rafael navarro vicente fernández-sánchez & norberto...
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![Page 1: Rafael Navarro Vicente Fernández-Sánchez & Norberto López-Gildigital.csic.es/bitstream/10261/122044/3/EMPVO12Present... · 2016. 2. 18. · Rafael Navarro Universidad de Murcia](https://reader035.vdocument.in/reader035/viewer/2022081621/6132636bdfd10f4dd73a6af8/html5/thumbnails/1.jpg)
Refractive error sensing in natural multifocal eyes
Rafael Navarro
Universidad de Murcia
Vicente Fernández-Sánchez& Norberto López-Gil
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Bifocal eyes? Progressive?
Bifocal designs: Spherical aberration
(aspherical, axicons, etc.)
Coma Combinations of HOA
IntroductionLENTIS Mplus
MPlus +3D
• Koomen et al., 1949; Ivanoff, 1953• Charman & Walsh, 1989• Legras & Bernard, 2011; Legras et al. 2012
Refraction changes across pupil
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Human Eyes:
Introduction
(Legras & Bernard, ARVO2011)
Trough focus visual quality(SA4 ± SA6 induced by adaptive optics)
MonofocalBiofocal
Experiment···VSR Metrics
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Introduction
y = 0.9279x ‐ 0.1662R² = 0.9366
‐10
‐8
‐6
‐4
‐2
0
2
4
6
‐10 ‐8 ‐6 ‐4 ‐2 0 2 4 6
RMS metric versus subjective (clinical) refraction
(López-Gil et al. 2009)
Good overall agreement
But Individual discrepancies
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Problem: Individual discrepanciesDiscrepancies > 1 D are frequent; in a few cases > 2.5 D
Explanations?- Wrong aberrometric Metric? But Most metrics give similar results- Bad subjective refraction? But all methods give consistent values- Different conditions? Illumination, pupil, individual neural response,…
Cannot explain large discrepancies
Cue: High discrepancy ↔ High HOA (coma, SA)
Unsatisfactory!
Hypothesis: Bifocal eyes?
WavefrontSubjective
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Methods1.- Data: from 178 normal eyes taken from previous study
(López-Gil et al., 2009)
Objective refraction: retinoscopy & autorefractometer (Canon T1000)Subjective refraction: Standard & custom Badal systemAberrometry: (irx3, Imagine Eyes)
2.- Refractive Error Sensing (RES):Refractive error from aberrometry
(Navarro, 2010)
YYXY
XYXX
WWWW
CSCCCS
045
450
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
-2
0
2
4
6
8
-6
-4
-2
0
2
4
Refractive Error = W Curvature
3.- Identify bifocals > 1 D: 8/178
4.- Analysis: Generalized RES for inhomogeneous/irregular pupils
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Standard RE sensingin monofocal eyes
Aberrometer
CentroidsSpots
W
W curvature
YYXY
XYXX
WWWW
W"
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
-2
0
2
4
6
8
-6
-4
-2
0
2
4
Refractive Error = W Curvature
Partial derivatives
YYXY
XYXX
WWWW
CSCCCS
045
450
Sphericalequivalent Cylinder 0º Cylinder 45º
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-9
-8
-7
-6
-5
-4
-3
-2
-1
0
Diopters
Distributions of refractive errorSpherical Equivalent
Monofocal Bifocal
Spatial (pupil)distribution
Probabilitydensity
distribution(histogram)
-1
0
1
2
3
4
Diopters
0 2 4 6 8 10-2 -1 0 1 2 3 4 5 6
3.125 D
0.75 D
Diopters
BimodalUnimodal-0.5 D
Diopters
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Multifocals(examples)
-4
-3.5
-3
-2.5
-2
-1.5
-1
-0.5
0
-5 -4 -3 -2 -1 0 1 2
3 modes
D ≈ 2D
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
3
-1 0 1 2 3 4 5 6
D ≈ 1.5D
Modes?Bimodal
-12 -11 -10 -9 -8 -7 -6 -5
-10
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
D ≈ 2.75D
Bimodal
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Discussion. Part 1
A small but significant number (5%) of eyes show bifocal or even multifocal properties
They show large amounts of HOA: Poor image quality
Highest discrepancies aberrometric/standard refraction
Questions: Strategies of the HVS to improve visual quality?
Role of SCE? neural response?
Generalization of RE Sensing to account for that?
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Generalized RE sensing
Irregular pupil shape
Inhomogeneous pupil transmission (SCE, etc.)
Probability(RE) =0 outside real pupil
Effective transmission
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-3
-2.5
-2
-1.5
-1
-0.5
0
Analysis of Eye #43Refraction (SE)
Retinoscopy: -0.5D Subjective (Badal): -0.4D
HOA: Coma: 0.125 m Spherical A.: 0.16 m RMS HOA: 0.29 m
= 5.6 mm
Diopters
Parax=-0.4D
Refraction: -0.4 D
RMSw=-1D
-2D ?Stiles-Crawford
effect
Spherical equivalent
-5 -4 -3 -2 -1 0 1 2 3
SE histogram
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Analysis of Eye #74
-10
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
Spherical equivalentRefraction (SE) Retinoscopy: -8.5D Subjective (Badal): -8.25D
HOA: Coma: 0.56 m Spherical A.: 0.37 m RMS HOA: 0.76 m
= 5.4 mm
-12 -11 -10 -9 -8 -7 -6 -5
Diopters
Parax=-5.25D Refraction
RMSw=-7.6D
Secondarymode refraction
?
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Strategies to improve vision?
-10
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
-12 -11 -10 -9 -8 -7 -6 -5
Full pupil
(huge amount of coma)
ABERROMETRY: SPHERE
-10
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
-12 -11 -10 -9 -8 -7 -6 -5
EyelidVignetting
SingleMode !
Refraction
His eyelid blocks the upper part of the pupil
(both eyes)
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Summary & Conclusions The eyes studied often show a complex distribution of RE.~5% show bimodal or multimodal histograms with peak distances > 1D (multifocality.) These eyes show large amounts of HOA (poor image quality) and discrepancies between aberrometric and standard refraction.
Generalized RE sensing seems well suited to analyze these cases, including irregular and/or inhomogeneous pupils.
SCE or even eyelid vignetting may help to avoid bifocality & improve image quality.
Future work- Implementation of complete & automatic histogram analysis
- Selection an deep study of potential multifocal eyes.
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Thanks for your attention