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We evaluated the dynamics of ocular surface temperature using thermal imaging in 21 glaucoma subjects and 19 healthy subjects. On opening of the eye, subjects with glaucoma showed significantly cooler temperatures in the central cornea compared to the control group. The upper eyelid was also significantly cooler just before the eye opened. Immediately after opening the eye, the dynamic of temperature change was different in the two groups. In subjects with glaucoma, the eyes cooled significantly faster, with an average decrease of 0.49°C during the first second compared to 0.24°C in the control group. Our results support the hypothesis that both the stability of the tear film and changes in the ocular blood supply in subjects with glaucoma play an important role in thermal dynamics of the ocular surface.

Purpose: The human eye has typically more optical aberrations than conventional artificial optical systems. While the lower order modes (defocus and astigmatism) are well studied, our purpose is to explore the influence of genes versus the environment on the higher order aberrations of the optical components of the eye., Methods: We have performed a classical twin study in a sample from the Region of Murcia (Spain). Optical aberrations using a Hartmann-Shack sensor (AOnEye Voptica SL, Murcia, Spain) and corneal aberrations (using corneal topography data) were measured in 138 eyes corresponding to 69 twins; 36 monozygotic (MZ) and 33 dizygotic (DZ) pairs (age 55 years, SD 7 years). Intraclass correlation coefficients (ICCs) were used to estimate how strongly aberrations of twins resemble each other, and genetic models were fitted to quantify heritability in the selected phenotypes., Results: Genes had a significant influence in the variance of most of the higher order aberration terms (heritability from 40% to 70%). This genetic influence was observed similarly in both cornea and complete eye aberrations. Additionally, the compensation factor of spherical aberration in the eye (i.e., how much corneal spherical aberration was compensated by internal spherical aberration) was found under genetic influence (heritability of 68%)., Conclusions: There is a significant genetic contribution to the variance of aberrations of the eye, not only at macroscopic levels, as in myopia or astigmatism, but also at microscopic levels, where a few micrometers changes in surface topography can produce a large difference in the value of the optical aberrations.

Purpose: Quality of vision in patients who have undergone corneal refractive surgery depends upon the optimal centration of the procedures used. The center of the pupil is used as a reference point in some corneal ablation procedures. The achromatic axis would be a more sensible option from an optical point of view, but it is not as readily detectable. As an alternative, other refractive techniques, like the small aperture corneal inlay for presbyopia correction, use the corneal reflex (first Purkinje image). To assess the relative position of these two marks, we developed a new instrument to simultaneously measure both the first Purkinje image (PI) and the intersection of the achromatic axis with the pupil plane., Methods: The apparatus records images of the pupil and the PI when illuminated with a circle of infrared light-emitting diodes. A second optical path allows determination of the achromatic axis by using a subjective method. Both the positions of the PI and the achromatic axis intersection are determined simultaneously., Results: A series of data were obtained in 48 eyes. The mean location of the achromatic point relative to the PI was [x = -0.05 ± 0.15 mm; y = 0.09 ± 0.18 mm]. Considered individually, in 55% of eyes, the distance between locations is less than 0.2 mm, and in 95% of eyes, distances are less than 0.4 mm., Conclusions: On average, achromatic axis crossing of the pupil and PI locations coincides within measurement errors. Although there was some intersubject variability, differences in location were less than 0.6 mm in all measured eyes., (Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.)

Purpose: To investigate the effect of age on the contributions of the anterior cornea and internal components to ocular aberrations in the peripheral visual field., Methods: Ocular aberrations were measured in 10 young emmetropes and 7 older emmetropes using a modified commercial Hartmann-Shack aberrometer across 42° × 32° of central visual field. Anterior corneal aberrations were estimated from anterior corneal topography using theoretical ray-tracing. Internal aberrations were calculated by subtracting anterior corneal aberrations from ocular aberrations., Results: Anterior corneal aberrations of young subjects were reasonably compensated by the internal aberrations, except for astigmatism for which the internal contribution was small out to the 21° field limit. The internal coma and spherical aberration of the older subjects were considerably smaller in magnitude than those of the young subjects such that the compensation for anterior corneal aberrations was poorer. This can be explained by age-related changes in the lens shape and refractive index distribution., Conclusions: Loss of balance between anterior cornea and internal components of higher order aberrations with increasing age, found previously for on-axis vision, applies also to the peripheral visual field.

