Ji C. He

SIGNIFICANCE: This study provides a new method to measure the refractive index of crystalline lens in the human eye in vivo . PURPOSE: Accessing the refractive index of crystalline lenses in the human eye in vivo has long been a challenge. This study aimed to measure the refractive index of a lens in vivo using an anterior segment optical coherence tomography (AS‐OCT) system combined with a Scheimpflug imaging system. METHOD: A ray‐traceable Scheimpflug imaging was developed and integrated into an AS‐OCT system. A theoretical study revealed that the combination of these two systems provides a unique solution for simultaneously measuring the refractive index and the thickness of the lens. The average lens refractive index along the ray pathway ( N _av ) and lens shape were measured for seven subjects. RESULTS: The lens N _av along the central ray varies from 1.383 to 1.419 between subjects. The lens refractive index function across the lens diameter varies from subject to subject. The lens N _av increases for accommodated eyes. The thicknesses and profiles of the lenses are also determined. CONCLUSIONS: The lens refractive index varies substantially from individual eye to individual eye, not only along the central ray pathway but also for the lens refractive index function across the lens diameter. Ray‐traceable Scheimpflug imaging‐equipped AS‐OCT is useful for testing the refractive index of lenses in the human eye in vivo .

Background: To investigate the effects of lighting conditions and accommodation on the three-dimensional position of Visian implantable collamer lens (ICL V4c). Methods: This observational study recruited 62 eyes of 31 myopia patients underwent ICL V4c implantation. Anterior segment optical coherence tomography (AS-OCT) assessed the anterior chamber depth (ACD), ACD-ICL (distance from the corneal endothelium to anterior surface of the ICL V4c), vault (distance between the posterior ICL V4c surface and anterior crystalline lens surface), and crystalline lens tilt under various lighting conditions and accommodation relative to the corneal topographic axis at one year after ICL V4c implantation. Baseline was defined as the scotopic condition, which was also the non-accommodative stimulus condition. The ICL V4c tilt was analyzed using MATLAB. The significance level was set at P < 0.05. Results: The ACD-ICL values were similar under various lighting conditions (P = 0.978) but decreased during accommodation (P < 0.001). The vault was significantly smaller under mesopic and photopic conditions than the baseline (P = 0.044 and P < 0.001, respectively) but remained unchanged during accommodation (P = 0.058). The inferotemporal proportion of ICL V4c (88.7%, 55 eyes) and crystalline lens (74.2%, 46 eyes) tilts were not significantly different (P = 0.063). Crystalline lens under various lighting conditions and accommodation exhibited similar tilts. The vertical tilt of ICL V4c was significantly larger under photopic conditions than the baseline (P = 0.038). The horizontal and total tilts were significantly decreased during accommodation (P = 0.043 and 0.013, respectively). Conclusions: The axial position of ICL V4c in the anterior chamber was stable under various lighting conditions. Lighting conditions and accommodation may influence vertical, horizontal and total tilts of ICL V4c.

The measurement and simulation of corneal and lenticular curvature radii using a single swept-source biometry device enables a more thorough evaluation of the shape and refractive power of the corn...

