REVIEW ARTICLE
Corneal Asphericity and Spherical
Aberration
Antonio Calossi, DipOptom
ABSTRACT
PURPOSE: To summarize the various values of asphe-
ricity in different notations and present how corneal
asphericity, corneal curvature, and entrance pupil di-
ameter influence the longitudinal spherical aberration of
the anterior corneal surface.
METHODS: After the conversion factors between the
different asphericity notations were described, finite ray
tracing through a conic section that models the ante-
rior cornea profile was performed. The anterior cornea
was given a range of curvatures and asphericities and a
range of entrance pupil diameters.
RESULTS: If the value of asphericity remains constant,
longitudinal spherical aberration increases with the
square of the entrance pupil diameter. If the pupil diam-
eter remains fixed, the spherical aberration becomes a
function of the value of asphericity, the refractive index,
and the radius of curvature. If the refractive index, pupil
diameter and asphericity are considered constant, the
spherical aberration will decrease if the corneal surface
flattens and increase as the cornea becomes steeper. In
this way, with the same shape factor and with the same
starting apical radius, longitudinal spherical aberration
became a function of the surgically induced refractive
change. With equal curvature, the longitudinal spherical
aberration becomes negative if the surface is more pro-
late than perfect Cartesian oval; it will become positive
if it is less prolate, spherical, or oblate.
CONCLUSIONS: A conversion chart for corneal asphe-
ricity notations with the corresponding spherical aber-
ration and a diagram reporting values of asphericity
necessary to maintain the physiological value of the
corneal spherical aberration after refractive procedures
may be useful tools in corneal surgery. [J Refract Surg.
2007;23:505-514.]
Journal of Refractive Surgery Volume 23 May 2007
T
he anterior surface of the cornea is the main dioptric
element of the entire ocular optical complex in that
it supplies the highest individual dioptric contribu-
tion to the whole system. In a normal eye, the anterior corneal
surface provides 80% of the whole refractive contribution1
and only slight variations in shape are sufficient to obtain a
significant dioptric change: in paraxial approximation, each
alteration in curvature equal to four hundredths of a millime-
ter in radius corresponds to a variation of 0.25 diopters. For
this reason, as well as the minimal degree of invasiveness,
the anterior surface of the cornea is the main chosen site for
refractive surgeries.
The area of the cornea that contributes to the formation
of the foveal image is called the optical zone, which covers
the entrance pupil. The diameter of the pupil determines the
width of the useful optical zone, which varies as a function
of the pupillary dynamics.2,3 For a retinal image to constantly
have high quality, no aberrations should be present within
the entrance pupil under conditions of maximum physiologi-
cal mydriasis. From an optical point of view, the ideal cornea
must have an optical zone consisting of an elliptical surface
with an adequate shape factor (asphericity). If possible com-
pensation from the internal optics of the eye is ignored, the
corneal surface must be perfectly smooth and have the apex
centered on the visual axis. Spherical aberration will exist if
the shape factor is not adequate. If the apex is not centered,
a prismatic effect will occur, astigmatism from oblique in-
cidence and coma. If the surface is irregular, there will be
higher order aberrations.4,5
DESCRIPTORS OF CORNEAL ASPHERICITY
The expression “aspheric surface” simply means a surface
that is not spherical. However, this expression is commonly
From private practice, Certaldo (FI), Italy.
The author has no proprietary interest in the materials presented herein.
Correspondence: Antonio Calossi, DipOptom, Via 2 Giugno 37, 50052 Certaldo
(FI), Italy. Fax: 39 571 656849; E-mail: calossi@tin.it
Received: August 9, 2006
Accepted: October 16, 2006
Posted online: March 30, 2007
505
Corneal Asphericity and Spherical Aberration/Calossi

TABLE 1
Formulas of Conversion Between
Various Shape Factors
of a Conic Section
p Q e e2
p= — 1
Q 1
e2 1
e2
Q= p
1 —
e 2

e2
_____ ____ ___
e= √1
p √
Q — √e2
e2 = 1
p
Q e2 —
p = conic parameter, Q = asphericity, e = eccentricity, e2 = index of
asphericity

the eccentricity e, and the coefficient of asphericity Q.

