Enhanced visual acuity and image perception following correction of highly aberrated eyes using an adaptive optics visual simulator.

PURPOSE: To evaluate the changes in visual acuity and visual perception generated by correcting higher order aberrations in highly aberrated eyes using a large-stroke adaptive optics visual simulator. METHODS: A crx1 Adaptive Optics Visual Simulator (Imagine Eyes) was used to correct and modify the wavefront aberrations in 12 keratoconic eyes and 8 symptomatic postoperative refractive surgery (LASIK) eyes. After measuring ocular aberrations, the device was programmed to compensate for the eye's wavefront error from the second order to the fifth order (6-mm pupil). Visual acuity was assessed through the adaptive optics system using computer-generated ETDRS opto-types and the Freiburg Visual Acuity and Contrast Test. RESULTS: Mean higher order aberration root-mean-square (RMS) errors in the keratoconus and symptomatic LASIK eyes were 1.88+/-0.99 microm and 1.62+/-0.79 microm (6-mm pupil), respectively. The visual simulator correction of the higher order aberrations present in the keratoconus eyes improved their visual acuity by a mean of 2 lines when compared to their best spherocylinder correction (mean decimal visual acuity with spherocylindrical correction was 0.31+/-0.18 and improved to 0.44+/-0.23 with higher order aberration correction). In the symptomatic LASIK eyes, the mean decimal visual acuity with spherocylindrical correction improved from 0.54+/-0.16 to 0.71+/-0.13 with higher order aberration correction. The visual perception of ETDRS letters was improved when correcting higher order aberrations. CONCLUSIONS: The adaptive optics visual simulator can effectively measure and compensate for higher order aberrations (second to fifth order), which are associated with diminished visual acuity and perception in highly aberrated eyes. The adaptive optics technology may be of clinical benefit when counseling patients with highly aberrated eyes regarding their maximum subjective potential for vision correction.

Expanding depth of focus by modifying higher-order aberrations induced by an adaptive optics visual simulator.

PURPOSE: To evaluate the impact of higher-order aberrations on depth of focus using an adaptive optics visual simulator. SETTING: Refractive Surgery Department, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA. METHODS: An adaptive optics simulator was used to optically introduce individual aberrations in eyes of subjects with a 6.0 mm pupil under cycloplegia (coma and trefoil, magnitudes +/-0.3 microm; spherical aberration, magnitudes +/-0.3, +/-0.6, +/-0.9 microm). A through-focus response curve was assessed by recording the percentage of Sloan letters at a fixed size identified at various target distances. The subject's ocular depth of focus and center of focus were computed as the half-maximum width and the midpoint of the through-focus response curve. RESULTS: The dominant eyes of 10 subjects were evaluated. The simulation of positive or negative spherical aberration had the effect of enhancing depth of focus and resulted in linearly shifting of the center of focus by 2.6 diopters (D)/microm of error. This increase in depth of focus reached a maximum of approximately 2.0 D with 0.6 microm of spherical aberration and became smaller when the aberration was increased to 0.9 microm. Trefoil and coma appeared to neither shift the center of focus nor significantly modify the depth of focus. CONCLUSION: The introduction of both positive and negative spherical aberration using adaptive optics technology significantly shifted and expanded the subject's overall depth of focus; simulating coma or trefoil did not produce such effects.

Effects of Zernike wavefront aberrations on visual acuity measured using electromagnetic adaptive optics technology.

PURPOSE: This study measured the changes in visual acuity induced by individual Zernike ocular aberrations of various root-mean-square (RMS) magnitudes. METHODS: A crx1 Adaptive Optics Visual Simulator (Imagine Eyes) was used to modify the wavefront aberrations in nine eyes. After measuring ocular aberrations, the device was programmed to compensate for the eye's wavefront error up to the 4th order and successively apply different individual Zernike aberrations using a 5-mm pupil. The generated aberrations included defocus, astigmatism, coma, trefoil, and spherical aberration at a level of 0.1, 0.3, and 0.9 microm. Monocular visual acuity was assessed using computer-generated Landolt-C optotypes. RESULTS: Correction of the patients' aberrations improved visual acuity by a mean of 1 line (-0.1 logMAR) compared to best sphero-cylinder correction. Aberrations of 0.1 microm RMS resulted in a limited decrease in visual acuity (mean +0.05 logMAR), whereas aberrations of 0.3 microm RMS induced significant visual acuity losses with a mean reduction of 1.5 lines (+0.15 logMAR). Larger aberrations of 0.9 microm RMS resulted in greater visual acuity losses that were more pronounced with spherical aberration (+0.64 logMAR) and defocus (+0.62 logMAR), whereas trefoil (+0.22 logMAR) was found to be better tolerated. CONCLUSIONS: The electromagnetic adaptive optics visual simulator effectively corrected and generated wavefront aberrations up to the 4th order. Custom wavefront correction significantly improved visual acuity compared to best-spectacle correction. Symmetric aberrations (eg, defocus and spherical aberration) were more detrimental to visual performance.

Adaptive optics with a magnetic deformable mirror: applications in the human eye.

A novel deformable mirror using 52 independent magnetic actuators (MIRAO 52, Imagine Eyes) is presented and characterized for ophthalmic applications. The capabilities of the device to reproduce different surfaces, in particular Zernike polynomials up to the fifth order, are investigated in detail. The study of the influence functions of the deformable mirror reveals a significant linear response with the applied voltage. The correcting device also presents a high fidelity in the generation of surfaces. The ranges of production of Zernike polynomials fully cover those typically found in the human eye, even for the cases of highly aberrated eyes. Data from keratoconic eyes are confronted with the obtained ranges, showing that the deformable mirror is able to compensate for these strong aberrations. Ocular aberration correction with polychromatic light, using a near Gaussian spectrum of 130 nm full width at half maximum centered at 800 nm, in five subjects is accomplished by simultaneously using the deformable mirror and an achromatizing lens, in order to compensate for the monochromatic and chromatic aberrations, respectively. Results from living eyes, including one exhibiting 4.66 D of myopia and a near pathologic cornea with notable high order aberrations, show a practically perfect aberration correction. Benefits and applications of simultaneous monochromatic and chromatic aberration correction are finally discussed in the context of retinal imaging and vision.

Ultrahigh-resolution full-field optical coherence tomography.

We have developed a white-light interference microscope for ultrahigh-resolution full-field optical coherence tomography of biological media. The experimental setup is based on a Linnik-type interferometer illuminated by a tungsten halogen lamp. En face tomographic images are calculated by a combination of interferometric images recorded by a high-speed CCD camera. Spatial resolution of 1.8 microm x 0.9 microm (transverse x axial) is achieved owing to the extremely short coherence length of the source, the compensation of dispersion mismatch in the interferometer arms, and the use of relatively high-numerical-aperture microscope objectives. A shot-noise-limited detection sensitivity of 90 dB is obtained in an acquisition time per image of 4 s. Subcellular-level images of plant, animal, and human tissues are presented.

High-resolution full-field optical coherence tomography with a Linnik microscope.

We describe an original microscope for high-resolution optical coherence tomography applications. Our system is based on a Linnik interference microscope with high-numerical-aperture objectives. Lock-in detection of the interference signal is achieved in parallel on a CCD by use of a photoelastic birefringence modulator and full-field stroboscopic illumination with an infrared LED. Transverse cross-section (en-face, or XY) images can be obtained in real time with better than 1-microm axial (Z) resolution and 0.5-microm transverse (XY) resolution. A sensitivity of approximately 80 dB is reached at a 1-image/s acquisition rate, which allows tomography in scattering media such as biological tissues.