Purpose To investigate the refractive and biometrical developments of children with retinopathy of prematurity (ROP) who received laser photocoagulation (LP) or intravitreal ranibizumab injection as treatment. Methods This case–control study involved cases with Zone II Stage 3 ROP. Fourteen children (28 eyes) who received single LP were included in the laser group, and 14 children (27 eyes) who received single intravitreal ranibizumab injection were included in the injection group. The mean age at operation was 37.00±1.72 and 36.36±1.66 weeks for the laser and injection groups, respectively (P=0.161), and refraction measurements and biometry were performed at the mean age of 5.00±1.63 and 5.00±0.94 years for the laser and injection groups, respectively (P=1.000). Spherical equivalent (SE) after mydriatic refraction and best corrected visual acuity (BCVA) were measured by refraction test. Central corneal thickness (CCT), anterior corneal surface curvature and curvature radius, anterior chamber depth (ACD), lens thickness (LT) and axial length (AL) were measured by biometry using the IOL Master700 biometric instrument (Carl Zeiss Meditec AG). The biometrical images were reanalysed using a self-developed program in MATLAB (R2016a, MathWorks, Inc.) to obtain additional eye parameters, including the curvatures of the posterior cornea and the anterior and posterior surfaces of the lens. SPSS (V.23.0) was used for statistical analysis. Independent sample t test was used to compare the eyeball biological and refractive state measures of the two groups, and Pearson correlation coefficient was used to evaluate the correlation between SE and the biological parameters. Results 1. (1) Cornea-related parameters: CCT (0.54±0.04mm vs 0.55±0.02mm, P>0.05), anterior corneal surface curvature radius (7.56±0.26 mm vs 7.67±0.43mm, P>0.05) and posterior corneal surface curvature radius (6.82±0.27mm vs 6.79±0.42mm, P>0.05). (2) ACD (3.21 ± 0.25mm vs 3.22 ± 0.19mm, P>0.05). (3) Lens-related parameters: anterior lens surface curvature radius (10.04±0.89mm vs 9.82±1.08mm, P>0.05), posterior lens surface curvature radius (5.49±0.55mm vs 5.92±0.73mm, PPPP0.05). 2. (1) The SE of children in the laser group was positively correlated with LT (r=0.438, Pr=−0.437, P0.05). (2) The SE of children in the injection group was negatively correlated with AL (r=−0.537, Pr=0.455, P0.05). Conclusion LP and intravitreal ranibizumab injection as ROP treatments produce myopic refraction with increased degree of myopia in children who received LP than in children who received ranibizumab injection. The increased myopia after LP is due to the increases in LT and posterior lens curvature and a shallow ACD.

SIGNIFICANCE: The study provides a new theory on the mechanism underlying myopia development, and it could be useful in clinical practice to control myopia development in schoolchildren. PURPOSE: To model the effect of the crystalline lens on refractive development in schoolchildren. METHODS: The Zemax 13 was used to calculate Zernike aberrations and refractions across 50° horizontal visual fields. Optical effects of the anterior chamber depth, lens thickness, and radii of curvature of the lens surfaces on refractions were modeled. Refractive changes induced by lens development in emmetropic and myopic eyes, based on a previous longitudinal study from literature, were calculated. RESULTS: A lens thickness reduction with an anterior chamber depth deepening caused a hyperopic shift over the visual fields and even more at the periphery. Opposite effects were found when the lens was thinned without any change of the anterior chamber depth. While a flattening of the anterior lens surface produced hyperopic refractions overall, a posterior lens flattening caused a myopic shift at the periphery, but a hyperopic shift of the central refraction. In the myopic eye, lens development induced refractive change toward more hyperopic over the visual fields and more at the periphery. CONCLUSIONS: Lens thinning and lens axial movement participate in peripheral refractive development in schoolchildren, and lens development with a deeper anterior chamber depth and a flatter lens surface in the myopic eye could generate extra hyperopia over visual fields. The myopic lens development could be due to a backward movement of the lens, driven by a backward growth of the ciliary process, which might be a causative factor of myopia development.

Purpose: The purpose of this study was to theoretically model the contributions of corneal asphericity ( Q ) and anterior chamber depth to peripheral wavefront aberrations. Methods: Ray‐tracing was performed on a model eye using a customised MatLab program to calculate Zernike aberrations up to the 5th order across ±60° of the horizontal visual field. The corneal Q was varied from −0.5 to 0.8, and the anterior chamber depth was changed from 2.05 to 4.05 mm while axial length was held constant. Spherical equivalent refractive error derived from Zernike defocus was used to estimate peripheral refraction. Results: Relative to axial Zernike aberrations, both defocus and astigmatism in the peripheral field increased with the corneal Q value, but the increases in relative peripheral astigmatism were much smaller in amplitude than relative peripheral defocus. Anterior chamber depth shortening caused the relative peripheral defocus and astigmatism to increase toward more positive values, although the changes in relative peripheral astigmatism with anterior chamber depth were small. Combination of the variations in both corneal Q and anterior chamber depth does not produce linear sum of the changes in relative peripheral defocus. The relative peripheral refractive error was more myopic when either the corneal Q was increased or the anterior chamber depth was shortened. The changes in relative peripheral x ‐axis coma, trefoil and spherical aberration with corneal Q value were complex but were barely changed with anterior chamber depth within the central 60° visual field. Conclusions: Both corneal asphericity and anterior chamber depth play important roles in determining peripheral wavefront aberrations. The two factors nonlinearly interact to affect peripheral aberrations. Higher corneal Q and/or shorter anterior chamber depth tend to produce relatively more myopic peripheral refraction. Increasing the Q value of the anterior surface of a contact lens might provide an interesting intervention to slow myopia progression.

