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The principal work in this thesis describes the investigation of the impact that alterations to ocular aberrations following refractive surgery have on the accommodative mechanism. A series of prospective studies were conducted with healthy adults (n=36) that had chosen to undergo refractive surgery at Manchester Royal Eye Hospital. A variety of monocular accommodative functions were assessed prior to surgery and then at one and three months following surgery on the same cohort of patients. Accommodative functions included amplitude of accommodation, accommodative facility (at 6m and 0.4m) including positive and negative response times, and accommodative stimulus-response functions. Dynamic accommodation responses were examined in a subgroup (n=10) at three months following refractive surgery and compared to an age-matched emmetropic control group (n=10) to evaluate differences in latency, amplitude, time constant and peak velocity of accommodation and disaccommodation. During the studies, ocular aberrations were concurrently measured to determine whether alterations to aberrations could help explain any observed changes in accommodative functions. Evaluation of visual, refractive and questionnaire outcome measures indicated that the patient cohort underwent successful surgery. Following surgery, significant alterations to a number of accommodative functions were discovered. Mean subjective ocular amplitude of accommodation increased by approximately 0.50D (p<0.05), mean stimulus-response function gradient decreased by approximately 10% (p<0.05) and distance facility rate increased by approximately 2-3 cycles/minute (p<0.05). Significant correlation was found between the change in accommodative stimulus-response function gradient, and the change in spherical aberration following surgery (p<0.05). Significant differences were also found in the parameters of accommodative dynamics, although some of these factors may be explained by refractive error differences between the refractive surgery patients (pre-operative myopes) and the emmetropic control group. The results suggest that alterations to aberrations following refractive surgery may be capable of influencing elements of the accommodation response. Additional studies were conducted to investigate the changes in aberrations during accommodation (n=31 subjects), and explore the contribution of the tear film (n=19 subjects) to higher order aberrations in eyes that have undergone refractive surgery. The results suggested that the rate of change in aberrations during accommodation is not affected by refractive surgery, but that the pattern of aberrations induced by post-blink tear film changes may differ in patients that have undergone refractive surgery. A further study is presented which investigated the form of the accommodative stimulus-response function to grating target of different spatial frequencies in groups of myopic (n=10) and emmetropic (n=10) participants recruited from among the staff and students at The University of Manchester. Both refractive groups appeared to show similar accommodative behavior, however the dominant feature of the data in both groups was between subject variation.

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.

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La aberración de onda ocular está estrechamente vinculada con la calidad visual y presenta valores característicos en cada ojo. Su medida y corrección tienen un gran interés tanto en el ámbito de ciencia básica como en la práctica clínica. En el presente trabajo se desarrolla un sistema experimental de medida del frente de onda ocular con gran rango dinámico basado en un sensor Shack-Hartmann. Con él se miden las aberraciones oculares monocromáticas en dos grupos de sujetos: uno de jóvenes con ojos sanos y otro de sujetos que han sido intervenidos de transplante de córnea (queratoplastia penetrante). Los resultados muestran que el valor RMS medio de las aberraciones de alto orden es 10 veces superior en estos últimos. Además se encontró una alta correlación entre las aberraciones corneales (obtenidas de la topografía corneal) y las aberraciones oculares del grupo con patología corneal.Se estudia, de forma simulada y real, la corrección de las aberraciones por medio de lentes de contacto hidrofílicas, diseñadas a partir del patrón de aberraciones de cada sujeto. El estudio se realiza para tres tipos de ojos: normales, con queratoconos y con transplante de córnea. Los resultados muestran que las principales limitaciones de este tipo de corrección se originan debido a la posición y orientación media de la lente de contacto en el ojo. Si tenemos en cuenta desplazamientos realistas de la lente de contacto encontramos que los sujetos normales presentan una pérdida de calidad óptica respecto de la corrección estándar (corrección esfero-cilíndrica). Sin embargo, existen casos patológicos en los que a pesar de las típicas rotaciones y traslaciones de las lentes de contacto, se podría disminuir el RMS de las aberraciones y aumentar la calidad visual, como se comprueba experimentalmente en los queratoconos. / The ocular wave aberration is strongly related with the visual quality having specific values for each eye. Its measurement and correction is challenging for fundamental research as well as for clinical practice. In this work we develop an experimental apparatus to measure the ocular wavefront based on a Shack-Hartmann sensor with a high dynamic range. We use it for measuring monochromatic ocular aberration in two subject groups: a) normal young subjects (normal group hereafter) and b) penetrating queratoplasty eyes (pathologic group hereafter). The results show that mean RMS values of the high order aberrations in the pathologic group was ten times higher than that of the normal group. Further, there is a strong correlation between the corneal aberrations (obtained by corneal topography) and ocular aberrations in the pathological group. We study the aberration correction using soft contact lenses, custom designed from each subject aberrations, by mean of both experiments and theoretical predictions. The study is carried out for three types of eyes: normal, keratoconus and penetrating queratoplasty. Results show that the main factors limiting this correction method are owing to both the mean position and rotation of the contact lenses on eye. We found that the normal subjects show a loss of optical quality relative to standard correction (sphere and cylinder), caused by expected displacements of the lenses contacts. In spite of the rotations and translations expected of contact lenses, there are, however, pathologic cases in which it is possible to reduce the RMS and increase visual quality, such as it was experimentally demonstrated in the keratoconus eyes.

