Higher-order Aberrations Root Mean Square Research Articles

Comparative Study of Primary SMILE, SMILE Enhancement, and Femtosecond Laser-Assisted LASIK on Higher Order Aberrations and Corneal Densitometry.

To compare differences in corneal densitometry (CD) and higher order aberrations (HOAs) in eyes that underwent small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for the treatment of myopia and myopic astigmatism at postoperative months 3, 6, and 12, and to evaluate their changes in a separate cohort of eyes after SMILE enhancement. In this prospective, randomized, paired-eye clinical trial, consecutive eligible participants were randomized to undergo SMILE or FS-LASIK in either eye. Main outcome measures were CD and HOAs preoperatively and at 3, 6, and 12 months postoperatively. A separate cohort of consecutive patients who had SMILE and underwent enhancement were also included for comparison. For CD, no significant differences were found between SMILE and FS-LASIK up to month 12. For HOA measured by wavefront aberrometry, both SMILE and FS-LASIK had an increase in total root mean square (RMS) HOAs, spherical aberration (SA), and vertical coma up to month 12. SMILE had an additional increase in vertical quatrefoil, and FS-LASIK had an increase in horizontal coma at month 12. FS-LASIK had higher SA than SMILE, whereas SMILE had higher vertical quatrefoil than FS-LASIK at month 12. Central and posterior zone CD had significantly decreased after SMILE enhancement compared to after primary SMILE up to 2 years after enhancement. RMS HOAs, lower order aberrations, and SA were all increased after SMILE enhancement compared to after primary SMILE. SMILE induced lower SA but higher vertical quatrefoil than FS-LASIK at 1 year. Both SMILE and FS-LASIK had similar increases in RMS HOAs and vertical coma up to 1 year. There were no differences in CD between both groups. SMILE enhancement additionally had decreased central and posterior CD but greater RMS HOAs and SA compared to primary SMILE. [J Refract Surg. 2024;40(5):e291-e303.].

Timing optimization for primary pterygium excision with conjunctival-limbal autograft to restore the corneal optical properties.

To propose the optimal value of baseline corneal astigmatism and pterygial morphological profiles for primary pterygium surgery to restore the corneal optical properties. We analysed 93 eyes from 84 subjects with nasal-only primary pterygium who underwent pterygium excision with conjunctival-limbal autograft and were assessed perioperatively using anterior segment swept-source optical coherence tomography (AS SS-OCT). We collected data on anterior corneal astigmatism (ACA) and root mean square (RMS) values for anterior corneal lower- (LoA) and higher-order aberrations (HoA) as corneal optical properties using AS SS-OCT. Using preoperative ACA and four pterygial morphological profiles (horizontal invasion length [HIL], height, thickness and the ratio of residual corneal thickness [RCT] to central corneal thickness [CCT]) measured in AS SS-OCT, we plotted receiver operating characteristic (ROC) curves. These curves aimed to determine cut-off values predicting a perioperative decrease exceeding 50% in ACA, RMS LoA and RMS HoA, as well as postoperative residual ACA higher than 1.25D. Preoperative ACA > 1.42D (AUC = 0.934) and >3.60D (AUC = 0.946) proved most effective in identifying subjects with perioperative decrease exceeding in ACA and RMS LoA, respectively. HIL > 3.34 mm (AUC = 0.941) was most effective in distinguishing subjects with perioperative reduction exceeding 50% in RMS HoA. Preoperative ACA > 5.78D (AUC = 0.776) and HIL > 5.03 mm (AUC = 0.700) significantly distinguished subjects with postoperative residual ACA higher than 1.25D. Optimizing the restoration of corneal astigmatism and aberrations after pterygium surgery may be facilitated by determining the optimal surgical timing based on preoperative ACA and HIL values.

Evaluation of the Agreement Between a New Pyramid Wavefront Sensor Aberrometer and Scheiner-Smirnov Aberrometers.

To assess agreement between a new aberrometer (Osiris-T; CSO) employing pyramid wavefront sensor technique and Scheiner-Smirnov aberrometer (OPD-Scan III; Nidek) on measuring ocular, corneal, and internal aberrations in healthy participants. The measurements were conducted three times consecutively by an experienced examiner. The total root mean square (RMS) aberrations, higher order aberration RMS, coma Z3±1, trefoil Z3±3, spherical aberration Z40, and astigmatism II Z4±2 up to 7th order were exported in both 4-and 6-mm pupil zones. The parameters between the two devices were statistically compared using the paired t-test, and the differences assessed with Bland-Altman plots and 95% limits of agreement. This prospective study included 70 right eyes of 70 healthy participants with an average age of 25.94 ± 6.59 years (range: 18 to 47 years). The mean difference in the two devices ranged from 0.01 µm for astigmatism II Z4±2 to 0.63 µm for total RMS in 4 mm and from 0.01 to 1.41 µm in 6-mm pupil size. The Bland-Altman analysis of ocular, corneal, and internal aberrations indicated high agreement between the two devices and the maximum absolute values for 95% limits of agreement ranged from 0.03 to 1.06 µm for 4-mm pupil diameters and 0.12 to 1.13 µm for 6-mm pupil diameters. The newly developed pyramid wavefront sensor technique aberrometer demonstrated a high agreement with a Scheiner-Smirnov aberrometer when measuring ocular, corneal, and internal aberrations in healthy participants. Thus, the two aberrometers may be considered interchangeable for clinical applications. [J Refract Surg. 2024;40(4):e218-e228.].

