Customized Contact Lenses

描述（由申请人提供）：该预防性工程研究项目的长期目标是改善患有圆锥角膜等异常角膜疾病的人的视力。在上一个资助期，我们开发了测量这些眼睛波前误差的能力，我们还开发了定制的软性角膜接触镜，可以补偿他们的极端高阶眼像差。虽然这些定制的镜片可以产生视觉性能的实质性改善，但需要做更多的工作来将敏锐度恢复到正常值。特别是，受益受到透镜在角膜上不可预测的平移和旋转的影响，并且可能受到矫正前对不良视网膜图像质量的神经适应的影响。我们在下一个资助期内的努力目标是克服这些限制的研究。目标1.1将通过塑造后表面轮廓以匹配角膜的圆锥形前表面来稳定定制软性角膜接触镜的移动。目标1.2将通过选择对视力有显著影响但对透镜移动不太敏感的高阶像差来优化矫正性能。目的1.3将确定无法用常规刚性透气性（RGP）矫正的圆锥角膜眼的内部光学像差的重要性。目标1.4是开发稳定地位于巩膜而不是角膜上的定制巩膜透镜。目的1.5是比较这些新型定制角膜和巩膜接触镜与传统RGP接触镜的视力结局，重点是增强定制接触镜的受益并减少其局限性。目标2将检验圆锥角膜患者可能无法立即获得定制矫正的全部益处的假设，因为在矫正前持续神经适应不良的视网膜图像质量。在正常眼睛和接受激光屈光手术的患者中也显示出类似的神经适应性，我们将在患有极度畸变角膜多年的患者中测试这种适应性的程度。在获得定制光学矫正的全部视觉益处之前，此类患者可能需要长时间暴露于改善的光学质量。因此，我们还将使用大行程自适应光学系统和定制的巩膜透镜进行实验，研究短期和长期适应高阶像差对这些异常角膜患者感知的视网膜图像质量的影响。公共卫生相关性：圆锥角膜的不规则形状引起的光学缺陷（高阶像差）随着疾病的进展导致视觉质量显著下降。设计用于校正个体眼睛的像差的定制接触镜可以为患者提供显著改善的视觉性能。

DESCRIPTION (provided by applicant): The long range goal of this translational-engineering research project is to improve the vision of people who have abnormal corneal conditions such as keratoconus. In the previous grant period, we developed the ability to measure wavefront error in these eyes and we also developed customized soft corneal contact lenses that can compensate for their extreme higher-order ocular aberrations. Although these customized lenses can produce substantial improvements in visual performance, more needs to be done to restore acuity to normal values. In particular, the benefit was compromised by the unpredictable translation and rotation of the lens on the cornea, and may have been compromised by neural adaptation to the poor retinal image quality before correction. Our efforts during the next grant period are targeted at research that will overcome these limitations. Aim1.1 will stabilize the movement of customized soft contact lenses by sculpting the back surface profile to match the keratoconic anterior surface of cornea. Aim1.2 will optimize correction performance by selecting higher order aberrations to be corrected that have a significant impact on vision but are less sensitive to lens movements. Aim 1.3 will determine significance of the internal optics aberration in keratoconic eyes that cannot be corrected with conventional rigid gas permeable (RGP). Aim1.4 is to develop customized scleral lenses that sit stably on the sclera rather than cornea. Aim 1.5 is to compare the visual outcomes of these new, customized corneal and scleral contact lenses with conventional RGP lenses focusing on enhancing the benefits and reducing the limitations of the customized lenses. Aim 2 will test the hypothesis that patients with keratoconus may not be able to immediately achieve the full benefit of customized correction because of persisting neural adaptation to the poor retinal image quality before correction. Similar neural adaptation has been shown in normal eyes and in patients who have received laser refractive surgery, and we will test the extent of this adaptation in patients who have lived for years with extremely aberrated corneas. Such patients may require a long period of exposure to improved optical quality before reaping the full visual benefit of a customized optical correction. Therefore, we will also use a large-stroke adaptive optics system and customized scleral lenses for experiments on the effects of short- and long-term adaptation to higher order aberrations on perceived retinal image quality in these abnormal corneal patients. PUBLIC HEALTH RELEVANCE: The optical defects (higher order aberrations) induced by irregular shapes of the cornea with keratoconus cause significant degradation in visual quality as the disease advances. Customized contact lenses designed to correct the aberration of individual eyes can provide the patients with substantially improved visual performance.