Thesis (M.S.)--New England College of Optometry, 2009. / Includes bibliographical references (p. 94-96).

Aim; This study looks at the effect of orthokeratology on a number of biometric parameters and refractive error in an adult population. Method; Forty three myopic subjects were recruited to a twelve month study into the effects of orthokeratology on ocular biometry and refractive error. Two different back surface lens designs were applied right eye) pentacurve and left eye) aspheric. The aspheric design was chosen to more closely mimic the cornea¿s natural shape. Anterior and posterior apical radii and p-values; corneal thickness and anterior chamber depth were measured using the Orbscan IIz; together with ocular biometry by IOL Master and a standard clinical refraction. All measurements were repeated at one night, one week, one, three, six and twelve months. Refractive changes were analysed against biometric changes. Results; Twenty seven participants completed one month of lens wear. Twelve subjects completed twelve months of lens wear. Subjects with myopia ¿ -4.00DS were successfully treated with orthokeratology. Both anterior and posterior apical radii and p values were altered by orthokeratology. Corneal thickness changes were in agreement with previously published studies. Axial length and anterior chamber depth were unaffected by the treatment. Conclusion; Orthokeratology should be available as an alternative to laser refractive surgery. It is best restricted to myopes of up to -4.00DS with low levels of with the rule corneal astigmatism. The use of an aspheric back design contact lens did not produce a significant benefit over that of a pentacurve.

The cornea is the anterior most surface of the eye and plays a critical role in vision. A thin fluid layer, the tear film, coats the outer surface of the cornea and serves to protect, nourish, and lubricate the cornea. At the same time, the tear film is responsible for creating a smooth continuous surface, where the majority of refraction takes place in the eye. A significant component of vision quality is determined by the shape of the cornea and stability of the tear film. A dual interferometer system for measuring the dynamic corneal topography is designed, built, verified, and qualified by testing on human subjects. The system consists of two coaligned simultaneous phase-shifting polarization-splitting Twyman-Green interferometers. The primary interferometer measures the surface of the tear film while the secondary interferometer tracks the absolute position of the cornea, which provides enough information to reconstruct the absolute shape of the cornea. The results are high-resolution and high-accuracy surface topography measurements of the in vivo tear film and cornea that are captured at standard camera frame rates. (C) 2016 Society of Photo-Optical Instrumentation Engineers (SPIE)

O objetivo deste trabalho e desenvolver um instrumento computadorizado para análise da superfície anterior da córnea humana, gerando para isto, um mapa topográfico bidimensional em código de cores. Utilizando a córnea como um espelho esférico convexo, projeta-se anéis luminosos sobre sua superfície e aquisiciona-se com uma câmera a imagem por ela refletida. Esta imagem e digitalizada e armazenada em um microcomputador para posterior processamento. Através de técnicas de computação gráfica e processamento de imagens digitais, extrai-se da imagem as informações necessárias para construção da topografia desejada. Por fim, a topografia e apresentada em forma de mapas coloridos, sendo cada cor associada a uma determinada dioptria, transmitindo ao médico oftalmologista uma noção exata da superfície da córnea do paciente em análise. / The main goal of this work is to develop a computerized instrument for the analysis of the anterior portion of the human cornea, which displays its result in topographic color maps. Approximating the cornea to a spherical convex mirror, and by projecting a known pattern over it, the reflected image is captured and stored. By means of computer graphics technology and image processing, the necessary information for mathematical calculations is extracted. The resulting maps are color-coded in accordance to the degree of power of each corneal region, that is, to the diopter value. The ophthalmologist can then make important diagnostics and surgery tactics from the analysis of these topographic maps.