Optimum pinhole size determination in pinhole pupilloplasty for higher-order aberrations.

To determine optimal pinhole size (OPS) and establish a relationship with visual acuity (VA) and RMS (root mean square) values in cases with higher-order aberrations (HOAs) undergoing pinhole pupilloplasty (PPP). Private practice, India. Prospective, interventional study. RMS value for 6-mm-diameter optical zone was determined by Scheimpflug imaging (Pentacam). Patients with RMS value >0.3 μm were included. Preoperatively, a hand-held pinhole gauge with varied apertures determined the OPS, and single-pass four-throw technique was used to perform pupilloplasty with Purkinje-1 reflex as a marker for centration. VA with OPS, correlation of RMS values with OPS and pupil size, and Strehl ratio were the main outcome measures. 29 eyes with HOAs were analyzed; all patients chose 1.0 or 1.5 mm as OPS. The mean preoperative and postoperative pupil size was 3.25 ± 0.81 mm and 1.8 ± 0.54 mm ( P = .000), respectively. Postoperative mean pupil size when compared with OPS denoted that 14 eyes had a difference of <0.1 mm, 8 eyes ranged from 0.2 to 0.45 mm, and 7 eyes had ≥0.6 mm (range from 0.6 to 1.8 mm) difference from OPS. Eyes with higher RMS values needed smaller pupil gauge to achieve better VA. Preoperatively, vision with OPS correlated well with preoperative 6-mm RMS HOAs ( r = 0.728; P = .00). Postoperative UDVA correlated well with VA measured with OPS ( r = 0.847; P = .00). The preoperative and postoperative mean Strehl ratio was 0.109 ± 0.07 and 0.195 ± 0.11 ( P = .001), respectively. Higher RMS values required a smaller pupil to achieve optimum VA. PPP can help achieve pinhole size in accordance with patient's optimum pinhole requirement.

Corneal Higher Order Aberrations and Epithelial Remodeling With Femtosecond Laser-Assisted LASIK Topography-guided and Customized Asphericity Ablation in the Contralateral Eye: A Randomized, Double-Blind, Prospective Study.

To evaluate refractive results, corneal higher order aberrations (HOAs), and epithelial remodeling in the preoperative and postoperative period of regular corneas that had topography-guided femtosecond laser-assisted laser in situ keratomileusis (LASIK) (Contoura WaveLight; Alcon Laboratories, Inc) and compare them with the contralateral eye that underwent ablation customized by asphericity (Custom-Q WaveLight; Alcon Laboratories, Inc) in myopic eyes with or without astigmatism. A prospective, randomized, and double-blind study was conducted. Patients underwent preoperative and postoperative epithelial mapping and corneal tomography to assess the epithelial thickness map, HOAs of the corneal anterior surface, visual acuity, and refractive evaluation. This study enrolled 96 normal eyes of 48 patients. Uncorrected distance visual acuity of 20/20 or better was achieved in 97% of patients and gains in corrected distance visual acuity and effectiveness in correcting refractive astigmatism were similar in both techniques. Seventeen sectors of the corneal epithelium map were assessed by spectral-domain optical coherence tomography and no significant differences were found between techniques preoperatively and postoperatively (P > .05). HOA root mean square, coma Z3±1, trefoil Z3-3, and tissue consumption exhibited statistically significant between-technique differences (P < .05). The Contoura and Custom-Q techniques were similar with respect to refractive and visual outcomes after 3 months, as well as in epithelial remodeling. The Contoura provides lower postoperative HOA root mean square, coma Z3±1, and trefoil Z3-3 values, but the techniques showed no differences in the correction of the corneal astigmatic wavefront component and in the spherical aberration after 3 months. [J Refract Surg. 2023;39(11):751-758.].