To quantitatively approach the relationship between optical changes in an accommodated eye and the geometrical deformation of its crystalline lens, a long scan-depth anterior segment OCT equipped wavefront sensor was developed and integrated with a Badal system. With this system, accommodation was stimulated up to 6.0D in the left eye and also measured in the same eye for three subjects. High correlations between the accommodative responses of refractive power and the radius of the anterior lens surface were found for the three subjects (r>0.98). The change in spherical aberration was also highly correlated with the change in lens thickness (r>0.98). The measurement was very well repeated at a 2nd measurement session on the same day for the three subjects and after two weeks for one subject. The novelty of incorporating the Badal system into the OCT equipped wavefront sensor eliminated axial misalignment of the measurement system with the test eye due to accommodative vergence, as in the contralateral paradigm. The design also allowed the wavefront sensor to capture conjugated sharp Hartmann-Shack images in accommodated eyes to accurately analyze wavefront aberrations. In addition, this design extended the accommodation range up to 10.0D. By using this system, for the first time, we demonstrated linear relationships of the changes between the refractive power and the lens curvature and also between the spherical aberration and the lens thickness during accommodation in vivo. This new system provides an accurate and useful technique to quantitatively study accommodation.

Purpose.: To measure dynamic change characteristics of spatial and temporal variations in the post-blink tear film of normal eyes. Methods.: A wavefront sensor was used to measure dynamic changes in wavefront aberrations, up to the seventh order, for 10 seconds in a group of 33 normal young adults. Tear menisci were imaged with an anterior segment optical coherence tomography (AS-OCT) system and tear film break-up times (TFBUTs) were determined. Results.: Systematic changes in main axis astigmatism (R ² = 0.933, P < 0.0001), vertical coma (R ² = 0.935, P < 0.0001) and spherical aberrations (R ² = 0.879, P = 0.0002) occurred during the 10-second post-blink period. Both lower tear meniscus height and area increased by 10 seconds compared with the initial levels (P < 0.0001 for each). The change of vertical coma had significant correlation with the increase of lower tear meniscus areas during the 10-second post-blink period (R ² = 0.181, P = 0.014). Subjects with TFBUTs < 15 seconds had significantly increased main axis astigmatism, vertical coma, and spherical aberrations by 10 seconds. Subjects with longer TFBUTs did not have any significant wavefront aberrations during that period. Conclusions.: Systematic changes in some Zernike aberrations after blinking are associated with the changes in tear menisci and TFBUT. There was a substantial individual variation in dynamic changes of Zernike aberrations, suggesting the necessity to explore individual differences in tear quality and tear performance. Dynamic wavefront measurement combined with anterior segment optical coherence tomography could provide a useful tool to understand spatial and temporal processes of the tear film in clinical practice.

To develop a method to process Scheimpflug images to estimate higher-order variations in ocular surfaces. New England College of Optometry, Boston, Massachusetts, USA. Zernike polynomial functions were used rather than lower-order surface functions to fit the ocular surfaces to evaluate higher-order variations. A related ray-tracing method was developed to correct optical distortion of the Scheimpflug image. The new method to process Scheimpflug images showed higher-order variations in the posterior corneal surface. In a simulation, ignoring higher-order variations in the anterior corneal surface, as in previous studies, produced an error as high as 202% for some estimated Zernike coefficients of the posterior corneal surface. The results indicate that it is necessary to correct refractive distortion in Scheimpflug images using higher-order surface functions and that the method developed in this study can be used to process scheimpflug images for measurement of ocular wavefront aberrations.