Purpose: To investigate binocular visual acuity and depth of focus when one eye forms images through a typical pupil diameter aperture (4 mm) and the other eye through a small pupil of 1.5-mm diameter., Methods: Using a recently developed adaptive optics binocular visual simulator, through focus monocular and binocular visual acuity were measured in three subjects under specially simulated visual conditions: right eyes had "small aperture" vision through a 1.5-mm pupil diameter and left eyes had normal vision through 4-mm pupil diameter. The measurements were performed in photopic and mesopic conditions., Results: An increase in binocular and monocular (for the small-aperture eye) depth of focus was measured with respect to the 4-mm pupil diameter eye. It ranged from 1 to 1.5 diopter (D) depending on the threshold requirement and the visibility conditions. For photopic conditions, the J2 visual acuity level was reached at 1 D of defocus for the 4-mm pupil diameter case, while for the 1.5-mm, the J2 level was reached at 2.5 D. Binocular summation occurred only in far vision conditions (no defocus added). For near vision, binocular visual acuity closely followed the values of monocular visual acuity for the eye with the smaller aperture., Conclusions: The small-aperture effect to increase depth of focus in the human eye was successfully implemented in a binocular visual simulator. Although certain limitations exist, the small-aperture approach provided a simple but attractive solution to increase depth of focus in the human eye.

Purpose: This study was conducted to determine the magnitude of pupil center shift between the illumination conditions provided by corneal topography measurement (photopic illuminance) and by Hartmann-Shack aberrometry (mesopic illuminance) and to investigate the importance of this shift when calculating corneal aberrations and for the success of wavefront-guided surgical procedures., Methods: Sixty-two subjects with emmetropia underwent corneal topography and Hartmann-Shack aberrometry. Corneal limbus and pupil edges were detected, and the differences between their respective centers were determined for both procedures. Corneal aberrations were calculated using the pupil centers for corneal topography and for Hartmann-Shack aberrometry. Bland-Altmann plots and paired t-tests were used to analyze the differences between corneal aberrations referenced to the two pupil centers., Results: The mean magnitude (modulus) of the displacement of the pupil with the change of the illumination conditions was 0.21+/-0.11 mm. The effect of this pupillary shift was manifest for coma corneal aberrations for 5-mm pupils, but the two sets of aberrations calculated with the two pupil positions were not significantly different. Sixty-eight percent of the population had differences in coma smaller than 0.05 microm, and only 4% had differences larger than 0.1 microm. Pupil displacement was not large enough to significantly affect other higher-order Zernike modes., Conclusions: Estimated corneal aberrations changed slightly between photopic and mesopic illumination conditions given by corneal topography and Hartmann-Shack aberrometry. However, this systematic pupil shift, according to the published tolerances ranges, is enough to deteriorate the optical quality below the theoretically predicted diffraction limit of wavefront-guided corneal surgery.

We studied the mechanism of compensation of aberrations within the young human eye by using experimental data and advanced ray-tracing modeling. Corneal and ocular aberrations along with the alignment properties (angle kappa, lens tilt, and decentration) were measured in eyes with different refractive errors. Predictions from individualized ray-tracing optical models were compared with the actual measurements. Ocular spherical aberration was, in general, smaller than corneal spherical aberration without relation to refractive error. However, horizontal coma compensation was found to be significantly larger for hyperopic eyes where angle kappa tended to also be larger. We propose a simple analytical model of the relationship between the corneal coma compensation effect with the field angle and corneal and crystalline shape factors. The actual shape factors corresponded approximately to the optimum shapes that automatically provide this coma compensation. We showed that the eye behaves as an aplanatic optical system, an optimized design solution rendering stable retinal image quality for different ocular geometries.