Comparative analysis of the correction of irregular postkeratoplastic astigmatism with scleral lenses and intrastromal ring implantation

Background. Many patients after penetrating keratoplasty (PK) experience induced postkeratoplastic astigmatism, which is often irregular and causes an increase in corneal aberrations that reduce visual acuity and quality. The aim of the study. To conduct a comparative analysis of the effect of rigid gas permeable scleral lenses and the MyoRing implantation method on clinical and functional parameters in patients with IPA. Material and methods. The clinical study included 60 patients (60 eyes). The age of patients with IPA was from 25 to 42 years. All patients underwent penetrating keratoplasty. All patients were divided into two groups depending on the method for irregular postkeratoplastic astigmatism correction. Group I included 30 patients (30 eyes) who were fitted with rigid gas permeable scleral lenses. Group II consisted of 30 patients (30 eyes) who underwent implantation of the MyoRing into a penetrating corneal graft. The observation period was 1 year. Results. After 12 months of observation, there was a greater increase in uncorrected visual acuity by an average of 3 lines, in corrected visual acuity – by 2 lines; a greater decrease in corneal aberrations in photo- (root mean square (RMS) of total aberrations (RMS total) by 0.30 ± 0.08 µm, RMS of higher order aberrations (RMS HOA) – by 1.01 ± 0.24 μm) and mesopic conditions (RMS total – by 0.33 ± 0.09 μm, RMS HOA – by 0.08 ± 0.03 μm) in patients wearing rigid gas permeable scleral lenses compared with patients after MyoRing implantation into a penetrating corneal graft. Conclusion. Patients of group I, wearing rigid gas permeable scleral lenses, showed a greater improvement in visual acuity and a decrease in corneal aberrations in photo- and mesopic conditions compared to the patients of group II (after MyoRing implantation) at a follow-up period of 12 months.

Rate of fractional change in corneal tomography parameters in keratoconus using a combination of predictive parameters

BackgroundTo compare the rate of fractional change for multiple corneal tomographic factors in progressive keratoconus (KC).MethodsIn this retrospective case series, 40 eyes (40 patients) with progressive KC (increase in central keratometry of 1.00 D or maximum keratometry of 1.50 D on two visits at least six months apart) were included. Cases with previous history of ocular surgery, poor scans, corneal scars, severe dry eyes, post-excimer ectasia, pellucid marginal degeneration were excluded. Medical records, corneal tomography and anterior corneal wavefront (8 mm) (Scheimpflug tomography, Pentacam, Oculus, Germany) were analyzed. Rate of fractional change (Rx = (x1 − x0)/(|x0|tm)); where, x1 = value at follow-up, x0 = value at initial visit and tm = time in months, was measured.ResultsThe mean age of the patients was 30.0 ± 8.4 years. The mean follow-up duration was 8.9 ± 4.2 months. Coma (0.076 ± 1.4) had the largest rate of fractional change (P = 1.7 × 10−14, Kruskal–Wallis test). The rate of fractional change was higher for aberrometric parameters (anterior corneal higher-order aberrations root mean square and anterior coma) compared to pachymetric and keratometric parameters (P values ranging from 1.4 × 10−4 to 7.4 × 10−10, Mann–Whitney test, effect size ranging from 0.4–0.7). The rate of fractional change was comparable between pachymetric and keratometric factors (P > 0.05 for all comparisons, Mann–Whitney test).ConclusionsAnterior corneal wavefront, especially anterior coma, were noted to have higher rate of fractional change compared to single point keratometric and pachymetric indices in progressive KC. This information can be used for decision-making when monitoring patients with KC.

One-year clinical efficacy evaluation of selective corneal wavefront aberration-guided FS-LASIK correction in patients with high myopia.

To evaluate the effectiveness, safety, predictability, precision and changes of higher-order aberrations (HOAs) on corneal front surface of selective corneal wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis (CW-FS-LASIK) in patients with high myopia 1-year postoperatively. Totally 74 eyes of 37 patients with high myopia or myopic astigmatism in both the eyes who underwent the CW-FS-LASIK procedure in Xi'an Gaoxin Hospital from January 2021 to June 2021 were included. The changes of uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), spherical equivalent refraction (SER), astigmatism, HOAs and Strehl ratio (SR) on the anterior surface of the cornea after 1y of the surgery were analyzed. At postoperative 1y, the UDVA (logMAR) of 74 eyes (100%) reached 0 or better, including 0 in 8 eyes (10.81%), -0.1 in 45 eyes (60.81%), and -0.2 in 21 eyes (28.38%). The effectiveness index was 1.29±0.134. There was no decrease in postoperative BCVA compared with preoperative BCVA in all patients. Postoperative BCVA was the same in 44 eyes (59.46%) as preoperative BCVA, increased by 1 line in 23 eyes (31.08%) and increased by 2 lines in 7 eyes (9.46%) compared with preoperative BCVA. The safety index was 1.11±0.159. The estimated corrected SER before surgery was (-7.76±1.21) D, and the actual corrected SER was (-7.83±1.25) D (Y=0.9811X+0.2156, R2=0.9084). There was a high correlation between the estimated corrected SER and the actual corrected SER. The postoperative SER in 74 eyes (100%) was within ±0.75 D. The postoperative astigmatism of all was within -0.75 D to 0. Root mean square (RMS) HOAs of spherical aberration and SR within 5 mm of the corneal front surface were all increased compared with those before operation (P<0.01). The total coma, horizontal coma and vertical coma were all decreased compared with those before operation (P<0.01). There was no statistically significant difference in horizontal trefoil and vertical trefoil compared with preoperative ones (P>0.05). Selective CW-FS-LASIK for correction of high myopia is effective, safe, predictive, and accurate. For patients with preoperative RMS HOAs over 0.25 defocus equivalent, postoperative coma aberration can be significantly reduced, and SR value can be increased, thus corneal imaging quality can be improved.