Figure 1. In mathematics, a conic section (or just conic) is a curve
formed by intersecting a cone (more precisely, a right circular conical
surface) with a plane. A conic section is the intersection of a plane and a
cone. By changing the angle and location of intersection, a circle, ellipse,
parabola, or hyperbola can be produced. (Image from Wikipedia, The
Free Encylopedia. Available at: http://en.wikipedia.org/wiki/Conic_section.
Accessed October 16, 2006.)
used to indicate the surfaces that can be described by
the equation of a conic. In geometry, the conic curves
have been given this name because they are generat-
ed by the section of a cone with a plane more or less
tilted with respect to the base, and these include the
circle, ellipse, parabola, and hyperbola (Fig 1). Each
of these curves, if rotated on its axis of symmetry, cre-
ates a sphere, an ellipsoid, a paraboloid, and a hyper-
boloid, respectively. These solid figures are called co-
nicoids. In a second order approximation, the typical
corneal section is a prolate ellipse, consisting of a more
curved central part, the apex, with a progressive flat-
tening towards the periphery. The asphericity of the
cornea usually is defined by determining the aspheric-
ity of the conicoid that best fits the portion of cornea
to be described. If we accept this approximation, the
profile of a meridian can be defined with two values
only: the apical radius (which is on the vertex of the
conic), which can be expressed in terms of a circle
with the same degree of curvature, and a shape factor,
which represents the variation in curvature from the
apex towards the periphery, which defines the degree
of asphericity. This last parameter can be defined in a
number of different ways.6,7 Four different coefficients
are used to express the shape factor of a conic, each
one of which is used in a different way to quantify the
same thing: the conic parameter p, the shape factor E,
If one of these indices is known, the others can be cal-
culated using the conversion formulas in Table 1.
Any conic can be represented by the following equa-
tion8:
y2 = 2r0x
px2 (1)
where y is the semi-chord, or rather the distance of a
point on the curve from the axis of symmetry; if the con-
ic represents the section of an aspheric optical surface,
the value y is the distance of a point on the surface from
its optical axis, x is the sagitta of the section, r0 is the
apical radius, whereas p indicates the rapidity of flat-
tening or steepening from the apex (Fig 2). In an ellipse
(Fig 3), if a is the major semi-axis and b the minor semi-
axis, the value p indicates the following proportion:
2
b
p = ___ (2)
a2
Equation (2) shows that in the circle, which is the
limit case of the ellipse, b = a and therefore p = 1. The
parabola is another limit case, where a tends to infinity
and therefore p = 0. The prolate ellipses are a family of
curves where the major axis coincides with the x axis,
b is less than a, and therefore p varies between 0 and 1.
The closer p is to 1, the less elongated the shape. In an
oblate ellipse, p1. In this case, the minor axis will be
found along the x axis and therefore the surface will be
progressively more curved as we move away from the
apex. In a hyperbola, p0. The conic parameter p is a
value that indicates how much a curve differs to a pa-
rabola instead of a circle. For this reason, a commonly
used term for defining the asphericity is Q, which is
related to p by the equation:
Q=p
1 (3)
If Q = 0 the curve is a circle, and if Q lies between

506 journalofrefractivesurgery.com

Figure 2. The general equation to all of the conic sections is given
by Baker’s equation as y2 = 2r0x
px2, where x is the sagitta for the
semi-cord y, r0 is the apical radius, and p is a shape factor that gives
an indication of the degree of flattening or steepening of curve from the
apex to the periphery.

