Poster Session: Peripheral blur may provide the eye with a cue for the sign of defocus.

The sign of defocus is used by the retina to guide emmetropization. However, the means by which the eye determines whether light is focused in front of, or behind the retina, remains elusive. In the current study, we propose a new cue for the sign of defocus: the orientation of the anisotropic peripheral blur. Previously published [1] population averages of wavefront aberrations across the horizontal visual field in hyperopes, emmetropes and myopes were used to assess peripheral optical quality and blur orientation. Due to the large magnitudes of off-axis astigmatism and coma, the peripheral retinal image quality was dominated by anisotropic blur, whose direction was also correlated with refractive error (vertically elongated peripheral blur in myopic eyes and horizontally elongated peripheral blur in emmetropic and hyperopic eyes). The differences in groups may be due to the interaction between peripheral wavefront aberrations and globe shape (i.e. peripheral axial length). We also found an interaction between longitudinal chromatic aberration and off-axis astigmatism, wherein peripheral blur orientation is wavelength dependent, raising additional questions pertaining to the nature of chromatic cues. The orientation of peripheral blur may provide the retina with an optical cue for the sign of defocus, potentially playing an important role in emmetropization. [1] Romashchenko et al., "Peripheral refraction and higher order aberrations." Clin Exp Optom 103.1 (2020): 86-94.

Peripheral optical anisotropy in refractive error groups.

INTRODUCTION: This study investigated differences in peripheral image quality with refractive error. Peripheral blur orientation is determined by the interaction of optical aberrations (such as oblique astigmatism) and retinal shape. By providing the eye with an optical signal for determining the sign of defocus, peripheral blur anisotropy may play a role in mechanisms of accommodation, emmetropisation and optical myopia control interventions. This study investigated peripheral through-focus optical anisotropy and image quality and how it varies with the eye's refractive error. METHODS: Previously published Zernike coefficients across retinal eccentricity (0, 10, 20 and 30° horizontal nasal visual field) were used to compute the through-focus modulation transfer function (MTF) for a 4 mm pupil. Image quality was defined as the volume under the MTF, and blur anisotropy was defined as the ratio of the horizontal to vertical meridians of the MTF (HVRatio). RESULTS: Across the horizontal nasal visual field (at 10, 20 and 30°), the peak image quality for emmetropes was within 0.3 D of the retina, as opposed to myopes whose best focus was behind the retina (-0.1, 0.4 and 1.5 D, respectively), while for hyperopes it lay in front of the retina (-0.5, -0.6 and -0.6 D). At 0.0 D (i.e., on the retina), emmetropes and hyperopes both exhibited horizontally elongated blur, whereas myopes had vertically elongated blur (HVRatio = 0.3, 0.7 and 2.8, respectively, at 30° eccentricity). CONCLUSIONS: Blur in the peripheral retina is dominated by the so-called "odd-error" blur signals, primarily due to oblique astigmatism. The orientation of peripheral blur (horizontal or vertical) provides the eye with an optical cue for the sign of defocus. All subject groups had anisotropic blur in the nasal visual field; myopes exhibited vertically elongated blur, perpendicular to the blur orientation of emmetropes and hyperopes.

Blue-LIRIC in the rabbit cornea: efficacy, tissue effects, and repetition rate scaling.