Aim: This study looks at the effect of orthokeratology on a number of biometric parameters and refractive error in an adult population. Method: Forty three myopic subjects were recruited to a twelve month study into the effects of orthokeratology on ocular biometry and refractive error. Two different back surface lens designs were applied right eye) pentacurve and left eye) aspheric. The aspheric design was chosen to more closely mimic the cornea's natural shape. Anterior and posterior apical radii and p-values; corneal thickness and anterior chamber depth were measured using the Orbscan IIz; together with ocular biometry by IOL Master and a standard clinical refraction. All measurements were repeated at one night, one week, one, three, six and twelve months. Refractive changes were analysed against biometric changes. Results: Twenty seven participants completed one month of lens wear. Twelve subjects completed twelve months of lens wear. Subjects with myopia ≤ -4.00DS were successfully treated with orthokeratology. Both anterior and posterior apical radii and p values were altered by orthokeratology. Corneal thickness changes were in agreement with previously published studies. Axial length and anterior chamber depth were unaffected by the treatment. Conclusion: Orthokeratology should be available as an alternative to laser refractive surgery. It is best restricted to myopes of up to -4.00DS with low levels of with the rule corneal astigmatism. The use of an aspheric back design contact lens did not produce a significant benefit over that of a pentacurve.

The cornea is the most powerful refractive component of the eye and as such, subtle changes in corneal shape can cause substantial changes in the optical characteristics of the eye. Monocular diplopia has previously been linked to corneal distortion following near work in various studies but has not been investigated in detail. The work reported in this thesis has investigated the optical effects of corneal distortions caused by eyelid forces and demonstrated that several corneal higher and lower order Zernike wavefront aberrations can change following reading. Measuring subtle changes in corneal topography requires the highest possible instrument accuracy, while software analysis tools should be able to detect and highlight those subtle changes with high reliability. The effect of ocular microfluctuations on the qualitative and quantitative analysis of corneal topography was investigated. A technique was developed to measure tilt, displacement, and cyclotorsion in multiple videokeratographs from the same cornea. This information was used to reposition each videokeratograph according to the average position of a sample of multiple measurements. The corneal topography of ten subjects was measured 20 times each, using videokeratoscopy. The RMSE calculated from difference between single videokeratographs and the average videokeratograph decreased by an average of 24.6 % for the ten subjects' data. The method can improve the precision performance of videokeratoscopy in multiple measurements of corneal topography. A study was undertaken, to investigate whether there are significant changes in corneal topography during accommodation in normal corneas and corneas that are pathologically thinner due to keratoconus. This was done to eliminate the possibility that changes in corneal aberrations associated with near work could be at least partly due to corneal changes caused by the effects of accommodation. A videokeratoscope was modified to present an accommodation stimulus that was coaxial with the instrument's measurement axis. Six subjects with normal corneas and four subjects with keratoconus were studied. In the initial analysis it was found that a number of the subjects showed significant changes in corneal topography as accommodation changed. However further analysis showed a significant group mean excyclotorsion of the topography maps for both accommodation stimuli compared with the 0 D stimulus. When the excyclotorsion was accounted for, no clear evidence of statistically significant changes in corneal topography as a result of accommodation were found. A small ocular excyclotorsion typically accompanies accommodation and this changes the relative orientation of the topography of the cornea. To investigate the effects of eyelid pressure on corneal shape and corneal aberrations during reading, twenty young subjects with normal ocular health were recruited. Cornea1 topography of one eye was measured with a videokeratoscope prior to reading and then again after a 60 minute reading task. Twelve of the twenty corneas showed significant changes in central topography immediately following reading. The location of the changes corresponded closely to the position and angle of the subject's eyelids during reading. Within the central region of the cornea there were significant changes in corneal wavefront Zernike coefficients, the root-mean-square error, overall refractive power and astigmatism. The changes observed in corneal topography appear to be directly related to the force exerted by the eyelids during reading. These findings may have important implications for the definition of refractive status and may also aid in the understanding of the relationship between reading and the development of refractive errors. To study whether corneal distortions after reading significantly differ between refractive error groups, corneal aberrations were measured before and after a period of reading, for a group of ten young progressing myopes and a group of ten young stable emmetropes. The major difference between the two groups was the location and magnitude of the corneal distortions, which had a significantly larger effect on central corneal optics in the myopic group compared to the emmetropic group. A significantly smaller palpebral aperture for the myopic group in the reading gaze position was the cause of this difference. The experiments described in this thesis have shown that numerous corneal characteristics can change due to eyelid forces during near work. The eye was shown to undergo a small cyclotorsion during higher levels of accommodation. There was a shift in direction of against the rule astigmatism of the cornea following reading and a change was found for primary vertical coma and trefoil. The changes in corneal shape following reading appear to be different in myope versus emmetropic refractive error groups. These findings are important for our understanding of the stability of the refractive error of the eye and could have important implications for refractive error development.

