Optik 124 (2013) 13201323

Contents lists available at SciVerse ScienceDirect

Optik
j our nal homepage: www. el sevi er . de/ i j l eo
An objective inspection method of visual acuity based
on wave front aberrations of human eye
Wei Quan
a
, Guicai Song
b
, Zhao-Qi Wang
c,
a
School of Science, Shenyang Ligong University, Shenyang 110159, PR China
b
School of Science, Changchun University of Science and Technology, Changchun 130022, PR China
c
Institute of Modern Optics, Nankai University, Tianjin 300071, PR China
a r t i c l e i n f o
Article history:
Received 1 November 2011
Accepted 15 March 2012
Keywords:
Visual acuity
Wavefront aberration
HartmannShack sensor
Modulation transfer functions
a b s t r a c t
Visual acuity is an important vision evaluation index. Visual acuity examination has great practical and
clinical signicance. Objective visual acuity detection method based on the wave front aberrations of
human eyes is explored in this paper. The wavefront aberrations of human eyes were measured with
the HartmannShack wavefront sensor and modulation transfer function was computed from the wave
front aberrations. The maximum spatial resolution of human eye was obtained from modulation transfer
function and the retinal aerial image modulation. Visual acuity can be derived from the maximum spatial
resolution of human eye. Visual acuity of randomly selected 15 eyes was examined with the objective
method based on wavefront aberrations of human eyes and with the subjective visual chart method as
well. The test results show that the visual acuity values are basically the same when visual acuity is tested
with the two methods. The inspection method of visual acuity based on wavefront aberrations of human
eyes possesses advantages of objectivity, rapidity and accuracy, without the shortcomings of the visual
chart method of slowness and subjectivity relying much on subject cognition and statement.
2012 Published by Elsevier GmbH.
1. Introduction
The human eye is the most important organ to obtain informa-
tion of outside world. 95% of the information comes from visual
sense when human beings perceive the world around them. Visual
acuity is the main parameter for the ophthalmologist to evaluate
the performance of visual system. Visual acuity is widely used to
characterize the global quality of vision of a subject. Visual acuity
is extremely helpful in detecting the presence of visual problems,
especially in performing subjective refraction [1]. Accurate mea-
surement of visual acuity is required not only for the selection
of optical correction in everyday practice, but also in the course
of medical exams to evaluate the degree of tness in professional
screening, as well as to evaluate the dynamics of the visual func-
tions. Visual acuity is the most important parameter of the organ
of vision and a necessary criterion for estimating visual capability
[2].
The most common method to test visual acuity is to use the
standard Snellen chart. Snellen visual acuity is obtained by ask-
ing the subject to perform a pattern-recognition task, typically
under maximum contrast conditions. The minimum size of the

Corresponding author. Tel.: +86 431 85582527; fax: +86 431 85582527.
E-mail addresses: songcust@163.com(G. Song), wangzq@nankai.edu.cn
(Z.-Q. Wang).
targets (optotypes) for which the number of correct answers is
above threshold determines the value of visual acuity. One of the
reasons for the great success of Snellen visual acuity among clini-
cians is its highsensitivity to optical imperfections, suchas defocus.
Indeed, visual acuity can easily detect defocus values equal to or
less than 1/4diopter (D). However, there are some difculties to
overcome when visual acuity is detected with Snellen chart: (1)
the method to test visual acuity with Snellen chart is slowand sub-
jective, which requires subjects cooperation and depends much on
subjects cognition and answer. Repeated use of the same Snellen
chart canleadtomemorizationof the letters. Inoccupational health
examination, the eye chart may be memorizedbeforehandby some
subjects so that the test results are false information. (2) For early
age children, it is difcult to have their eyes tested. Sometimes their
eyes cannot even be examined because they cannot be in cooper-
ation. The visual acuity children graph vision inspection is used in
some hospitals, but children still need to be trained before test. (3)
There is often not enough distance in the laboratory for the sub-
ject to stand 20ft (or 6m) from the Snellen chart. However, the
test distance is 20ft (or 6m) with Snellen chart. And the attend-
ing investigator has to stand next to the subject to adequately hear
subject reading the letters. This becomes more critical in the case
of the poor sound transmission through the respirator and the loud
background noise generated by a treadmill [3,4].
A signicant development in the visual optics and ophthalmol-
ogyat the endof 20thcenturyis the progress inmeasurement of the
0030-4026/$ see front matter 2012 Published by Elsevier GmbH.
http://dx.doi.org/10.1016/j.ijleo.2012.03.038
W. Quan et al. / Optik 124 (2013) 13201323 1321
Table 1
The maximumspatial resolution of 15 human eyes.
Eye no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
f
0
cycle/