1 and 0, the curve is a prolate ellipse. If Q =
1, it is
a parabola; if Q 
1, it is a hyperbola; and if Q  0,
the curve is an oblate ellipse. It is likely that the term Q
is not highly intuitive because the normal prolate cor-
neas are expressed as negative numbers. An alternative
way of expressing the degree of flattening of a conic is
to use the term eccentricity (e). The relationship be-
tween e and p is the following:
p = 1
e2 (4)
and therefore
______
e = √1
p (5)
If e = 0 the curve is a circle; if it lies between 0 and 1,
the curve is an ellipse; if e = 1, the curve is a parabola;
and if e  1 the curve is a hyperbola. The main prob-
lem that emerges when eccentricity is used to express
the shape of a conic is that sometimes p can have a
value 1, so in these cases e2 is negative, and e no
longer makes sense because it equals the square root of
a negative number, which is in the realm of imaginary
numbers. Negative values of e are purely conventional
and, for the oblate ellipse, can be expressed in the fol-
lowing way:
______
if p  1 then e =
√ p
1 (6)
With this convention, if e  0, the curve is oblate.
The second problem with the parameter e is that the
relationship between the variations of eccentricity and
the variations of peripheral flattening coefficients are
Journal of Refractive Surgery Volume 23 May 2007
Corneal Asphericity and Spherical Aberration/Calossi
Figure 3. In an ellipse, if a is the major semi-axis and b the minor semi-
axis, the value p indicates the ratio between b2 and a2.
not linear. The variation in curvature, which corre-
sponds to 0.1 units of e, is different in the transition
from 0.1 to 0.2 compared to the transition from 1.1 to
1.2. In the first instance, the two curves are almost the
same; in the second case, they differ considerably. For
this reason, the shape factor of a cornea is sometimes
indicated in terms of e2. Originally, this was chosen for
the Wesley-Jessen (Des Plaines, Ill) Photoelectronic Ker-
atoscope (PEK), where the term e2 was replaced by shape
factor (SF).9,10 In the American National Standard,11 this
parameter was designated by symbol E. As a result
E = SF = e2 (7)
and
E = SF = 1
p (8)
As for p, e2 was introduced in an attempt to produce
a definition for the oblate forms as well, which steep-
en from the apex towards the periphery. If e2 = 0, the
curve is a circle; if e2 lies between 0 and 1, the curve
is a prolate ellipse; if e2 = 1, the curve is a parabola; if
e2  1, the curve is a hyperbola; and if e2  0, the curve
is an oblate ellipse. It is useful to point out that if E (or
e2) is used to describe the shape of the cornea, the terms
negative and positive asphericity mean the opposite to
Q, given that 0  E  1 for a prolate ellipse and E  0
for an oblate ellipse. This may cause some confusion,
given that the same surface can be described by a posi-
tive or negative number, depending on whether E or Q
has been used. Table 2 summarizes the various types
of conic sections with the corresponding values of the
507
Corneal Asphericity and Spherical Aberration/Calossi
TABLE 2
Different Types of Conical Section With the Corresponding Values of the Various
Coefficients of Asphericity
p Q
Hyperbola 0 
1
Parabola 0
1
Prolate ellipse 0p1
1  Q  0
Circle 1 0
Oblate ellipse 1 0
Average normal cornea6 0.78
0.22
p = conic parameter, Q = asphericity, e = eccentricity, e2 = index of asphericity
different shape factors, and Table 3 reports the various
values of asphericity in different notations.
In the more recent publications of optometric lit-
erature, the p value is reported frequently whereas the
coefficient Q is used more frequently in ophthalmol-
ogy journals. In ISO (International Organization for
Standardization) standards, the symbol K is also used
for Q.11 In publications relative to contact lenses, the
common term is eccentricity (e). We prefer the index
e2 to define asphericity instead of SF or E, because the
value of a sphere t is zero. Contrary to Q, in the prolate
surfaces, as in a physiological cornea, the value e2 is
positive and increases with an increase in the degree
of asphericity. In oblate corneas, which have a reverse
shape with respect to the physiological cornea, asphe-
ricity (e2) has a value of less than zero. The negative
value is greater the more the geometry is reversed, or
rather the more the cornea is oblate. The index e2 is lin-
ear and allows the representation of the oblate surfaces
without the limits of eccentricity.
If the index of asphericity (e2) is used, Eq.(1) becomes:
y2 = 2r0x
(1
e2)x2 (9)
whereas the three-dimensional version of the conic, ie,
a conicoid with the axis of revolution Z, can be ex-
pressed in the following form:
x2  y2  (1
e2)z2
2zr0 = 0 (10)
THE REAL CORNEA AND ELLIPTICAL MODEL
Approximating the corneal profile to a conic is
useful from a mathematical point of view because,
as mentioned above, this permits the straightforward
description of its shape using two parameters—the
apical radius and an index that expresses how much
the curve differs from the circumference described by
508
e e2
1 1
1 1
0e1 0  e2  1
0 0
0 0
0.45 0.22
the apical radius. In the field of eye optics, this ap-
proach is useful for examining spherical aberration.12
In general, it is possible to approximate the profile of
each meridian and semi-meridian of the cornea to an
elliptical curve. The direct evolution of the elliptical
model is the ellipso-toric model.13 This is a surface
with the following characteristics: every meridian has
a different apical radius; a meridian of maximum and
minimum curvature can be identified; the difference
between these two principal meridians produces the
corneal astigmatism; and along each meridian, from
the center to the periphery, the curvature flattens with
elliptical progression. The conic model includes some
approximations and, in particular, assumes that the
apex coincides with the vertex and with the geometri-
cal center of the cornea, and that the corneal surface is
symmetrical in relation to the visual axis. Other pro-
posed models can be generally considered as more or
less sophisticated variations of these approaches.14
A general quadric surface to model the corneal
shape was introduced by Campbell15 and then used as
a basis for generating corneal parameters in the Hum-
phrey MasterVue Corneal Topography system (Carl
Zeiss, Jena, Germany). As used in the MasterVue sys-
tem, the quadric surface found is general, in that it may
be decentered and rotated so that it not only includes
the toricity found in most corneas but also the decen-
tration and tilt with respect to the pupil center and cor-
neal vertex. The usefulness of this model was reported
in a recent paper by Navarro et al.16 In actuality, the
cornea differs from the mono-elliptical progression in
the more peripheral areas, where the flattening is more
accentuated and the asphericity is greater than at the
center.17 However, in many cases, the ellipse may be a
valid model if limited to the optical zone of the cornea.
On the other hand, in real eyes, this model is exces-
sively simplified, because each cornea has a specific
journalofrefractivesurgery.com
 Corneal Asphericity and Spherical Aberration/Calossi