This thesis consists of two parts: a report on the use of a binocular Shack-Hartmann (SH) sensor to study the dynamic correlation of ocular aberrations; and the application of an adaptive optics (AO) system to investigate the effect of the manipulation of aberrations on the accommodation control. The binocular SH sensor consists of one laser source and one camera to reduce system cost and complexity. Six participants took part in this study. Coherence function analysis showed that coherence values were dependent on the subject, aberration and frequency component. Inter-ocular correlations of the aberration dynamics were fairly weak for all participants. Binocular and monocular viewing conditions produced similar wavefront error dynamics. The AO system has a dual wavefront sensing channel. The extra sensing channel permits direct measurement of the eye's aberrations independent of the deformable mirror. Dynamic correction of aberrations during steady-state fixation did not affect the accommodation microfluctuations, possibly due to the prior correction of the static aberration level and/or the limited correction bandwidth. The inversion of certain aberrations during dynamic accommodation affected the gain and latency of accommodation response (AR), suggesting that the eye used the aberrations to guide its initial path of accommodative step response. Corrections of aberrations at various temporal locations of AR cycle produced subject- and aberration-dependent results. The gain and phase lag of the AR to a sinusoidally moving target were unaffected by aberration correction. The predictable nature of the target had been suggested as the reason for its failure to produce any significant effect on the AR gain and phase lag.

Fluctuations in accommodation have been shown to be correlated in the two eyes of the same subject. However, the dynamic correlation of higher-order aberrations in the frequency domain has not been studied previously. A binocular Shack-Hartmann wavefront sensor is used to measure the ocular wavefront aberrations concurrently in both eyes of six subjects at a sampling rate of 20.5 Hz. Coherence function analysis shows that the inter-ocular correlation between aberrations depends on subject, Zernike mode and frequency. For each subject, the coherence values are generally low across the resolvable frequency range (mean 0.11), indicating poor dynamic correlation between the aberrations of the two eyes. Further analysis showed that phase consistency dominates the coherence values. Monocular and binocular viewing conditions showed similar power spectral density functions.

This thesis consists of two parts: a report on the use of a binocular Shack-Hartmann (SH) sensor to study the dynamic correlation of ocular aberrations; and the application of an adaptive optics (AO) system to investigate the effect of the manipulation of aberrations on the accommodation control. The binocular SH sensor consists of one laser source and one camera to reduce system cost and complexity. Six participants took part in this study. Coherence function analysis showed that coherence values were dependent on the subject, aberration and frequency component. Inter-ocular correlations of the aberration dynamics were fairly weak for all participants. Binocular and monocular viewing conditions produced similar wavefront error dynamics. The AO system has a dual wavefront sensing channel. The extra sensing channel permits direct measurement of the eye¿s aberrations independent of the deformable mirror. Dynamic correction of aberrations during steady-state fixation did not affect the accommodation microfluctuations, possibly due to the prior correction of the static aberration level and/or the limited correction bandwidth. The inversion of certain aberrations during dynamic accommodation affected the gain and latency of accommodation response (AR), suggesting that the eye used the aberrations to guide its initial path of accommodative step response. Corrections of aberrations at various temporal locations of AR cycle produced subject- and aberration-dependent results. The gain and phase lag of the AR to a sinusoidally moving target were unaffected by aberration correction. The predictable nature of the target had been suggested as the reason for its failure to produce any significant effect on the AR gain and phase lag.

