Aberrometry for the Common

Joe

Thomas O. Salmon, OD, PhD, FAAO
8/19/11 Revision

Basic teaching objectives
1. What are aberrations?
2. What are aberrometers?
3. How do they work?
4. How do we interpret the data?
5. How can you diagnose abnormal
values?

1. What are aberrations?
Aberrations = refractive errors
• Myopia, hyperopia, astigmatism =
LOA
• But there are others …
• Higher-order aberrations (HOA)

Coma
 Spherical aberration
 Trefoil
 Others

Clarification … which
aberrations?
Monochromatic
• Not chromatic
• Not Seidel





Coma
Spherical aberration
Oblique astigmatism
Petzval
Curvature of field

Pupil size, pupil size, pupil
size, …

20/200
sized letter

Courtesy of Dr. Donald Miller, Indiana University
Retinal Imaging and Vision at the Frontiers of Adaptive Optics, Physics Today (Jan 2000)

Summary 1 What are aberrations? A. Refractive errors beyond sphere and cyl. Refractive errors Q. Q. What are higher-order aberrations? A. .

cylinder + HOAs (Higher-order aberrations) ≠ corneal topography! COAS .2. What are aberrometers? • • • • • • Instruments that measure … Refractive errors (super auto-refractors) Sphere.

K topography vs aberrometry High-resolution keratometry High-resolution auto-refraction .

History of HO aberrometry Reagan • • • • • • 1970s and 80s Strategic defense Refraction through the atmosphere Shack-Hartman wavefront sensor Shack Astronomy Adaptive optics (AO) .

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Ocular HO aberrometry research • 1960 MS Smirnov • 1977 Howard Howland • 1990 Josef Bille and … • Junzhong Liang • J Opt Soc Am A. July 1994 • Mid 1990s .other labs Howland Bille Liang .

IU Shack-Harmann Wavefront Sensor (catch a wave!) .

Clinical HO aberrometry • Laser refractive surgery • Large HOAs • Clinical aberrometry • Wavefront-guided LASIK COAS .

How do they work? • • • • • • Light is projected in. Reconstruct the optical wavefront’s shape .3. Catch the light. Reflect off the retina Light passes through the eye’s optics. Analyze it.

Courtesy of Alcon .

Shack-Hartmann aberrometry } x + Light exiting the eye } y Analyze each dot’s position Reconstruct wavefront shape .

5 -0.0 0.5 Wavefront error (um) 2.What does the wavefront tell you? • Flat wavefront = perfects optics (no aberrations) • Elevations = wavefront errors • Wavefront distortions reveal refractive errors.0 -0.0 0.5 1.0 Topographic map Surface plot .5 2 1 0 0.5 0. -0.5 1.0 1.0 -1 (mm) pupil -2 -0.5 -2 -1 0 1 2 pupil (mm) -1.

Higher-order wavefront maps Normal eye Post LASIK .

CL. spectacles.Besides refractive errors … • Optical quality metrics  Modulation transfer function (MTF)  Point spread function (PSF)  Strehl ratio • Visual performance metrics • Simulate the patient’s vision! • Design the ideal optical correction for the eye  W-guided RS. etc. IOL. .

Simulated retinal image emmetropia .

51 µm (6.50 x 100 HO RMS 0.0mm pupil) .00 -0.Simulated retinal image for AI -1.

Simulated retinal image emmetropia .

38 µm 6.00 x 170 HO RMS 0.00 -2.0-mm pupil .Simulated vision for TO -3.

. How do aberrometers work? A. Q.Summary 3 Q. The wavefront provides a wealth of info about the eye's optics and vision. Measure light that has passed through the eye's optics. Why? (Who cares?) A.

How aberrations does this eye bad are they? .4. Which have? 2. How do we interpret wavefront data? • Does this eye have good or bad optics? • How good or bad is the optical correction? • Are HO aberrations the problem? • Specifically: 1.

Which aberrations are present? • Wavefront . . • Zernike system = hierarchy of aberrations • Each aberration causes a particular shape of wavefront distortion.distorted by all the aberrations combined • Specifically. which ones are present? • Need Zernike analysis to break it down.

Some example wavefronts sphere astigmatism trefoil -3 Z7 .

+ + spherical aberration + Z44 Z42 .Zernike analysis breaks it down = + sphere + coma + astigmatism trefoil + ...

order (n) Zernike m Z(n.m) Zn ormodes 0 0 1 -1 1 2 -2 2 0 3 -3 -1 H O A 3 1 4 -4 -2 0 4 2 5 -5 -3 -1 1 3 5 .

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Z1-1 Z11 Combined Zernike modes 1 Z11 Z2-2 Z20 Z22 2 Z22 Z3-3 Z33 Z31 3 order (n) Z31 Z3-1 Z33 .

0 Magnitud e & axis form piston Z0 1 prism Z11 2 sphere Z20 3 coma trefoil Z31 4 order (n) astigmati sm Z22 spherical aberration Z33 quadrafoil Z40 Z42 Z44 secondary astigmatism .