The human eye suffers various optical aberrations that degrade the retinal image. These aberrations include defocus and astigmatism, as well as the higher order aberrations that also play an important role in our vision. The optics of the eye are not static, but are continuously fluctuating. The work reported in this thesis has studied the nature of the microfluctuations of the wavefront aberrations of the eye and has investigated factors that influence the microfluctuations. The fluctuations in the ocular surface of the eye were investigated using high speed videokeratoscopy which measures the dynamics of the ocular surface topography. Ocular surface height difference maps were computed to illustrate the changes in the tear film in the inter-blink interval. The videokeratoscopy data was used to derive the ocular surface wavefront aberrations up to the 4th radial order of the Zernike polynomial expension. We examined the ocular surface dynamics and temporal changes in the ocular surface wavefront aberrations in the inter-blink interval. During the first 0.5 sec following a blink, the tear thickness at the upper edge of the topography map appeared to thicken by about 2 microns. The influence of pulse and instantaneous pulse rate on the microfluctuations in the corneal wavefront aberrations was also investigated. The fluctuations in ocular surface wavefront aberrations were found to be uncorrelated with the pulse and instantaneous heart rates. In the clinical measurement of the ocular surface topography using videokeratoscopy, capturing images 2 to 3 seconds after a blink will result in more consistent results. To investigate fluctuations in the wavefront aberrations of the eye and their relation to pulse and respiration frequencies we used a wavefront sensor to measure the dynamics of the aberrations up to the Zernike polynomial 4th radial order. Simultaneously, the subject's pulse rate was measured, from which the instantaneous heart rate was derived. An auto-regressive process was used to derive the power spectra of the Zernike aberration signals, as well as pulse and instantaneous heart rate signals. Linear regression analysis was performed between the frequency components of Zernike aberrations and the pulse and instantaneous heart rate frequencies. Cross spectrum density and coherence analyses were also applied to investigate the relation between fluctuations of wavefront aberrations and pulse and instantaneous heart rate. The correlations between fluctuations of individual Zernike aberrations were also determined. A frequency component of all Zernike aberrations up to the 4th radial order was found to be significantly correlated with the pulse frequency (all > 2R0.51, p<0.02), and a frequency component of 9 out of 12 Zernike aberrations was also significantly correlated with instantaneous heart rate frequency (all>2R0.46, p<0.05). The major correlations among Zernike aberrations occurred between second order and fourth order aberrations with the same angular frequencies. Higher order aberrations appear to be related to the cardiopulmonary system in a similar way to that reported for the accommodation signal and pupil fluctuations. A wavefront sensor and high speed videokeratoscopy were used to investigate the contribution of the ocular surface, the effect of stimulus vergence, and refractive error on the microfluctuations of the wavefront aberrations of the eye. The fluctuations of the Zernike wavefront aberrations were quantified by their variations around the mean and using power spectrum analysis. Integrated power was determined in two regions: 0.1 Hz ─ 0.7 Hz (low frequencies) and 0.8 Hz ─ 1.8 Hz (high frequencies). Changes in the ocular surface topography were measured using high speed videokeratoscopy and variations in the ocular wavefront aberrations were calculated. The microfluctuations of wavefront aberrations in the ocular surface were found to be small compared with the microfluctuations of the wavefront aberrations in the total eye. The variations in defocus while viewing a closer target at 2 D and 4 D stimulus vergence were found to be significantly greater than variations in defocus when viewing a far target. This increase in defocus fluctuations occurred in both the low and high frequency regions (all p<0.001) of the power spectra. The microfluctuations in astigmatism and most of the 3rd order and 4th order Zernike wavefront aberrations of the total eye were found to significantly increase with the magnitude of myopia. The experiments reported in this thesis have demonstrated the characteristics of the microfluctuations of the wavefront aberrations of the eye and have shown some of the factors that can influence the fluctuations. Major fluctuation frequencies of the eye's wavefront aberrations were shown to be significantly correlated with the pulse and instantaneous heart rate frequencies. Fluctuations in the ocular surface wavefront aberrations made a small contribution to those of the total eye. Changing stimulus vergence primarily affected the fluctuations of defocus in both low and high frequency components. Variations in astigmatism and most 3rd and 4th order aberrations were associated with refractive error magnitude. These findings will aid our fundamental understanding of the complex visual optics of the human eye and may allow the opportunity for better dynamic correction of the aberrations with adaptive optics.