Laser-induced refractive index change (LIRIC) is being developed as a non-invasive way to alter optical properties of transparent, ophthalmic materials including corneas ex vivo and in vivo. This study examined the optical and biological effects of blue-LIRIC (wavelengths 400-405 nm) of ex-vivo rabbit corneas. Following LIRIC treatment at low and high repetition rates (8.3 MHz and 80 MHz, respectively), we interferometrically measured optical phase change, obtained transmission electron microscopy (TEM) micrographs, and stained histological sections with collagen hybridizing peptides (CHP) to assess the structural and organizational changes caused by LIRIC at different repetition rates. Finally, we performed power and scan speed scaling experiments at three different repetition rates (1 MHz, 8.3 MHz, and 80 MHz) to study their impact on LIRIC efficacy. Histologic co-localization of CHP and LIRIC-generated green autofluorescence signals suggested that collagen denaturation had occurred in the laser-irradiated region. TEM imaging showed different ultrastructural modifications for low and high repetition rate writing, with discrete homogenization of collagen fibrils at 80 MHz, as opposed to contiguous homogenization at 8.3 MHz. Overall, this study confirmed that LIRIC efficacy can be dramatically increased, while still avoiding tissue ablation, by lowering the repetition rate from 80 MHz to 8.3 MHz. Modeling suggests that this is due to a higher, single-pulse, energy density deposition at given laser powers during 8.3 MHz LIRIC.

Femtosecond Lasers in Cornea & Refractive Surgery.

Since the introduction of femtosecond laser (FS) systems for corneal flap creation in laser-assisted in-situ keratomileusis there have been numerous applications for FS laser in corneal surgery. This manuscript details the utility of FS lasers in corneal surgical procedures including refractive laser surgeries, intracorneal ring segment tunnels, presbyopic treatments, and FS-assisted keratoplasty. We also review the role of FS lasers in diagnostic procedures such as two photon excitation fluorescence and second harmonic generation.

Neural adaptation to peripheral blur in myopes and emmetropes.

In the presence of optical blur at the fovea, blur adaptation can improve visual acuity (VA) and perceived image quality over time. However, little is known regarding blur adaptation in the peripheral retina. Here, we examined neural adaptation to myopic defocus at the fovea and parafovea (10° temporal retina) in both emmetropes and myopes. During a 60-min adaptation period, subjects (3 emmetropes and 3 myopes) watched movies with +2 diopters of defocus blur through a 6-mm artificial pupil in two separate, counter-balanced sessions for each retinal location. VA was measured at 10-min intervals under full aberration-corrected viewing using an adaptive optics (AO) vision simulator. By correcting subjects' native optical aberrations with AO, we bypassed the influence of the individual subjects' optical aberrations on visual performance. Overall, exhibited a small but significant improvement after the 60-min of adaptation at both the fovea (mean±SE VA improvement: -0.06±0.04 logMAR) and parafovea (mean±SE VA improvement: -0.07±0.04 logMAR). Myopic subjects exhibited significantly greater improvement in parafoveal VA (mean±SE VA improvement: 0.10±0.02 logMAR), than that of emmetropic subjects (mean±SE VA improvement: 0.04±0.03 logMAR). In contrast, there was no significant difference in foveal VA between the two refractive-error groups. In conclusion, our results reveal differences in peripheral blur adaptation between refractive-error groups, with myopes displaying a greater degree of adaptation.

Optical and neural anisotropy in peripheral vision.

Optical blur in the peripheral retina is known to be highly anisotropic due to nonrotationally symmetric wavefront aberrations such as astigmatism and coma. At the neural level, the visual system exhibits anisotropies in orientation sensitivity across the visual field. In the fovea, the visual system shows higher sensitivity for cardinal over diagonal orientations, which is referred to as the oblique effect. However, in the peripheral retina, the neural visual system becomes more sensitive to radially-oriented signals, a phenomenon known as the meridional effect. Here, we examined the relative contributions of optics and neural processing to the meridional effect in 10 participants at 0°, 10°, and 20° in the temporal retina. Optical anisotropy was quantified by measuring the eye's habitual wavefront aberrations. Alternatively, neural anisotropy was evaluated by measuring contrast sensitivity (at 2 and 4 cyc/deg) while correcting the eye's aberrations with an adaptive optics vision simulator, thus bypassing any optical factors. As eccentricity increased, optical and neural anisotropy increased in magnitude. The average ratio of horizontal to vertical optical MTF (at 2 and 4 cyc/deg) at 0°, 10°, and 20° was 0.96 ± 0.14, 1.41 ± 0.54 and 2.15 ± 1.38, respectively. Similarly, the average ratio of horizontal to vertical contrast sensitivity with full optical correction at 0°, 10°, and 20° was 0.99 ± 0.15, 1.28 ± 0.28 and 1.75 ± 0.80, respectively. These results indicate that the neural system's orientation sensitivity coincides with habitual blur orientation. These findings support the neural origin of the meridional effect and raise important questions regarding the role of peripheral anisotropic optical quality in developing the meridional effect and emmetropization.