TABLE 3
Conversion Table for the Different Notations of Asphericity With the
Corresponding Longitudinal Spherical Aberration in Diopters*
Longitudinal Spherical Aberration (Pupil Diameter)
P e Q e2
3 mm 5 mm 7 mm
3.00
1.41 2.00
2.00 2.43 7.90 21.35
2.90
1.38 1.90
1.90 2.33 7.51 19.89
2.80
1.34 1.80
1.80 2.23 7.13 18.53
2.70
1.30 1.70
1.70 2.12 6.76 17.24
2.60
1.26 1.60
1.60 2.02 6.39 16.03
2.50
1.22 1.50
1.50 1.92 6.03 14.88
2.40
1.18 1.40
1.40 1.82 5.68 13.79
2.30
1.14 1.30
1.30 1.72 5.33 12.76
2.20
1.10 1.20
1.20 1.62 4.99 11.78
2.10
1.05 1.10
1.10 1.52 4.66 10.85
2.00
1.00 1.00
1.00 1.43 4.34 9.96
1.90
0.95 0.90
0.90 1.33 4.01 9.11
1.80
0.89 0.80
0.80 1.23 3.70 8.29
1.70
0.84 0.70
0.70 1.14 3.39 7.51
1.60
0.77 0.60
0.60 1.04 3.09 6.76
1.50
0.71 0.50
0.50 0.95 2.79 6.04
1.40
0.63 0.40
0.40 0.85 2.50 5.35
1.30
0.55 0.30
0.30 0.76 2.21 4.69
1.20
0.45 0.20
0.20 0.66 1.93 4.05
1.10
0.32 0.10
0.10 0.57 1.65 3.43
1.00 0.00 0.00 0.00 0.48 1.37 2.83
0.90 0.32
0.10 0.10 0.39 1.10 2.26
0.80 0.45
0.20 0.20 0.30 0.84 1.70
0.70 0.55
0.30 0.30 0.21 0.58 1.16
0.60 0.63
0.40 0.40 0.11 0.32 0.64
0.50 0.71
0.50 0.50 0.03 0.07 0.14
0.40 0.77
0.60 0.60
0.06
0.18
0.35
0.30 0.84
0.70 0.70
0.15
0.42
0.82
0.20 0.89
0.80 0.80
0.24
0.66
1.28
0.10 0.95
0.90 0.90
0.33
0.90
1.73
0.00 1.00
1.00 1.00
0.18
0.48
1.85
*Calculated for n = 1.376, r = 7.80 mm.

profile, similar to a fingerprint,17 and in some cases,
particularly in pathologies, trauma, or as a result of
surgery, the profile of the cornea is entirely different to
the one described above. To define corneal asphericity,
the best-fit aspherotoric surface can be calculated, or
rather, the profile that minimizes the difference in cur-
vature between the surface and the portion of cornea
that is represented. The degree with which this sur-
face reflects the cornea may be defined by an index, the
root-mean-square (RMS) of curvature, which means
how far the surface measured differs on average from
the best-fit surface. The RMS of the instantaneous cur-