O objetivo deste trabalho e desenvolver um instrumento computadorizado para análise da superfície anterior da córnea humana, gerando para isto, um mapa topográfico bidimensional em código de cores. Utilizando a córnea como um espelho esférico convexo, projeta-se anéis luminosos sobre sua superfície e aquisiciona-se com uma câmera a imagem por ela refletida. Esta imagem e digitalizada e armazenada em um microcomputador para posterior processamento. Através de técnicas de computação gráfica e processamento de imagens digitais, extrai-se da imagem as informações necessárias para construção da topografia desejada. Por fim, a topografia e apresentada em forma de mapas coloridos, sendo cada cor associada a uma determinada dioptria, transmitindo ao médico oftalmologista uma noção exata da superfície da córnea do paciente em análise. / The main goal of this work is to develop a computerized instrument for the analysis of the anterior portion of the human cornea, which displays its result in topographic color maps. Approximating the cornea to a spherical convex mirror, and by projecting a known pattern over it, the reflected image is captured and stored. By means of computer graphics technology and image processing, the necessary information for mathematical calculations is extracted. The resulting maps are color-coded in accordance to the degree of power of each corneal region, that is, to the diopter value. The ophthalmologist can then make important diagnostics and surgery tactics from the analysis of these topographic maps.

The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman- Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods. The in vitro interferometer system has measured the formation and break up of fluid layers. Different fluid and contact lens material combinations have been used, and significant fluid layer properties have been observed in some cases. This dissertation discusses the design of this interferometer along with analysis methods used. Example measurement results of different contact lens are presented highlighting the capabilities of the instrument. This dissertation also provides the in vivo interferometer design, along with the considerations that must be taken when designing an interferometer for on-eye diagnostics. Discussions include accommodating eye movement, design of null optics for a range of ocular geometries, and laser emission limits for on-eye interferometry in general.

The purpose of this thesis is to describe the development of an anatomically based, young adult eye model, which includes a crystalline lens with a gradient refractive index (GRIN). This model will then be used to investigate the effect of laser refractive surgery. The first step in this process involved developing a symmetrical eye model that was found to be a better predictor of empirical longitudinal spherical aberration than any previous model. Myopia was simulated by either a purely axial or refractive technique. While these models were found to be good predictors of the spherical aberration measured in young adults, they did not predict the total amount of high-order aberrations. The techniques used to simulate a single type of myopia caused the myopic models to become anatomically inaccurate. To improve the eye models a biconic surface was used to quantify the anterior corneal shape as a function of myopia. A method to describe the refractive error and biconic shape parameters in Jackson Cross Cylinder terms was implemented to determine correlations. Results indicate that a biconic accurately models the average shape of the anterior corneal surface as a function of myopia. Adopting the biconic model for the anterior corneal surface and adding average misalignments of the ocular components transformed the models from symmetrical to asymmetrical. Refractive error was now simulated by the anatomically accurate changes in both the anterior corneal shape and axial length. The asymmetrical aberrations resulted from the misalignment of the ocular components and provided a good prediction of average empirical aberrations but underestimated the aberrations of individual subjects. Photorefractive keratectomy, a form of laser refractive surgery, was simulated by theoretically calculated and by empirically measured changes in the shape of the anterior corneal surface. Applying the change in anterior corneal shape to the asymmetrical models was used to develop postoperative models. Changes in corneal shape and model aberrations attributed to theoretical calculations do not match empirical observations. The prediction of increased high-order aberrations in postoperative models based on empirically measured changes in the anterior corneal topography was similar to clinical results. Average anatomically based, GRIN eye models have been developed that accurately predict the average aberrations of emmetropic and myopic young adults. These models underestimate the asymmetrical and total high-order aberrations that have been measured in individual subjects but are still useful for investigating the average effects of procedures like refractive surgery.