Comparison of Higher Order Aberrations between Wavefront Optimized Photorefractive Keratectomy and Laser in situ Keratomileusis in Myopic Patients.

To compare the higher order aberrations (HOA) between wavefront optimized (WFO) laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in myopic patients. Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from December 2021 to December 2022. Forty-four patients underwent wavefront optimized PRK and fifty-seven patients underwent wavefront optimized LASIK. All variables were recorded before the procedure and at 1, 3, 6, and 12 months postoperatively and included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), root mean square (RMS) of HOAs, spherical aberration (SA), and coma aberration (CA). A total of 101 eyes of 51 patients were considered in the final analysis. Patients were divided into two groups. Group A comprised of 44 (43.6%) eyes of 22 patients who underwent PRK while group B comprised of 57 (56.4%) eyes of 29 patients who underwent LASIK. UCVA significantly improved postoperatively at 3 and 6 months in both PRK and LASIK groups (p<0.001 for both groups). In this study, the increase in root mean square (RMS) of higher order aberrations from baseline value was 77% after PRK and 28% after LASIK, similar ratio was observed in spherical aberration (SA). The trend of rise in Coma aberrations was more in LASIK group 66.49%as compared to 46.2% in PRK group. Both Wavefront Optimized PRK and LASIK are safe and have elicited comparable results of post-procedure visual recovery. There was a marked increase in RMS of HOAs in PRK group as compared to WFO LASIK group while coma aberration increased more in LASIK as compared to PRK postoperatively. LASIK, PRK, RMSh, HOAs, Spherical aberration, Coma, Myopia.

Characteristics and influencing factors of corneal higher-order aberrations in patients with cataract

PurposeTo observe the distribution characteristics of corneal higher-order aberrations (HOAs) in cataract patients, and analyze the relationship of HOAs with patients’ age and ocular biometric parameters.MethodsThis retrospective study reviews the patients with cataract in Wuhan Aier Eye Department from January to August 2022. Root mean square (RMS) of the total HOA (tHOA), spherical aberration (SA), coma and trefoil aberration of the anterior cornea at central 4 and 6 mm optic zone were measured by the Wavefront Aberrometer (OPD-Scan III; Nidek Inc, Tokyo, Japan). The biometric parameters including axial length (AL), keratometry (K), central corneal thickness (CCT) and lens thickness (LT) were measured by swept-source coherence laser interferometry (OA-2000; TOMEY Corp, Aichi, Japan). Subgroup analyses and multiple linear regression analyses were used to determine whether HOAs were associated with age and ocular biometric parameters.ResultsA total of 976 patients (976 eyes) were included, averagely aged 65 years. At central 4 and 6 mm optic zone, the mean RMS of tHOA were respectively 0.20 and 0.65 μm, the SA were 0.06 and 0.30 μm, the coma aberration were 0.11 and 0.35 μm, and the trefoil aberration were 0.12 and 0.30 μm. The tHOA decreased with age until 60 years and then started to increase afterwards. The tHOA, coma and trefoil aberration increased with corneal astigmatism. The tHOA, SA, and coma aberration differ among different AL groups, and emmetropes had the smallest tHOA, SA, and coma aberration.ConclusionsWith increasing age, the value of tHOA decrease first and started increasing at 60 years. The trends of corneal HOAs are consistent with corneal low-order aberrations. The values of tHOA, SA and coma aberration were the smallest in emmetropic eyes.

Optical changes and association with axial elongation in children wearing orthokeratology lenses of different back optic zone diameter