Journal of Refractive Surgery Volume 23 May 2007 509

Corneal Asphericity and Spherical Aberration/Calossi

TABLE 3 CONTINUED
Conversion Table for the Different Notations of Asphericity With the
Corresponding Longitudinal Spherical Aberration in Diopters*
Longitudinal Spherical Aberration (Pupil Diameter)
P e Q e2
3 mm 5 mm 7 mm

0.10 1.05
1.10 1.10
0.50
1.37
2.59

0.20 1.10
1.20 1.20
0.59
1.59
3.00

0.30 1.14
1.30 1.30
0.68
1.82
3.40

0.40 1.18
1.40 1.40
0.76
2.04
3.79

0.50 1.22
1.50 1.50
0.85
2.25
4.17

0.60 1.26
1.60 1.60
0.93
2.47
4.54

0.70 1.30
1.70 1.70
1.01
2.68
4.90

0.80 1.34
1.80 1.80
1.10
2.89
5.25

0.90 1.38
1.90 1.90
1.18
3.09
5.59

1.00 1.41
2.00 2.00
1.26
3.30
5.93

1.10 1.45
2.10 2.10
1.35
3.50
6.25

1.20 1.48
2.20 2.20
1.43
3.69
6.57

1.30 1.52
2.30 2.30
1.51
3.89
6.89

1.40 1.55
2.40 2.40
1.59
4.08
7.19

1.50 1.58
2.50 2.50
1.67
4.27
7.49

1.60 1.61
2.60 2.60
1.75
4.46
7.78

1.70 1.64
2.70 2.70
1.83
4.64
8.07

1.80 1.67
2.80 2.80
1.91
4.83
8.35

1.90 1.70
2.90 2.90
1.99
5.01
8.62

2.00 1.73
3.00 3.00
2.07
5.18
8.89

2.10 1.76
3.10 3.10
2.15
5.36
9.15

2.20 1.79
3.20 3.20
2.22
5.53
9.41

2.30 1.82
3.30 3.30
2.30
5.71
9.66

2.40 1.84
3.40 3.40
2.38
5.88
9.91

2.50 1.87
3.50 3.50
2.45
6.04
10.16

2.60 1.90
3.60 3.60
2.53
6.21
10.39

2.70 1.92
3.70 3.70
2.61
6.37
10.63

2.80 1.95
3.80 3.80
2.68
6.53
10.86

2.90 1.97
3.90 3.90
2.76
6.69
11.08

3.00 2.00
4.00 4.00
2.83
6.85
11.30
*Calculated for n = 1.376, r = 7.80 mm.

vature can be used as an index of surface irregularity MATERIALS AND METHODS

because it indicates how far the corneal surface differs
from a perfectly smooth aspherotoric surface.4
This article presents theoretical results about how
corneal asphericity, corneal curvature, and entrance
pupil diameter influence the spherical aberration of
the anterior corneal surface.
Spherical aberration is a rotationally symmetric ab-
erration in which the light rays that pass through the
paraxial zone of the pupil focus at a different distance
than the rays that pass through the marginal pupil. By
convention, spherical aberration is positive when the
marginal rays focus ahead of the paraxial rays, whereas