The role of sensory ocular dominance on through-focus visual performance in monovision presbyopia corrections.

Monovision presbyopia interventions exploit the binocular nature of the visual system by independently manipulating the optical properties of the two eyes. It is unclear, however, how individual variations in ocular dominance affect visual function in monovision corrections. Here, we examined the impact of sensory ocular dominance on visual performance in both traditional and modified monovision presbyopic corrections. We recently developed a binocular adaptive optics vision simulator to correct subjects' native aberrations and induce either modified monovision (1.5 D anisometropia, spherical aberration of +0.1 and -0.4 µm in distance and near eyes, respectively, over 4 mm pupils) or traditional monovision (1.5 D anisometropia). To quantify both the sign and the degree of ocular dominance, we utilized binocular rivalry to estimate stimulus contrast ratios that yield balanced dominance durations for the two eyes. Through-focus visual acuity and contrast sensitivity were measured under two conditions: (a) assigning dominant and nondominant eye to distance and near, respectively, and (b) vice versa. The results revealed that through-focus visual acuity was unaffected by ocular dominance. Contrast sensitivity, however, was significantly improved when the dominant eye coincided with superior optical quality. We hypothesize that a potential mechanism behind this observation is an interaction between ocular dominance and binocular contrast summation, and thus, assignment of the dominant eye to distance or near may be an important factor to optimize contrast threshold performance at different object distances in both modified and traditional monovision.

Correlating optical bench performance with clinical defocus curves in varifocal and trifocal intraocular lenses.

PURPOSE: To investigate the correlations existing between a trifocal intraocular lens (IOL) and a varifocal IOL using the "ex vivo" optical bench through-focus image quality analysis and the clinical visual performance in real patients by study of the defocus curves. METHODS: This prospective, consecutive, nonrandomized, comparative study included a total of 64 eyes of 42 patients. Three groups of eyes were differentiated according to the IOL implanted: 22 eyes implanted with the varifocal Lentis Mplus LS-313 IOL (Oculentis GmbH, Berlin, Germany); 22 eyes implanted with the trifocal FineVision IOL (Physiol, Liege, Belgium), and 20 eyes implanted with the monofocal Acrysof SA60AT IOL (Alcon Laboratories, Inc., Fort Worth, TX). Visual outcomes and defocus curve were evaluated postoperatively. Optical bench through-focus performance was quantified by computing an image quality metric and the cross-correlation coefficient between an unaberrated reference image and captured retinal images from a model eye with a 3.0-mm artificial pupil. RESULTS: Statistically significant differences among defocus curves of different IOLs were detected for the levels of defocus from -4.00 to -1.00 diopters (D) (P < .01). Significant correlations were found between the optical bench image quality metric results and logMAR visual acuity scale in all groups (Lentis Mplus group: r = -0.97, P < .01; FineVision group: r = -0.82, P < .01; Acrys of group: r = -0.99, P < .01). Linear predicting models were obtained. CONCLUSIONS: Significant correlations were found between logMAR visual acuity and image quality metric for the multifocal and monofocal IOLs analyzed. This finding enables surgeons to predict visual outcomes from the optical bench analysis.

Impact of pupil transmission apodization on presbyopic through-focus visual performance with spherical aberration.

