Sabesan Ramkumar, Johns Lynette, Tomashevskaya Olga, Jacobs Deborah S, Rosenthal Perry, Yoon Geunyoung
Flaum Eye Institute, Center for Visual Science, Institute for Optics, University of Rochester, Rochester, NY 14624, USA.
Optom Vis Sci. 2013 Apr;90(4):314-23. doi: 10.1097/OPX.0b013e318288d19c.
To investigate the feasibility of correcting ocular higher order aberrations (HOAs) in keratoconus (KC) using wavefront-guided optics in a scleral lens prosthetic device (SLPD).
Six advanced KC patients (11 eyes) were fitted with an SLPD with conventional spherical optics. A custom-made Shack-Hartmann wavefront sensor was used to measure aberrations through a dilated pupil wearing the SLPD. The position of SLPD, that is, horizontal and vertical decentration relative to the pupil and rotation were measured and incorporated into the design of the wavefront-guided optics for the customized SLPD. A submicron-precision lathe created the designed irregular profile on the front surface of the device. The residual aberrations of the same eyes wearing the SLPD with wavefront-guided optics were subsequently measured. Visual performance with natural mesopic pupil was compared between SLPDs having conventional spherical and wavefront-guided optics by measuring best-corrected high-contrast visual acuity and contrast sensitivity.
Root mean square of HOA in the 11 eyes wearing conventional SLPD with spherical optics was 1.17 ± 0.57 μm for a 6-mm pupil. Higher order aberrations were effectively corrected by the customized SLPD with wavefront-guided optics, and root mean square was reduced 3.1 times on average to 0.37 ± 0.19 μm for the same pupil. This correction resulted in significant improvement of 1.9 lines in mean visual acuity (p < 0.05). Contrast sensitivity was also significantly improved by factors of 2.4, 1.8, and 1.4 on average for 4, 8, and 12 cycles/degree, respectively (p < 0.05 for all frequencies). Although the residual aberration was comparable to that of normal eyes, the average visual acuity in logMAR with the customized SLPD was 0.21, substantially worse than normal acuity.
The customized SLPD with wavefront-guided optics corrected the HOA of advanced KC patients to normal levels and improved their vision significantly.
探讨在巩膜镜片假体装置（SLPD）中使用波前引导光学技术矫正圆锥角膜（KC）患者眼高阶像差（HOA）的可行性。
为6例晚期KC患者（11只眼）佩戴具有传统球面光学的SLPD。使用定制的Shack-Hartmann波前传感器，通过佩戴SLPD时的散瞳瞳孔测量像差。测量SLPD的位置，即相对于瞳孔的水平和垂直偏心以及旋转，并将其纳入定制SLPD的波前引导光学设计中。一台亚微米精度车床在装置的前表面加工出设计好的不规则轮廓。随后测量佩戴具有波前引导光学的SLPD时同一只眼的残余像差。通过测量最佳矫正高对比度视力和对比敏感度，比较具有传统球面光学和波前引导光学的SLPD在自然中度瞳孔下的视觉性能。
对于6mm瞳孔，佩戴具有球面光学的传统SLPD的11只眼中HOA的均方根为1.17±0.57μm。定制的具有波前引导光学的SLPD有效矫正了高阶像差，对于相同瞳孔，均方根平均降低3.1倍至0.37±0.19μm。这种矫正使平均视力显著提高了1.9行（p<0.05）。对于4、8和12周/度，对比敏感度也分别平均显著提高了2.4、1.8和1.4倍（所有频率p<0.05）。尽管残余像差与正常眼相当，但使用定制SLPD时的平均logMAR视力为0.21，明显低于正常视力。
定制的具有波前引导光学的SLPD将晚期KC患者的HOA矫正至正常水平，并显著改善了他们的视力。