510 journalofrefractivesurgery.com

Figure 4. Schematic representation of ray tracing for longitudinal spheri-
cal aberration (LSA) calculation.
it is negative when the opposite is true.18 The differ-
ence in diopters between the marginal and paraxial fo-
cal points is called longitudinal spherical aberration.
Applying the Snell law of refraction, finite ray tracing
is performed through a conic section that models the
anterior cornea profile.12 The anterior cornea was given
a range of curvatures, asphericities, and entrance pupil
diameters. All corneas were taken to have a refractive
index of 1.376.1 This procedure has the following limi-
tations: it does not take into account nonrotationally
symmetric irregularities in the anterior corneal surface
and ignores the contribution of the internal optics to
image quality. The purpose is to show how the surgi-
cal changes of corneal curvature and corneal aspheric-
ity may alter the spherical aberrations of the eye. The
changes to this aberration of the eye can be approximat-
ed to changes in the aberration of the anterior cornea
because this is the main dioptric component changed
by corneal refractive surgery.
The longitudinal spherical aberration (LSA) associ-
ated with the ray passing through the edge of the pupil
for the centered system was calculated by comparison
of where the ray intersects the optical axis with the
paraxial image position, according to
LSA = n/lm
n/lp (11)
where n is the refractive index of the cornea and lm
and lp are the distances from the anterior corneal sur-
face vertex to the marginal ray intersection position
and the paraxial image plane, respectively (Fig 4).
Finally, to determine the values of asphericity nec-
essary to maintain the physiological value of the cor-
neal spherical aberration after keratorefractive proce-
dures, the following were calculated:
Journal of Refractive Surgery Volume 23 May 2007
Corneal Asphericity and Spherical Aberration/Calossi
Figure 5. Longitudinal spherical aberration (LSA) as a function of the
entrance pupil diameter (e2 = 0.20, r = 7.80 mm).
● Vertex transposition from spectacle plane for a range
of spherical ametropias;
● Apical radius variations for those corrections; and
● The value of asphericity corresponding to each api-
cal radius, holding constant the programmed post-
operative longitudinal spherical aberration.
Calculations were performed using equations
stored in a file generated by a spreadsheet program
running on a PC.
RESULTS
As for all of the monochromatic aberrations, the
value of the spherical aberration increases with an in-
crease in pupil diameter. If the value of asphericity re-
mains constant, longitudinal spherical aberration will
increase with the square of the entrance pupil diameter
(Fig 5). Considering a cornea with an apical radius =
7.80 mm and an asphericity (e2) = 0.2, the relation be-
tween the pupil diameter (x) and longitudinal spherical
aberration may be approximated by the following para-
bolic regression equation: LSA = 0.0332x2 (R2=0.99).
If the pupil diameter remains fixed, the spherical ab-
erration becomes a function of the value of aspheric-
ity, refractive index, and radius of curvature. If the
refractive index, pupil diameter, and asphericity are
considered as constant, the spherical aberration will
decrease if the corneal surface flattens and increase as
the cornea becomes more curved (Fig 6). Considering
a cornea with an asphericity (e2) = 0.2 and an entrance
pupil = 5 mm, the relation between the apical radius
(r0) and longitudinal spherical aberration may be ap-
proximated by the following power regression equation:
LSA = 447.79r0-3 (R2=0.99). With equal curvature, the
longitudinal spherical aberration becomes negative if
the surface is more prolate than perfect Cartesian oval
511
Corneal Asphericity and Spherical Aberration/Calossi
Figure 6. Longitudinal spherical aberration (LSA) as a function of apical
radius (e2 = 0.20; diameter 5 mm).
shape19,20; it will become positive if it is less prolate,
spherical, or oblate (Fig 7). Positive spherical aberra-
tion is greater the more the cornea is oblate.
Considering a cornea with an apical radius = 7.80 mm
and an entrance pupil = 5 mm, the relation between
the asphericity (e2) and longitudinal spherical aberra-
tion may be approximated by the following parabolic
regression equation: LSA = 0.1938(e2)2
2.7209(e2) 
1.384 (R2=1), or, in a more approximated way, by the
following linear regression equation: LSA =
2.4884(e2)
 1.4589 (R2=0.99). Table 3 reports different values of
asphericity in the different notations with the corre-
sponding longitudinal spherical aberration for three
pupil diameters. The diagram in Figure 8 reports the
values of asphericity necessary to maintain the physi-
ological value of the corneal spherical aberration21 as
512
Figure 7. Longitudinal spherical aberration (LSA) as a function of asphe-
ricity (r = 7.80 mm; diameter 5 mm).
Figure 8. Asphericity as a function of
the surgically induced refractive change to
maintain physiological spherical aberration.
Preoperative: e2 = 0.2; r = 7.80 mm;
longitudinal spherical aberration for 5 mm
0.84 D (Q =
e2).
a function of the spherical equivalent corrected with
photoablative surgery.
DISCUSSION
The conventional procedures of photoablative or
incisional refractive surgery significantly improve low
order refractive defects (defocus and regular astigma-
tism) but produce higher order corneal aberrations,
which are not observed prior to surgery.22 Usually only
an increase of spherical aberration occurs, whereas in
cases that are complicated by decentering, surface ir-
regularities, regression, or ectasias, more invalidating
aberrations, such as coma, in addition to other higher
order aberrations, may appear.5 The recent technolo-
gies for customization on a topographic basis or on a
wavefront basis aim at overcoming the limits of cur-
journalofrefractivesurgery.com