PURPOSE: To investigate the impact on through-focus retinal image quality and visual performance of apodizing the pupil's transmission function in combination with extended depth of focus presbyopic corrections, such as spherical aberration (SA). METHODS: Through-focus retinal image quality was determined theoretically for various magnitudes of pupil transmission apodization and Zernike primary SA (-0.5 to +0.5 µm) for a 4-mm pupil. The impact of pupil transmission apodization was also assessed psychophysically with a vision simulator equipped with a liquid crystal spatial light modulator for controlling pupil transmission. Through-focus visual acuity (VA) was measured with and without apodization in three cyclopleged subjects from distance to near with monochromatic light (550 nm) under two multifocal aberration conditions. Phase plates induced +0.2 and -0.2 µm of SA over a 4-mm artificial pupil. A baseline condition of zero SA was also included for comparison. RESULTS: The theoretical investigation showed that pupil transmission apodization significantly improved distance image quality in the presence of positive and negative SA. Retinal image quality at all target vergences for negative SA conditions was improved by apodization. Pupil transmission apodization improved through-focus VA by 0.1 to 0.2 logMAR at intermediate and near object distances for the zero and negative SA conditions. In the positive SA condition, apodization degraded VA by approximately 0.1 logMAR at intermediate object distances. CONCLUSIONS: Pupil transmission apodization had a significant impact on though-focus visual performance. Pupil transmission apodization affects through-focus retinal image quality by diminishing the relative contribution to the retinal image from the peripheral region of the wavefront aberration. Through-focus visual performance in presbyopic eyes with negative SA was improved due to pupil transmission apodization.

Modified monovision with spherical aberration to improve presbyopic through-focus visual performance.

PURPOSE: To investigate the impact on visual performance of modifying monovision with monocularly induced spherical aberration (SA) to increase depth of focus (DoF), thereby enhancing binocular through-focus visual performance. METHODS: A binocular adaptive optics (AO) vision simulator was used to correct both eyes' native aberrations and induce traditional (TMV) and modified (MMV) monovision corrections. TMV was simulated with 1.5 diopters (D) of anisometropia (dominant eye at distance, nondominant eye at near). Zernike primary SA was induced in the nondominant eye in MMV. A total of four MMV conditions were tested with various amounts of SA (± 0.2 and ± 0.4 µm) and fixed anisometropia (1.5 D). Monocular and binocular visual acuity (VA) and contrast sensitivity (CS) at 10 cyc/deg and binocular summation were measured through-focus in three cyclopledged subjects with 4-mm pupils. RESULTS: MMV with positive SA had a larger benefit for intermediate distances (1.5 lines at 1.0 D) than with negative SA, compared with TMV. Negative SA had a stronger benefit in VA at near. DoF of all MMV conditions was 3.5 ± 0.5 D (mean) as compared with TMV (2.7 ± 0.3 D). Through-focus CS at 10 cyc/deg was significantly reduced with MMV as compared to TMV only at intermediate object distances, however was unaffected at distance. Binocular summation was absent at all object distances except 0.5 D, where it improved in MMV by 19% over TMV. CONCLUSIONS: Modified monovision with SA improves through-focus VA and DoF as compared with traditional monovision. Binocular summation also increased as interocular similarity of image quality increased due to extended monocular DoF.

Binocular visual performance and summation after correcting higher order aberrations.

Although the ocular higher order aberrations degrade the retinal image substantially, most studies have investigated their effect on vision only under monocular conditions. Here, we have investigated the impact of binocular higher order aberration correction on visual performance and binocular summation by constructing a binocular adaptive optics (AO) vision simulator. Binocular monochromatic aberration correction using AO improved visual acuity and contrast sensitivity significantly. The improvement however, differed from that achieved under monocular viewing. At high spatial frequency (24 c/deg), the monocular benefit in contrast sensitivity was significantly larger than the benefit achieved binocularly. In addition, binocular summation for higher spatial frequencies was the largest in the presence of subject's native higher order aberrations and was reduced when these aberrations were corrected. This study thus demonstrates the vast potential of binocular AO vision testing in understanding the impact of ocular optics on habitual binocular vision.