PurposeTo compare changes in ocular aberrations in children wearing orthokeratology (ortho-k) lenses with a back optic zone diameter (BOZD) of 6 mm (6-MM group) or 5 mm (5-MM group) and their associations with axial elongation (AE) over two years.MethodsSeventy Chinese children, aged 6 to < 11 years, with myopia between − 4.00 to − 0.75 D, were randomly allocated to 5-MM and 6-MM groups. Ocular aberrations were measured, rescaled to a 4-mm pupil, and fitted with a 6th order Zernike expansion. Measurements, including axial length, were taken prior to commencing ortho-k treatment and then every six months over two years.ResultsAfter two years, the 5-MM group displayed a smaller horizontal treatment zone (TZ) diameter (by 1.14 ± 0.11 mm, P < 0.001) and less AE (by 0.22 ± 0.07 mm, P = 0.002) compared with the 6-MM group. A greater increase in total root mean square (RMS) of higher-order aberrations (HOAs), primary spherical aberration (SA) ({mathrm{C}}_{4}^{0}), and coma were also observed in the 5-MM group at all follow-up visits. The horizontal TZ diameter was significantly associated with changes in RMS HOAs, SA (RMS, primary and secondary SA), and RMS coma. After controlling for baseline parameters, RMS HOAs, RMS SA, RMS coma, and primary ({mathrm{C}}_{4}^{0}) and secondary ({mathrm{C}}_{6}^{0}) SA were significantly associated with AE.ConclusionsOrtho-k lenses with a smaller BOZD created a smaller horizontal TZ diameter and a significant increase in total HOAs, total SA, total coma, and primary SA and a decrease in secondary SA. Of these ocular aberrations, total HOAs, total SA, and primary SA were negatively correlated with AE over two years.Trial registration: ClinicalTrial.gov, NCT03191942. Registered 19 June 2017, https://clinicaltrials.gov/ct2/show/NCT03191942.

Effect of preoperative pupil offset on corneal higher-order aberrations after femtosecond laser-assisted in situ keratomileusis

BackgroundThis study aimed to investigate the relationship between multiple higher-order aberrations (HOAs) subgroups and pupil offset, as well as to analyze the factors affecting postoperative corneal HOAs in patients with different degrees of refractive errors.MethodsWe enrolled 160 patients (316 eyes) aged ≥ 18 years who had undergone femtosecond laser-assisted in situ keratomileusis (FS-LASIK) treatment. Based on the relationship between the preoperative pupil offset and the postoperative ΔHOAs, all patients were divided into two groups: group I (pupil offset ≤ 0.20 mm) and group II (pupil offset > 0.20 mm). All of the eyes had low to high myopia with or without astigmatism (manifest refraction spherical equivalent (MRSE) < -10.00 D). Uncorrected distance visual acuity, corrected distance visual acuity, MRSE, pupil offset, central corneal thickness, corneal HOAs, vertical coma (Z3−1), horizontal coma (Z31), spherical aberration (Z40), trefoil 0° (Z33), and trefoil 30° (Z3−3) over a 6 mm diameter central corneal zone diameter were evaluated preoperatively and at 1 and 3 months postoperatively.ResultsOur result revealed significant differences in postoperative corneal total root mean square (RMS) HOAs, RMS vertical coma, RMS horizontal coma, RMS spherical aberration, and RMS trefoil 30° between group I and group II. ΔMRSE was found to be an effective factor for ΔRMS HOAs (R2 = 0.383), ΔRMS horizontal coma (R2 = 0.205), and ΔRMS spherical aberration (R2 = 0.397). In group II, multiple linear regression analysis revealed a significant correlation between preoperative pupillary offset and Δtotal RMS HOAs (R2 = 0.461), ΔRMS horizontal coma (R2 = 0.040), and ΔRMS trefoil 30°(R2 = 0.089). The ΔRMS vertical coma effect factor is the Y-component, and the factor influencing ΔRMS spherical aberration was ΔMRSE (R2 = 0.256).ConclusionA small pupil offset was associated with a lower induction of postoperative corneal HOAs. Efforts to optimize centration are critical for improving surgical outcomes in patients with FS-LASIK.

Retinal image quality in myopic children undergoing orthokeratology alone or combined with 0.01% atropine

BackgroundThe retinal image quality derived from lower-order (LOA) and higher-order aberrations (HOA) for fixed 3-mm and photopic pupil diameters, in children undergoing combined 0.01% atropine and orthokeratology (AOK) versus those receiving orthokeratology alone (OK) over two years was evaluated.MethodsThe visual Strehl ratio based on the optical transfer function (VSOTF), derived from 2nd- to 4th-order terms (LOA and HOA combined), 2nd-order terms (LOA only), and 3rd- to 4th-order terms (HOA only) for fixed 3-mm and natural photopic pupil diameters, was compared between the two treatment groups. The individual Zernike coefficients for a fixed 3-mm pupil size of 2nd- to 4th-orders, root mean square (RMS) of LOA ({Z}_{2}^{0}, {Z}_{2}^{-2}, and {Z}_{2}^{2} combined), HOA (3rd to 4th orders inclusive), and Coma ({Z}_{3}^{-1}{mathrm{and }Z}_{3}^{1} combined) were also compared between the two groups.ResultsRight eye data of 33 AOK and 35 OK participants were analysed. Under photopic conditions, significantly lower VSOTF based on HOA only was observed in the AOK group compared with that in the OK group at all post-treatment visits (all P < 0.05); however, interactions between HOA and LOA resulted in comparable overall retinal image quality (i.e., VSOTF based on LOA and HOA combined) between the two groups at all visits (all P > 0.05). For a fixed 3-mm pupil size, the VSOTF based on HOA only, LOA only, or HOA and LOA combined, were not different between the two groups (all P > 0.05). AOK participants had slower axial elongation (mean ± SD, 0.17 ± 0.19 mm vs. 0.35 ± 0.20 mm, P < 0.001), a larger photopic pupil size (4.05 ± 0.61 mm vs. 3.43 ± 0.41 mm, P < 0.001) than OK participants, over two years.ConclusionsHOA profile related to an enlarged pupil size may provide visual signal influencing eye growth in the AOK group.