rent standard treatments.23,24 In general, a single di-
optric surface that separates two homogeneous media
can be free from spherical aberration for a given pair of
conjugate axial points (ie, for an object point placed on
the optical axis at a determinate distance) if its section
is a perfect Cartesian oval.19,20 This is a curve of the
fourth degree, not an ellipse but a true oval. For cer-
tain special pairs of conjugates, the curve degenerates
into various conic sections including a circle, hence
the “aplanatic point” of a sphere. Unfortunately, a sur-
face free from spherical aberration for a specified pair
of conjugates will exhibit some aberration for all other
pairs.25 If, as in the case of the cornea, the medium that
gives origin to the light rays is air and the object is
placed at infinity, the perfect oval has the shape of a
prolate ellipsoid where the asphericity (e2) is given by
the following equation:
e2 = 1/n2 or e = 1/n (12)
where n is the refractive index of the medium that re-
fracts the rays. If a homogeneous refractive index is as-
sumed for corneal tissue equal to 1.376, e2 should be
0.5282 (e = 0.7268; p = 0.4718; Q =
0.5282).
In a normal eye, it is unlikely that the cornea will
have this value of asphericity.21 Normally, a certain
quantity of positive spherical aberration is present,
which is considered physiological and is compensated
for, at least in part, by the internal optics.21,26-28
Following myopic photoablative treatment, the ef-
fect of reduction in the spherical aberration due to
flattening is generally not sufficient to compensate
for the increase in spherical aberration due to the
substantial variation in shape obtained with the ma-
jority of the current ablation profiles.29,30 This effect
is even greater in the incisional operations of radial
keratotomy, where with equal dioptric correction, the
cornea becomes even more oblate.31 The opposite oc-
curs with hyperopic treatments, as the current ablation
profiles produce a hyper-prolate cornea. This variation
in shape produces a negative spherical aberration,32
which usually is not compensated by the increase in
positive from the increased curvature.
The spherical aberration of the anterior corneal sur-
face is added to that of the posterior surface and crys-
talline lens. These will tend to counterbalance if they
are of opposite signs.26-28 If all of the components of
spherical aberrations do not mutually compensate, the
image of a point-object will consist of a disk surround-
ed by a diffused halo. If the overall spherical aberration
is not excessive, a slight loss in contrast transfer will
be present, with an improvement in the depth of the
field.33 The latter phenomenon is due to the multifo-
Journal of Refractive Surgery Volume 23 May 2007
Corneal Asphericity and Spherical Aberration/Calossi
cal effect of the spherical aberration. This is the reason
why, in the event of residual ametropia, eyes operated
by corneal refractive surgery have a better unaided vi-
sual acuity than would be expected on the basis of the
residual refractive error.34,35 A slight residue of spheri-
cal aberration may also prove useful in the event of
presbyopia. This is the principle of some types of mul-
tifocal contact lenses with simultaneous vision or mul-
tifocal intraocular lenses, which have been created in
such a way as to produce a certain degree of spherical
aberration. With these lenses, if the spherical aberra-
tion is positive (as in a myopic treatment), the center of
the pupil is used for distance vision and the peripheral
zones for near. If the spherical aberration is negative
(as in a hyperopic photoablative treatment), the center
is for near vision and the periphery for distance.
If the spherical aberration becomes excessive, a sig-
nificant loss in contrast transfer and increasing blur-
ring of the images can occur, which can be irritating
particularly under conditions of low light intensity
when the increase of the pupil diameter causes an in-
crease in the value of spherical aberration. It is not easy
to define a threshold for spherical aberration that can
be tolerated or that might be useful, as the subjective
responses to the loss of contrast sensitivity and toler-
ance to blurring are variable. In refractive surgery treat-
ments on virgin corneas, it is a good rule to leave the
same value of spherical aberration. The graph in Figure
8 reports the values of asphericity necessary to main-
tain the physiological value of the cornea’s spherical
aberration21 as a function of the spherical equivalent
corrected with photoablative surgery. However, when
the surgeon intentionally aims for a certain degree of
spherical aberration, it is possible to simulate differ-
ent values of spherical aberration using contact lenses
with appropriate eccentricity, choosing the one that
produces the most satisfactory visual results.
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