Effect of pupil size on longitudinal focal distribution after photorefractive keratectomy

Abstract

Optical aberrations induced by the transition zone of a myopic photorefractive keratectomy (PRK) may degrade the image quality. The subjectively evaluated visual acuity and contrast sensitivity may be reduced significantly especially with mydriasis. The purpose of this study was to calculate the image forming properties of the eye using raytracing techniques of a spot light source based on topographic height data of a scanning slit videokeratoscope. Refractive surfaces were calculated from raw height data sets of the anterior and posterior corneal surface measurements (Orbscan, Orbtec, USA). The characteristics of the residual refractive surfaces were derived from Navarro's eye model. The focal distance was calculated using the exact raytracing calculation. Point spread function was determined at the focal plane and at 5 (delta = 0.2 mm) parafocal planes in front of and behind the focal distance in accordance to the pupil diameter (2, 3 and 6 mm). The algorithm was applied to 11 selected eyes (6 left, 5 right) of 8 patients before and after PRK with myopia (n = 6) and myopic astigmatism (n = 5). Before PRK the focal distance did not decrease significantly with increasing pupil size (2 to 6 mm), but decreased significantly after PRK (-0.41 +/- 0.12 mm, p = 0.02). Preoperatively, the variance of the point spread function did not differ significantly between a 2 mm (0.046 +/- 0.015 mm) and a 6 mm (0.055 +/- 0.021 mm) pupil size but was affected significantly by the pupil size postoperatively (2 mm: 0.049 +/- 0.018 mm, 6 mm: 0.096 +/- 0.045 mm, p = 0.04). Raytracing of corneal topography height data based on refined eye models with the option of calculation of the focus has the potential of tracing the optical resolution of the eye as a function of the pupil size. Due to of the altered surface geometry of the cornea after myopic PRK, both the variance of the point-spread function and the depth of focus increase with pupil size. This may be an explanation for impaired subjective refractometry and reduced contrast sensitivity of the patient after conventional keratorefractive surgery.