Evaluation of Higher Order Aberrations and Anterior Segment Parameters Changes After Implantable Collamer Lens Implantation for High Myopia.

To evaluate changes in higher order aberrations (HOAs) induced by implantable collamer lens (ICL) implantation in correction of high myopia and to compare the anterior segment parameters before and after surgery. Also, to correlate these parameters with HOAs, the best corrected visual acuity (BCVA) and intraocular pressure (IOP). This prospective interventional cohort case series study included 40 eyes with high myopia that underwent ICL V4c implantation. They were evaluated pre-operatively and post-operatively at 1st and 3rd month HOAs using Scheimpflug Sirius Camera. The anterior segment parameters were evaluated by optical biometry. Correlations between HOAs, BCVA and anterior segment parameters were evaluated. The mean pre-operative BCVA was 0.67 ± 0.17, while post-operative BCVA was 0.74 ± 0.16 (p-value < 0.001). The spherical equivalent was -13.66 ± 2.23 pre-operatively, while post-operatively it was -0.77 ± 0.65 (p-value < 0.001). The mean pre-operative root mean square (RMS) of HOAs was 0.62 ± 0.11 µm, while mean post-operative RMS in the 1st month was 0.82 ± 0.29 µm (p-value < 0.001). At 3rd month, it was 0.63 ± 0.17 µm (p-value = 0.685). The mean pre-operative anterior chamber depth (ACD) was 3.66 ± 0.26 mm. It decreased in the post-operative 1st month to 3.46 ± 0.30 mm, while in 3rd month 3.45 ± 0.24 mm (p-value < 0.001, < 0.001) respectively. The mean pre-operative anterior chamber angle (ACA) 45.98 ± 8.39 o while, the mean ACA was 31.65 ± 4.14, 31.03 ± 3.74 post-operatively (p-value < 0.001, < 0.001) respectively. There was significant increase in IOP (p-value < 0.001). ICL implantation is safe and effective in correction of high myopia, as HOAs increase at first month post-operatively then, return to the pre-operative level by 3rd month. However, anterior segment parameters show significant changes which may need longer follow up.

Higher order aberrations and visual function in a young Asian population of high myopes

PurposeTo examine the associations between higher order aberrations (HOAs), visual performance, demographics, and ocular characteristics in a young Asian population with high myopia. MethodsThis was a retrospective review of military pre-enlistees conducted between March 2014 to September 2018. Visual acuity and contrast sensitivity were tested under photopic, mesopic and simulated night conditions. Ocular, corneal and internal HOAs were measured with a Hartmann–Shack wavefront aberrometer (KR-1W, Topcon Co., Tokyo, Japan). Results522 eyes of 263 consecutive subjects with severe high myopia (defined as spherical equivalent refraction [SER] ≤ −10.00D) in at least one eye, and high myopia (SER ≤ −6.00D) in the fellow eye, [mean (SD) SER −11.85 (2.03D)] were analysed. The mean (SD) age of subjects was 18.5 (1.6) years. Chinese eyes had significantly greater internal total HOA root-mean-square (RMS) compared to Malay eyes [mean difference (SD) 0.0246 (0.007) μm, p < 0.001). More negative SER was associated with greater ocular total HOA (p = 0.038), primary coma (p = 0.003) and tetrafoil (p = 0.025) RMS, as well as more positive ocular (p = 0.003) and internal primary spherical aberration (p = 0.009). Greater ocular total HOAs was associated with reduced visual acuity in simulated night conditions and low contrast, decreased contrast sensitivity under mesopic and simulated night conditions (all p < 0.05). ConclusionsGreater HOAs were associated with Chinese ethnicity and more negative SER in a young Asian population with high myopia. Greater HOAs were associated with poorer visual performance in low luminance and reduced contrast conditions.