Impact of corneal aberrations on through-focus image quality of presbyopia-correcting intraocular lenses using an adaptive optics bench system.

PURPOSE: To measure the impact of corneal aberrations on the through-focus image quality of presbyopia-correcting intraocular lenses (IOLs) using an adaptive optics IOL metrology system. SETTING: Flaum Eye Institute, University of Rochester, Rochester, New York, USA. DESIGN: Experimental study. METHODS: An adaptive optics IOL metrology system comprising a model eye, wavefront sensor, deformable mirror, and an image-capturing device acquired through-focus images of a letter chart with 3.0 mm and 5.0 mm pupil diameters. The system was used to induce corneal astigmatism and higher-order aberrations (HOAs) in previously measured pseudophakic presbyopic eyes. A single-optic accommodating IOL (Crystalens HD (HD500), an apodized (Restor +3.0 diopter [D] SN6AD1) and full-aperture (Tecnis ZM900) diffractive multifocal IOL, and a monofocal IOL (Acrysof SN60AT) were evaluated. Image quality was quantified using the correlation-coefficient image-quality metric. RESULTS: The single-optic accommodating IOL and monofocal IOL performed similarly; however, with a 3.0 mm pupil, the former had better intermediate (1.50 D) image quality. The multifocal IOLs had bimodal through-focus image quality trends. Corneal astigmatism reduced through-focus image quality and depth of focus with all IOLs; however, the multifocal IOLs had the most severe decline in depth of focus. Ocular spherical aberration had the strongest impact on image quality when typical pseudophakic corneal HOAs were present. CONCLUSIONS: The uncorrected corneal astigmatism and HOAs in pseudophakic eyes significantly affected through-focus performance of presbyopia-correcting IOLs. Although multifocal IOLs significantly increased depth of focus, this benefit diminished when more than 0.75 D astigmatism remained uncorrected. Residual ocular spherical aberration had a significant effect on image quality in the presence of other corneal HOAs.

Objective evaluation of through-focus optical performance of presbyopia-correcting intraocular lenses using an optical bench system.

PURPOSE: TO evaluate spherical aberration and through-focus optical performances of 5 presbyopia-correcting and 2 monofocal intraocular lenses (IOLs). SETTING: Flaum Eye Institute, University of Rochester, Rochester, New York, USA. DESIGN: Experimental study. METHODS: Five presbyopia-correcting IOLs (Restor +4D SN6AD3, Restor +3D SN6AD1, Rezoom NXG1, Tecnis multifocal ZM900, Crystalens HD500) were tested using an optical bench system consisting of a model eye, a high-resolution Hartmann-Shack wavefront sensor, and an image-capturing device. Two monofocal IOLs (Sofport AO LI60AOV, Acrysof SN60AT) were measured for comparison. No accommodation was simulated. The spherical aberration profiles of each IOL were measured using the wavefront sensor. Through-focus performance was evaluated by calculating cross-correlation coefficients and comparing the likenesses of captured images of a resolution target and a perfect reference image. RESULTS: With a 5.0 mm entrance pupil, the SN6AD3, SN6AD1, ZM900, NXG1, and HD500 IOLs had spherical aberration of -0.18 µm, -0.14 µm, -0.15 µm, -0.07 µm, and -0.01 µm, respectively. Distance image quality was poorer with multifocal and accommodating IOLs than with monofocal IOLs. All multifocal IOLs had effective distance and near image quality but had a loss in intermediate image quality. The HD 500 accommodating IOL had decreased distance image quality and slightly increased depth of focus compared with the monofocal IOLs because of the bispheric design. CONCLUSIONS: The presbyopia-correcting IOLs had different optical characteristics, including spherical aberration profile and through-focus performance. An accurate understanding of the optical characteristics of individual IOLs is essential to selecting the best presbyopia-correcting IOL and thus improving cataract surgery outcomes. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.