flap creation and the Concept System 1000 for photoablation. Patients were examined preoperatively as well as 1, 3 and 6 months after the treatment. Manifest sphere and cylinder, uncorrected (UCDVA) and best corrected (BCDVA) distance visual acuity, corneal topography and pachymetry were analysed.

RESULTS

We observed no adverse events that might have been associated with the use of a repetition rate of 1000 Hz. All eyes maintained or had improved BCDVA at 6 months after treatment when compared to preoperative values. Six months after LASIK, UCDVA was 20/20 or better in 85% and 20/25 or better in 100% of the eyes. The spherical equivalent refraction was within ±0.50 D in 95% of the eyes at 6 months after surgery. The refraction stayed stable over time; 95% of the eyes changed<0.5 D postoperatively.

CONCLUSION

LASIK with the prototype 1000-Hz excimer laser was safe, efficient and predictable. The postoperative refraction was stable over time. There were no specific clinical side-effects that might be associated with the use of such a high repetition rate.

Normal and diseased personal eye modeling using age-appropriate lens parameters

Personalized eye modeling of normal and diseased eye conditions is attractive due to the recent availability of detailed ocular measurements in clinic environments and the promise of its medical and industrial applications. In the customized modeling, the optical properties of the crystalline lens including the gradient refractive index, the lens bio-geometry and orientation are typically assigned with average lens parameters from literature since typically they are not clinically available. Although, through the optical optimization by assigning lens parameters as variables, the clinical measured wavefront aberration can be achieved, the optimized lens biometry and orientation often end up at edges of the statistical distribution. Without an effective validation of these models today, the fidelity of the final lens (and therefore the model) remains questionable. To develop a more reliable customized model without detailed lens information, we incorporate age-appropriate lens parameters as the initial condition of optical optimization. A biconic lens optimization was first performed to provide a correct lens profile for accurate lower order aberration and then followed by the wavefront optimization. Clinical subjects were selected from all ages with both normal and diseased corneal and refractive conditions. 19 ammetropic eyes ( + 4D to -11D), and 16 keratoconus eyes (mild to moderate with cylinder 0.25 to 6D) were modeled. Age- and gender-corrected refractive index was evaluated. Final models attained the lens shapes comparable to the statistical distribution in their age.

Role of ocular aberrations in dynamic accommodation control

BACKGROUND

Accommodation control is mediated by a number of cues, including blur,chromatic aberration and target proximity. Data from wavefront measurements have shown clear shifts in ocular aberrations during increasing accommodative demand, most notably a negative shift in spherical aberration. Work in adaptive optics, where aberrations have been corrected, has suggested a role for aberrations in the control of accommodation for some individuals. This study aimed to determine the relative effects of aberration correction and inversion on closed-loop stepwise accommodation responses to small increases and decreases in stimulus vergence.

METHODS

An adaptive optics system was used to modify ocular aberrations, while five participants viewed a high contrast target stepping 0.5 D in an inward or outward direction. Aberrations were variously unchanged, corrected or inverted following the step change in stimulus vergence. A Shack-Hartmann wavefront sensor was used to record accommodative responses to the stepwise changes in stimulus vergence. Accommodative response data were analysed using a curve fitting method to calculate the gain,latency and response time.

RESULTS

Correction of aberrations failed to have a significant effect on dynamic accommodative responses. Inversion of even-order aberration terms produced a significant reduction in accommodative response gain for outward steps in stimulus vergence.Additionally, an increase in the number of accommodative responses in the wrong direction was seen following aberration inversion. Inward steps were not altered significantly by aberration inversion.

CONCLUSION

Accommodation in humans appears to derive a cue from the even-order aberrations of the eye to help guide the initial direction of responses to reductions in stimulus vergence (that is, disaccommodation). With all aberrations and even-order aberrations inverted, the number of incorrect directional responses to outward moving stimuli increases, suggesting that aberrations are important in determining the initial path of stepwise accommodative responses.