Zernike analysis tells us … • Which aberrations are present. . • Breaks the wavefront down into the  Standard Zernike modes or …  Magnitude & axis form • Each Zernike mode = one aberration • But. … how bad are the aberrations? • Z analysis also provides a value for each.

Zernike coefficients • One for each Zernike mode • Units in microns • ± sign • Must specify pupil size • Absolute Zernike coefficient = magnitude .

51 µm 3rd order 4th order Z3-3 Z3-1 Z31 Z33 Z4-4 Z4-2 Z40 Z42 Z44 -.0.03 .76 µm Higher-order RMS: 0.04 .25 -0.03 .07 -.64 Rx: +0.+0.19 .75 x 111 Conventional Rx: Zernike coefficients Mode: Coefficient (µm): 2nd -2 Z order Z0 Z2 2 2 2 .6 mm Total RMS: 0.06 Unit = µm .11 0 -.27 .08 + or - values .67 x 111 Pupil diameter: 5.05 .56 .

.individual Zernike coefficients • How bad are combined aberrations? • Total aberrations (LOAs + HOAs) • Just higher-orders (HOA RMS) • Or. etc.. just third-order aberrations.RMS wavefront error • The basic data .+ ( Z ) . m 2 n m 2 n RMS = ( Z ) + .

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pupil size. pupil size ! . Interpreting the data • Aberrometers measure wavefronts • Wavefront .Summary 4.magnitude of grouped aberrations • Pupil size.distorted by aberrations • Zernike analysis .how bad they are • Data in microns.which aberrations are present • Zernike coefficients . with ± signs • RMS .

5. are those Zernike or RMS values good or bad? • Need reference norms . • So.what’s normal? • Aberrometry .diagnoses abnormal optics • Ideal eye = zero aberrations. but … • every eye has some aberrations. Diagnosis .

560 normal eyes 9 sites Zernike & RMS norms Data on www Google “Dr.OCO Norms • • • • • • JCRS Dec 2006 2. Salmon” .

4.edu/~salmonto .Downloadable info • Full article in PDF • Norms table . 6 • http://arapaho.nsuok. 5.PDF & Excel • Signed Zernike coefficients • Absolute values • Combined (polar) Zernike modes • RMS for HOA and orders 3.

0 0.11 .0 0.10 0.0 0.20 • Prominent individual HOAs (6.13 • Z3-3 (oblique trefoil) = 0.0-mm pupil) • Z3-1 (vertical coma) = 0.19 0.38 4.HOA results Pupil diameter Mean (µm) 2x mean 6.66 5.14 • Z40 (spherical aberration) = 0.33 0.

Compare the data to norms If more than double the norms … (for that pupil size) suspect abnormal optics. How can you know what’s normal? A. .Summary 5 Q.

33 µm . • Compare values to norms • Mean HO RMS (6 mm) = 0.Summary – the basics • Aberrations = refractive errors • Aberrometers measure wavefronts. • Zernike analysis tells which aberrations • Zernike coefficients & RMS tell how bad the aberrations are.

.And .. Dont’ forget pupil diameter! .

Case example • 34 yof. eye strain. especially at night • RK OU at age 21 • Spec Rx = plano. diplopia. glare.OU • Aberrometry confirmed large HOAs . complained of shadows. 20/20.

25 0.00 1.00 1.0 mm) OD OS 2 2 1 1 mm0 mm0 -1 -1 -2 -2 -2 -1 0 mm 1 2 -2.50 -1 0 mm 1 2 -1.25 0.89 µm -2 -2.92 µm .50 Wavefront error (um) RMS=0.HOA wavefront maps (5.50 -1.25 2.50 Wavefront error (um) RMS=0.25 2.

3) Z(4.3)Z(5.Zernike coefficients 0.-4)Z(4.4) Z(5.-1)Z(3.10 Abs Zernike coefficient (um) 0.30 0.-1)Z(5.20 0.60 OD 0.0-mm pupil 0.-3)Z(3.00 Z(3.40 5.-5)Z(5.0)Z(4.1)Z(3.2)Z(4.1)Z(5.-2)Z(4.-3)Z(5.5) Zernike mode .50 OS Normal 0.

8 OS Normal 0.0 3.6 3.0 mm 5.0 4.2 0 5.5 5.0 .5 4.0 mm 0.0 Pupil diameter (mm) 2.4 HO RMS (um) 0.5 2.5 3.HO RMS & pupil size 1 OD Pupil & RMS data 0.

Aberrometry & refractive surgery • Replace conventional auto-refractor • Verify pre-op refraction • Guide choice of laser procedure • Data sent to laser for custom correction • Evaluate quality of the correction .

00 -0.06 0.10 0.Eye research • Optics of the eye • Optical corrections • • Visual perception Optics-related phenomena 0.04 0.08 0.Day Acuvue Moist 0.12 Eye without SCL Proclear 1 Day 1.02 0.02 0 10 20 30 40 Time (seconds) 50 60 .

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