10.56 14.17 19.32 20.84 23.61 25.55 27.78 28.77 29.83 31.11 32.51 36.11 35.44 37.17 39.39
wave front aberrations of human eye and the advanced vision cor-
rection using adaptive optics [5]. In the middle of 1990s, Liang and
Josef F. Bille demonstrated a new technique to measure the eyes
wavefront aberration, basedontheHartmannShackprinciple, and
provided a more complete description of all the wave front aber-
rations of the eye with the Zernike terms up to 65, corresponding
to tenth-order or Zernike modes [6]. With the wave front technol-
ogy, the measurement of the wave front aberrations of human eye
can be completed rapidly within 1s. The accuracy of the wave front
sensor is /400 (=0.633m) and the repeatable standard devia-
tion of the wave front aberration measurement is /14 in average.
More importantly, the measurement of wave front aberrations of
human eye based on HartmannShack technology is objective and
rapid.
Thegoal of this paper is toexploreanobjectiveandrapidmethod
to test visual acuity. This paper proposes an objective detection
method of visual acuity based on wave front aberrations of human
eye. Withthis test method the visual acuity can be measured objec-
tively, rapidly and accurately, which avoids the shortcomings of
the visual chart method such as slowness and subjectivity in the
inspection.
Firstly, the wave front aberrations of human eye were measured
withtheHartmannShackwavefront sensor andmodulationtrans-
fer function (MTF) was computed fromthe wave front aberrations
of human eye. Then the maximumspatial resolution of human eye
was obtained from modulation transfer function and the retinal
aerial image modulation (AIM). Visual acuity was derived fromthe
maximumspatial resolution of human eye. The visual acuity mea-
surement method based on wave front aberrations of human eye
is objective, rapid and accurate. The inspection results can be given
within several seconds.
2. Method
2.1. Measurements of the wave front aberrations of human eyes
The wave front aberrations of 50 human eyes were measured
withHartmannShackwave front sensor, andexpressedbyZernike
polynomials. The range of the subjects ages was from20 to 46 with
diopters from0D to 5.0D, and the measurements were repeated
for 20 times for each eye. The tested wave front aberrations W(x,y)
were assumed to be expressed by
W(x, y) =
kmax

k
C
k
Z
k
(x, y) (1)
where Z
k
(x,y) is the kth Zernike polynomial function, C
k
is the coef-
cient of the Zernike polynomial, k
max
is the maximumtruncation
itemand k
max
=65.
Fig. 1shows the coefcient discrete distributions of thirdto65th
Zernike terms obtained by an average of 20 measurements for 50
human eyes. Since the coefcients C
1
and C
2
are not important to
the optical performance they are ignored here and after.
2.2. Modulation transfer function calculation
Modulation transfer function of optical system of human eye
can be calculated fromthe wave front aberrations acquired by the
HartmannShack sensor [7]. First the wave front aberrations W(x,y)
are used to construct the generalized pupil function P(x,y):
P(x, y) = p(x, y) exp[iw(x, y)] (2)
where p(x,y) denotes a pupil aperture of radius r, dened as
p(x, y) =

1
r
2
, x
2
+y
2
r
2
0, otherwise
(3)
Optical transfer function (OTF) is obtained as the complex autocor-
relation of P(x,y)
OTF(x, y) =