Agreement between anterior segment swept source‐OCT and Scheimpflug imaging corneal aberration measurements in healthy eyes

AbstractPurpose: To assess agreement between corneal aberration measurements made through swept‐source optical coherence tomography using a new anterior segment imaging device (Anterion) and a Scheimpflug imaging device (Pentacam HR) in healthy subjects.Methods: Cross‐sectional study. In 50 eyes of 50 healthy subjects, 14 aberration parameters (7 across the anterior corneal surface and 7 across the total surface) were measured in 4 mm and 6 mm optic zones using each device: oblique trefoil (Z3_‐3), vertical coma (Z3_‐1), horizontal coma (Z3_1), horizontal trefoil (Z3_3), spherical aberration (Z4_0), root mean square (RMS) lower order aberrations (LOA) and RMS higher order aberrations (HOA). Data for the two devices were compared through intraclass correlation coefficients (ICC), paired t tests, limits of agreement (LoA) and Bland Altman plots.Results: Vertical coma was the only corneal aberration parameter that consistently showed excellent agreement (ICC &gt; 0.8, mean difference −0.019, LoA −0.165 to 0.126). Good agreement (ICC = 0.75) between the devices was observed for RMS HOA, but this was slightly worse in the 6 mm optical zone (ICC = 0.667 for anterior RMS HOA). No over‐ or underestimation trend by one or other device was noted. Agreement was poor to moderate for the rest of the corneal parameters (ICC 0.2–0.7).Conclusions: Despite good agreement overall for vertical coma and RMS HOA values, agreement for the remaining corneal aberration measurements was poor to moderate. As mean differences in our sample were overall small, in normal eyes these devices could be clinically judged as interchangeable.

Corneal and Whole-Eye Higher Order Aberrations Do Not Correlate With Ocular Residual Astigmatism in Prepresbyopic Refractive Surgery Candidates.

Ocular residual astigmatism (ORA) is the proportion of manifest astigmatism that is not explained by anterior corneal astigmatism. The role of higher order aberrations (HOAs) in the level of ORA has not been profoundly studied. The purpose of this study was to evaluate the effect of different corneal and whole-eye HOAs on levels of ORA using a multivariate modeling approach. This is a retrospective analytical study including a sample of healthy refractive surgery candidates. One eye of every patient was randomly selected. A total of 294 eyes from an equal number of patients were included. Corneal and whole-eye HOAs were measured with a Pentacam AXL Wave, and subjective manifest refraction was taken. Astigmatism values were converted into power vectors and ORA was calculated. The Spearman rank-order correlation was initially used to explore correlation between HOA and ORA. All variables with a P value under 0.10 were included into a multiple linear regression model to explore this correlation adjusting for confounding variables. The mean age was 28.81 ± 5.40 years. Simple bivariate correlation was significant for root mean square (RMS) total, RMS lower order aberrations, RMS HOAs, defocus, and vertical astigmatism. After being included into a multivariate regression model adjusting for confounding variables, the only variable that was significant was RMS total [F (3, 282) = 78.977; P < 0.001; adjusted R 2 = 0.451]. For every μm increase in corneal RMS total, ORA increases by 0.135 diopters. About 45% of variability in ORA can be explained by corneal RMS total, corneal J 0 , and manifest J 0 . No individual HOA correlated with ORA in the multivariate regression model. ORA increases with general corneal irregularity, especially regular astigmatism. Irregular astigmatism expressed by corneal and whole-eye HOAs does not seem to be a significant contributor of ORA in healthy refractive surgery candidates.

Survival analysis of myopic regression after small incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis for low to moderate myopia

BackgroundTo report the predictive factors of myopic regression in patients who had undergone small incision lenticular extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileuses (FS-LASIK) after 3–12 months of follow-up.MethodsThis retrospective case series study recruited patients with a subjective sphere of − 1.00 to − 6.00 D myopia. SMILE was performed in 1629 eyes of 1629 patients with a subjective refraction spherical equivalent (SEQ) of − 4.57 ± 1.20 D and 1414 eyes of 1414 patients with a subjective SEQ of − 4.53 ± 1.26 D in FS-LASIK. Refractive outcomes were recorded at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Predictors affecting myopic regression and other covariates were estimated with a Cox proportional hazard (Cox PH) model for the two surgical methods.ResultsAt 12 months, no significant difference was evident in the efficacy (P = 0.934), predictability (P = 0.733), or stability (P = 0.66) between FS-LASIK and SMILE. The survival rates were 83.7% in the FS-LASIK group and 88.1% in the SMILE group. Multivariate analysis by the Cox PH model revealed a similar probability of postoperative myopic regression with SMILE or FS-LASIK (P = 0.630). Predictors of myopic regression included preoperative higher-order aberration root mean square with 3 mm pupil diameter (pre-HOA-RMS3) (P = 0.004), anterior chamber depth (ACD) (P = 0.015), pre-subjective sphere (P = 0.016), corneal diameter (P = 0.016), optical zone (OZ) (P = 0.02), and predicted depth of ablation (DA) (P = 0.003).ConclusionSMILE and FS-LASIK had a similar risk of myopic regression for low to moderate myopia. Pre-HOA-RMS3, ACD, pre-subjective sphere, corneal diameter, OZ, and predicted DA were predictors of myopic regression.