Aberrations affect image quality of the eye away from the line of sight as well as along it. High amounts of lower order aberrations are found in the peripheral visual field and higher order aberrations change away from the centre of the visual field. Peripheral resolution is poorer than that in central vision, but peripheral vision is important for movement and detection tasks (for example driving) which are adversely affected by poor peripheral image quality. Any physiological process or intervention that affects axial image quality will affect peripheral image quality as well. The aim of this study was to investigate the effects of accommodation, myopia, age, and refractive interventions of orthokeratology, laser in situ keratomileusis and intraocular lens implantation on the peripheral aberrations of the eye. This is the first systematic investigation of peripheral aberrations in a variety of subject groups. Peripheral aberrations can be measured either by rotating a measuring instrument relative to the eye or rotating the eye relative to the instrument. I used the latter as it is much easier to do. To rule out effects of eye rotation on peripheral aberrations, I investigated the effects of eye rotation on axial and peripheral cycloplegic refraction using an open field autorefractor. For axial refraction, the subjects fixated at a target straight ahead, while their heads were rotated by ±30º with a compensatory eye rotation to view the target. For peripheral refraction, the subjects rotated their eyes to fixate on targets out to ±34° along the horizontal visual field, followed by measurements in which they rotated their heads such that the eyes stayed in the primary position relative to the head while fixating at the peripheral targets. Oblique viewing did not affect axial or peripheral refraction. Therefore it is not critical, within the range of viewing angles studied, if axial and peripheral refractions are measured with rotation of the eye relative to the instrument or rotation of the instrument relative to the eye. Peripheral aberrations were measured using a commercial Hartmann-Shack aberrometer. A number of hardware and software changes were made. The 1.4 mm range limiting aperture was replaced by a larger aperture (2.5 mm) to ensure all the light from peripheral parts of the pupil reached the instrument detector even when aberrations were high such as those occur in peripheral vision. The power of the super luminescent diode source was increased to improve detection of spots passing through the peripheral pupil. A beam splitter was placed between the subjects and the aberrometer, through which they viewed an array of targets on a wall or projected on a screen in a 6 row x 7 column matrix of points covering a visual field of 42 x 32. In peripheral vision, the pupil of the eye appears elliptical rather than circular; data were analysed off-line using custom software to determine peripheral aberrations. All analyses in the study were conducted for 5.0 mm pupils. Influence of accommodation on peripheral aberrations was investigated in young emmetropic subjects by presenting fixation targets at 25 cm and 3 m (4.0 D and 0.3 D accommodative demands, respectively). Increase in accommodation did not affect the patterns of any aberrations across the field, but there was overall negative shift in spherical aberration across the visual field of 0.10 ± 0.01m. Subsequent studies were conducted with the targets at a 1.2 m distance. Young emmetropes, young myopes and older emmetropes exhibited similar patterns of astigmatism and coma across the visual field. However, the rate of change of coma across the field was higher in young myopes than young emmetropes and was highest in older emmetropes amongst the three groups. Spherical aberration showed an overall decrease in myopes and increase in older emmetropes across the field, as compared to young emmetropes. Orthokeratology, spherical IOL implantation and LASIK altered peripheral higher order aberrations considerably, especially spherical aberration. Spherical IOL implantation resulted in an overall increase in spherical aberration across the field. Orthokeratology and LASIK reversed the direction of change in coma across the field. Orthokeratology corrected peripheral relative hypermetropia through correcting myopia in the central visual field. Theoretical ray tracing demonstrated that changes in aberrations due to orthokeratology and LASIK can be explained by the induced changes in radius of curvature and asphericity of the cornea. This investigation has shown that peripheral aberrations can be measured with reasonable accuracy with eye rotation relative to the instrument. Peripheral aberrations are affected by accommodation, myopia, age, orthokeratology, spherical intraocular lens implantation and laser in situ keratomileusis. These factors affect the magnitudes and patterns of most aberrations considerably (especially coma and spherical aberration) across the studied visual field. The changes in aberrations across the field may influence peripheral detection and motion perception. However, further research is required to investigate how the changes in aberrations influence peripheral detection and motion perception and consequently peripheral vision task performance.