P(x

, y

)P

(x

x, y

y)dx

dy

(4)
where P*(x,y) is the conjugate of P(x,y). MTF is dened as the mod-
ulus of OTF:(5)MTF =|OTF|
According to the wave front aberrations of human eyes given
by Fig. 1, the modulation transfer functions of 50 human eyes were
calculated from Eqs. (1)(5). Fig. 2 shows the modulation transfer
functions of 15humaneyes selectedrandomlyandthe retinal aerial
image modulation curve expressed by dotted line.
2.3. The maximumspatial resolution of human eyes
The retinal aerial image modulation curve shown with dotted
line in Fig. 2 is based on date found in Ref. [8]. Retinal aerial image
modulationcurveindicates theimagemodulationrequiredinorder
for that image to be resolved by the visual system. The retinal aerial
image modulation curve is a function of the frequency as well, and
on the dimensions and structure of the sensor elements (cones) of
the retina, at the region of maximum resolution, fovea. The hori-
zontal ordinate of the intersection of modulation transfer function
and retinal aerial image modulation curve is the maximum spa-
tial resolution of human eye. Table 1 shows the maximum spatial
resolution of 15 human eyes provided by the abscissa of the cross-
ing point of modulation transfer function and retinal aerial image
modulation curve in Fig. 2.
Fig. 1. 3-65 Zernike terms coefcient discrete distribution of 20 measurements for
50 eyes.
1322 W. Quan et al. / Optik 124 (2013) 13201323
Fig. 2. Modulationtransfer functionof 15humaneyes selectedrandomlyandretinal
aerial image modulation curve expressed by dotted line.
2.4. Visual acuity
Visual acuity, visual performance evaluation parameters, can be
computed fromthe maximumspatial resolution of human eye.
Visual size perception excited by the outside object depends on
the size of its image on the retina. According to the principle of
geometry optics, we have
size of image on the retina
=
size of object distance fromretina to image nodal point
distance fromobject to object nodal point
(6)
Because the angle of optotype E is small in common visual chart,
the tangent of the angle can be approximated by radians. The radi-
ans value of the intersection angle of optotype E is dened as visual
angle. Therefore, the object size perceived by human eye depends
on visual angle, shown in Fig. 3.
Visual acuity is dened as the ability of resolution of the min-
imum distance between two objects and measured with visual
angle. The smaller the visual angle resolved is, the better the visual
acuity. So visual acuity is usually expressed by the reciprocal of
visual angle. Visual acuity is the reciprocal of the visual angle of the
smallest test-object resolved by individual. Clinically, visual acuity
has different expressions on the basis of different eye charts, but
their signicance is synonymous. Here international universal frac-
tions eye chart is used to express visual acuity. Fractions eye chart
is represented by Snellen fraction. Visual acuity measurements
Fig. 3. Target and visual angle.
Fig. 4. Visual acuity measurements withthe Snellenchart are baseduponthe ability
of a particular individual tosee at 20ft what a normal individual cansee at a different
distance, x. Both letters subtend a visual arc of 5

.
with the Snellen chart are based upon the ability of a particular
individual to see at 20ft (or 6m) fromthe chart to read the letters.
Fig. 4 shows an individual can see at a different distance x. Both
letters subtend a visual arc of 5

.
The Snellen chart expresses the visual angle with the test dis-
tance and letter height. Namely,
visual acuity =
test distance
distance corresponding to5min letter
(7)
Therefore, inEq. (7) thenumerator test distance is 20ft (or 6m)
with Snellen chart, and the denominator distance corresponding
to 5min letter is the distance which the minimum letter height,
identied by individual as standing at 20ft (or 6m) fromthe chart,
forms a 5min angle. For example, a visual acuity score of 20/200
indicates the distance, which the minimumsize letter height iden-
tied by individual forms a 5min angle, is 200ft when individual
stands 20ft fromthe chart to read the letters. Thus, a score of 20/20
indicates vision equal to normal, and a visual acuity score of 20/10
indicates vision better than normal, a score of 20/40 worse than
normal.
Fig. 5is theSnellenchart, whichuses letters Ewithdifferent sizes
and orientations. This Snellen chart is organized with a large E at
the top, and ten additional horizontal lines of letters of decreasing
Fig. 5. The Snellen chart.
W. Quan et al. / Optik 124 (2013) 13201323 1323
Table 2
Two sets of visual acuity values of 15 human eyes.
Eye no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Visual acuity fromwave-front aberrations 0.35 0.47 0.64 0.69 0.79 0.85 0.93 0.96 0.99 1.04 1.08 1.12 1.18 1.24 1.31
Visual acuity fromSnellen chart 0.3 0.4 0.6 0.6 0.8 0.8 0.8 1.0 1.0 1.0 1.0 1.0 1.2 1.2 1.2
Fig. 6. Twosets of visual acuity values of 15humaneyes fromwavefront aberrations
and Snellen chart.
size appears fromtop to bottom. Each line of letters E gives a visual
acuity score that relates the ability of an individual standing 20ft
(or 6m) from the chart to read the letters on that particular line
to the same ability of a normal individual to read the same letters
while standing at a different distance fromthe chart (see Fig. 4).
If maximum spatial resolution of human eye is f
0
(cycle/