Effect of time sequences in scanning algorithms on the surface temperature during corneal laser surgery with high-repetition-rate excimer laser

PURPOSE

To investigate the influence of temporal and spatial spot sequences on the ocular surface temperature increase during corneal laser surgery with a high-repetition-rate excimer laser.

SETTING

Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland, and WaveLight AG, Erlangen, Germany.

METHODS

An argon-fluoride excimer laser system working at a repetition rate of 1050 Hz was used to photoablate bovine corneas with various myopic, hyperopic, and phototherapeutic ablation profiles. The temporal distribution of ablation profiles was modified by 4 spot sequences: line, circumferential, random, and an optimized scan algorithm. The increase in ocular surface temperature was measured using an infrared camera.

RESULTS

The maximum and mean ocular surface temperature increases depended primarily on the spatial and temporal distribution of the spots during photoablation and the amount of refractive correction. The highest temperature increases were with the line and circumferential scan sequences. Significant lower temperature increases were found with the optimized and random scan algorithms.

CONCLUSIONS

High-repetition-rate excimer laser systems require spot sequences with optimized temporal and spatial spot distribution to minimize the increase in ocular surface temperature. An ocular surface temperature increase will always occur depending on the amount of refractive correction, the type of ablation profile, the radiant exposure, and the repetition rate of the laser system.

Comparison between anterior corneal aberration and ocular aberration in laser refractive surgery

Purpose

To compare changes of anterior corneal aberration (Pentacam®) and ocular aberration (aberrometer, LADARWave®) after laser refractive surgery.

Methods

Sixty-six eyes underwent laser refractive surgery and were retrospectively reviewed. Anterior corneal aberration and ocular aberration were measured by Pentacam® and an aberrometer (LADARWave®) respectively. Changes of root mean square (RMS) values of coma, spherical aberration, and total high order aberration (HOA) were evaluated before, 1 month, and 3 months after surgery

Results

Ocular aberrations displayed low preoperative values, but after laser refractive surgery, anterior corneal aberration and ocular aberration increased equally. There were no statistically significant differences of internal optics aberration values (ocular aberration minus anterior corneal aberration) in coma, spherical aberration, and total HOA. Anterior corneal aberration and ocular aberration showed statistically significant correlations at 1 and 3 months after surgery.

Conclusions

Internal optics aberration compensated the anterior corneal aberration effectively before surgery, but the increase of anterior corneal aberration after laser refractive surgery exceeded the compensation of internal optics. As a result, anterior corneal aberration and ocular aberration increased equally. The correlation between anterior corneal aberration and ocular aberration after surgery was statistically significant due to the increased proportion of anterior corneal aberration in ocular aberration.

Contrast Sensitivity After LASIK, LASEK, and Wavefront-guided LASEK With the VISX S4 Laser

PURPOSE

To evaluate the changes in contrast sensitivity and glare after corneal refractive surgery for moderate myopia.

METHODS

The study comprised 267 eyes of 149 patients who underwent LASIK, laser epithelial keratomileusis (LASEK), or wavefront-guided LASEK with the VISX STAR S4. Contrast sensitivity was measured with VCTS 6500 before surgery and at 2 and 6 months postoperatively. Glare was evaluated using questionnaires and the ALC glare test at last follow-up. Contrast sensitivity at 2 and 6 months was compared with preoperative contrast sensitivity in each group. Glare sensitivity in each group was compared to normal controls.

RESULTS

Contrast sensitivity did not change after LASIK (P > .05). Contrast sensitivity of 3 and 6 cycles per degree (cpd) at 2 months increased after LASEK (P < .05) and contrast sensitivity of 6, 12, and 18 cpd at 2 months and 3, 6, 12, and 18 cpd at 6 months improved in wavefront-guided LASEK (P < .05). Glare test and questionnaires did not show any significant difference between the groups.

CONCLUSIONS

Wavefront-guided LASEK induced significant increases in contrast sensitivity of moderate myopes at high spatial frequencies under mesopic conditions by 6 months. Glare was not affected by the different refractive procedures.