Wavefront-guided scleral lens prosthetic device for keratoconus.
Wavefront-guided scleral lens prosthetic device for keratoconus.
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DOI：
10.1097/opx.0b013e318288d19c
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发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
Yoon G
中科院分区：
文献类型：
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作者：
Sabesan R;Johns L;Tomashevskaya O;Jacobs DS;Rosenthal P;Yoon G
目的探讨应用波前引导光学系统矫正圆锥角膜(KC)眼高阶像差的可行性。为6例(11眼)晚期圆锥角膜患者配戴传统球镜的SLPD。一个定制的Shack-Hartmann波前传感器被用来测量戴着SLPD的放大的瞳孔的像差。测量了SLPD的位置，即相对于瞳孔的水平和垂直偏心以及旋转，并将其融入到定制的SLPD的波前导引光学系统的设计中。一台亚微米精度的车床在设备的前表面产生了设计的不规则轮廓。随后测量了佩戴带有波前引导光学元件的SLPD的同一只眼的残余像差。通过测量最佳矫正的高对比度视力和对比敏感度，比较了传统球面和波前引导光学的SLPD与自然中间视瞳孔的视觉表现。配戴传统球镜的11只眼，6 mm瞳孔的均方根值为1.17±0.57μm。自制的波前引导光学系统有效地矫正了HOA，同一瞳孔的均方根值平均降低了3.1倍，为0.37±0.19μm。矫正后平均视力提高1.9行(p<；0.05)。对比敏感度也显著提高，分别为4、8和12周/度时的2.4、1.8和1.4倍(p<；0.05)。虽然残余像差与正常眼相当，但定制SLPD的LogMAR的平均视力为0.21，明显低于正常视力。定制的波前引导光学SLPD矫正晚期KC患者的HOA至正常水平，并显著提高他们的视力。
To investigate the feasibility of correcting ocular higher order aberrations (HOA) in keratoconus (KC) using wavefront-guided optics in a scleral lens prosthetic device (SLPD). Six advanced keratoconus patients (11 eyes) were fitted with a SLPD with conventional spherical optics. A custom-made Shack-Hartmann wavefront sensor was used to measure aberrations through a dilated pupil wearing the SLPD. The position of SLPD, i.e. horizontal and vertical decentration relative to the pupil and rotation were measured and incorporated into the design of the wavefront-guided optics for the customized SLPD. A submicron-precision lathe created the designed irregular profile on the front surface of the device. The residual aberrations of the same eyes wearing the SLPD with wavefront-guided optics were subsequently measured. Visual performance with natural mesopic pupil was compared between SLPDs having conventional spherical and wavefront-guided optics by measuring best-corrected high-contrast visual acuity and contrast sensitivity. Root-mean-square of HOA(RMS) in the 11 eyes wearing conventional SLPD with spherical optics was 1.17±0.57μm for a 6 mm pupil. HOA were effectively corrected by the customized SLPD with wavefront-guided optics and RMS was reduced 3.1 times on average to 0.37±0.19μm for the same pupil. This correction resulted in significant improvement of 1.9 lines in mean visual acuity (p<0.05). Contrast sensitivity was also significantly improved by a factor of 2.4, 1.8 and 1.4 on average for 4, 8 and 12 cycles/degree, respectively (p<0.05 for all frequencies). Although the residual aberration was comparable to that of normal eyes, the average visual acuity in logMAR with the customized SLPD was 0.21, substantially worse than normal acuity. The customized SLPD with wavefront-guided optics corrected the HOA of advanced KC patients to normal levels and improved their vision significantly.