), the
minimumintersection angle identied by human eye is 1/f
0
. Corre-
spondingly, the height of minimumsize letter identied by human
eye is 2.520(1/f
0
). Here number of 20 indicates the distance of
20ft fromthe chart where the individual stands to read the letters,
and 2.5 is the cycle of letter E. The distance of the minimum size
letter height of 2.520(1/f
0
) forming a 5min angle (5/60

) is L:
L =
2.5 20
f
0

5/60
(8)
According to Eqs. (7) and (8), visual acuity is
visual acuity =
20
L
=
f
0
30
(9)
The dimension of f
0
is cycle/

.
From the above derivation modulation transfer function of
optical system of human eye is calculated from the wave front
aberrations measured with the HartmannShack sensor, and the
maximum spatial resolution of human eye f
0
can be given by
the intersection of modulation transfer function and retinal aerial
image modulation curve. Visual acuity can be obtained from Eq.
(9). Thus visual acuity, main clinical index to evaluate the perfor-
mance of visual system, canbe derivedfromwave front aberrations
of human eye.
3. Results
Table 2 lists two sets of visual acuity values of 15 human eyes,
one of which is calculated fromEq. (9) according to the maximum
spatial resolutionof 15humaneyes (givenbyTable1), andtheother
is the measurement results with Snellen chart.
Fig. 6 shows two sets of visual acuity values of 15 human eyes
from wave front aberrations and from Snellen chart (date from
Table 2), respectively. The white bars are the visual acuity values
calculatedfromwave front aberrations andblackbars are that mea-
sured with Snellen chart. We can see fromFig. 6 that the two sets
of visual acuity values are slightly different. The main reason is that
visual acuity values fromSnellen chart are discrete, which are 0.1,
0.15, 0.2, 0.3, 0.4, 0.6, 0.8, 1.0, 1.2, 1.5, 2.0 (see Fig. 5), but visual acu-
ity values calculated from wave front aberrations are continuous.
Thus there is not a one-to-one correspondence between the two
sets of visual acuitydata. However, the differences betweenthe two
sets of visual acuity values are within the gradient of visual acuity
expressed by adjacent rows in Snellen chart. The visual acuity cal-
culated from wave front aberrations is more accurate. Moreover,
the vision inspection method based on wave front aberrations of
human eye is objective and rapid as compared with the method
of visual chart. The inspection can be completed within several
seconds.
Acknowledgment
This research is supported by the National Nature Science Foun-
dation of China (no. 60978068)
References
[1] Oscar Nestares, Rafael Navarro, Bayesian model of Snellen visual acuity, J. Opt.
Soc. Am. A20 (2003) 13711381.
[2] S.A. Koskin, .V. Boko, Modern methods of measuring the resolving power of
the visual system, J. Opt. Soc. Am. Technol. 75 (1) (2008) 1720.
[3] A.T. Johnson, C.R. Dooly, C.R. Simpson, Generating the Snellenchart by computer,
Comput. Methods Programs Biomed. 57 (1998) 161166.
[4] A.T. Johnson, C.R. Dooly, M.S. Sahota, K.M. Coyne, M.B. Benjamin, Effect of altered
vision on constant load exercise performance while wearing a respirator, Am.
Ind. Hyg. Assoc. J. 58 (1997) 578582.
[5] J. Liang, D.R. Williams, D.T. Miller, Supernormal vision and high-resolution reti-
nal imaging through adaptive optics, J. Opt. Soc. Am. A14 (1997) 28842892.
[6] J. Liang, D.R. Williams, Aberrations and retinal image quality of the normal
human eye, J. Opt. Soc. Am. A 14 (1997) 28732883.
[7] P.M. Prieto, F. Vargas-Martin, St. Goelz, P. Artal, Analysis of the performance of
the HartmannShack sensor in the human eye, J. Opt. Soc. Am. A 17 (8) (2000)
13881398.
[8] P. Mouroulis, Visual Instrumentation: Optical DesignandEngineering Principles,
McGraw-Hill, NewYork, 1999, pp. 278280.