Correlations between Quality of Vision, Higher Order Aberrations and Non-Invasive Keratographic Tear Film Break-Up Time in Pseudophakic Eyes after Uncomplicated Phacoemulsification

Aims: In this study, we aimed to investigate the intercorrelations between tear film break up time, measured non-invasively using non-invasive keratographic break-up time (NIKBUT), higher order aberrations (HOA) and quality of vision (QoV) in pseudophakic patients.&#x0D; Study Design: Cross-sectional.&#x0D; Methods: Thirty-five pseudophakic aged patients aged 50 years or older, and 35 control phakic patients aged 17 to 23 years with corrected visual acuity of 20/20 were included in this study. All subjects underwent similar examination including QoV questionnaire, aberrometry to measure HOA, and NIKBUT. HOA was measured with the OPD-Scan/ ARK 10000 corneal analyzer (Nidek CO. Ltd), expressed as Root Mean Square (RMS) HOA and NIKBUT was assessed using non-invasive TF-Scan module Keratograph 5M (K5M), equipped with modified tear film scanning function (Oculus, Wetzlar, Germany). Statistical analysis was performed to find the correlation between NIKBUT, HOA and QoV.&#x0D; Results: Patients in the pseudophakic group were significantly older (median age 66 vs. 20 years; P&lt;0.01), had shorter NIKBUT (10.5 vs. 17.2; P&lt;0.01), lower QoV score (1.63 vs. 0.68; P=0.04), and higher RMS HOA (0.5 vs. 0.26; P&lt;0.01) compared to control group. NIKBUT was inversely correlated with RMS HOA (r = -0.19; p = 0.03) and RMS HOA was significantly correlated with QoV, even after adjustment for age and gender (r = -0.21; P0.04). NIKBUT &lt;9.93s was correlated with lower QoV. The area under the curve was 0.81 (95% CI = 0.67 – 0.95, p = 0.012), and had 100% sensitivity and 61% specificity.&#x0D; Conclusion: Shorter NIKBUT was correlated with greater HOA and greater HOA was correlated with lower QoV. NIKBUT value of shorter than 9.93s could potentially predict pseudophakic patients who will likely experience visual symptoms leading to decreased QoV; thus, the use of artificial tears might be beneficial.

Repeatability and Agreement of a New Scheimpflug Device and a Hartmann-Shack Aberrometer With a Ray-Tracing Aberrometer in Normal, Keratoconus, and CXL Groups

To assess repeatability and agreement of a Scheimpflug topographer and a Hartmann-Shack aberrometer with a ray-tracing aberrometer in normal, keratoconus, and corneal cross-linking (CXL) groups. In this cross-sectional, observational study, normal, keratoconus, and CXL groups with 125 eyes in each of the three groups were included. All eyes underwent three sets of measurements, at a single visit, using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) and iTrace (Tracey Technologies). Keratometry, pachymetry, objective refraction, and total ocular aberrations including root mean square (RMS) lower order aberrations (LOAs), RMS higher order aberrations (HOAs), RMS coma, and spherical aberrations (SA) were analyzed. Objective assessment of haze after CXL was done using the Pentacam AXL Wave. Repeatability was assessed using within-subject standard deviation (Sw), test-retest variability, within-subject coefficient of variation (COV), and intraclass correlation coefficient (ICC). Bland-Altman analysis assessed 95% limits of agreement and correlation coefficient (r) determined the strength of the relationship between measurements. The Pentacam AXL Wave had Sw for keratometry of 0.12 in the normal group and 0.15 in the keratoconus group and lower (poorer) Sw of 0.17 in the CXL group. For pachymetry, Sw was 9.18, 9.53, and 10.11 in the normal, keratoconus, and CXL groups, respectively. Total aberrations had ICCs ranging from 0.88 for RMS HOAs to 0.95 for SA in the normal group, 0.86 for RMS HOAs to 0.92 for SA in the keratoconus group, and 0.72 for RMS HOAs to 0.82 for SA (poorer) in the CXL group. In the normal group, mean differences between the two devices were nonsignificant for all parameters except SA (0.011 ± 0.038 μm, P < .01; limits of agreement = -0.09 to 0.07; r = 0.87). In the keratoconus group, mean differences were significant in all aberrations except RMS LOAs (-0.27 ± 0.85 μm, P = .10; limits of agreement = -3.3 to 3.8; r = 0.92). In the CXL group, all parameters varied significantly (P < .006). The Pentacam AXL Wave showed comparable repeatability in the normal and keratoconus groups, but was poorer in the CXL group, more so with increasing corneal haze. Both devices can be used interchangeably in normal eyes, except for SA, but not in eyes with keratoconus or CXL for aberration measurements. [J Refract Surg. 2022;38(3):201-208.].