Purpose: When keratorefractive surgery is used to treat a central corneal diameter smaller than the resting pupil, visual symptoms of polyopia, ghosting, blur, haloes, and glare can be experienced. Progress has been made to enlarge the area of surgical treatment to extend beyond the photopic pupil; however, geometric limitations can pose restrictions to extend the treatment beyond the mesopic pupil diameter and can lead to impediments in night vision. The size of the treated area that has achieved good optical performance has been defined as the functional optical zone (FOZ). In this study the authors developed three objective methods to measure the FOZ., Methods: Corneal topography examination results from 1 eye of 34 unoperated normal eyes and 32 myopic eyes corrected by laser in situ keratomileusis (LASIK) were evaluated in three ways. First, a uniform axial power method (FOZ(A)) assessed the area of the postoperative cornea that was within a +/-0.5-D window centered on the mathematical mode. Second, FOZ was determined based on the corneal wavefront true RMS error as a function of the simulated pupil size (FOZ(R)). Third, FOZ was determined from the radial MTF, established at the retinal plane as a function of pupil size (FOZ(M))., Results: Means for each of the FOZ methods (FOZ(A), FOZ(R), and FOZ(M)) were 7.6, 9.1, and 7.7 mm, respectively, for normal eyes. For LASIK-corrected eyes, these means were 6.0, 6.9, and 6.0 mm. Overall, an average decrease of 1.8 mm in the functional optical zone was found after the LASIK procedure. Correlations between the FOZ methods after LASIK showed acceptable and statistically significant values (R = 0.71, 0.70, and 0.61; P < 0.01)., Conclusions: These methods will be useful to more fully characterize corneal treatment profiles after keratorefractive surgery. Because of its ease of implementation, direct spatial correspondence to corneal topography, and good correlation to the other more computationally intensive methods, the semiempiric uniform axial power method (FOZ(A)) appears to be most practical in use. The ability to measure the size of the FOZ should permit further evolution of keratorefractive surgical lasers and their algorithms to reduce the night vision impediments that can arise from functional optical zones that do not encompass the entire mesopic pupil.

We present a new methodology to obtain, to the best of our knowledge, the first intraocular lens (IOL) designed to balance the coma induced by the cornea due to the global ocular tilt. This lens is designed to mimic the situation naturally occurring in the normal healthy eye. The new proposed IOL provides an improved optical quality for all lens powers.

Purpose: To determine the optimum position to center a small-aperture corneal inlay and the effect of residual defocus in the surgical eye to maximize depth of focus. Setting: Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain. Design: Cohort study. Methods: Personalized eye models were built using actual data (corneal topography, eye length, ocular aberrations, and eye alignment). A small aperture 1.6 mm in diameter was placed at the corneal plane in each model. The monochromatic and polychromatic Strehl ratios were calculated as a function of the pinhole position. Different residual defocus values were also incorporated into the models, and the through-focus Strehl ratios were calculated. Results: Sixteen eye models were built. For most subjects, the optimum location of the aperture for distance vision was close to the corneal reflex position. For a given optimized centration of the aperture, the best compromise of depth of focus was obtained when the eyes had some residual myopic defocus (range −0.75 to −1.00 diopter [D]). Strehl ratio values were over 0.1 for far distance, which led to visual acuities better than 20/20. The depth of focus was 2.50 D with a mean near visual acuity of Jaeger 1 or better. Conclusions: In eyes with little astigmatism and aberrations, the optimum centration of the small aperture was near the corneal reflex position. To improve optical outcomes with the inlay, some small residual myopia and correction of corneal astigmatism might be required. Financial Disclosure: Dr. Artal is a consultant to Acufocus, manufacturer of the Acufocus Kamra corneal inlay. Dr. Tabernero has no financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]