Light scattering model for donor lenses as a function of depth

Gaze-Dependent Simulation of Light Perception in Virtual Reality

The perception of light is inherently different inside a virtual reality (VR) or augmented reality (AR) simulation when compared to the real world. Conventional head-worn displays (HWDs) are not able to display the same high dynamic range of brightness and color as the human eye can perceive in the real world. To mimic the perception of real-world scenes in virtual scenes, it is crucial to reproduce the effects of incident light on the human visual system. In order to advance virtual simulations towards perceptual realism, we present an eye-tracked VR/AR simulation comprising effects for gaze-dependent temporal eye adaption, perceptual glare, visual acuity reduction, and scotopic color vision. Our simulation is based on medical expert knowledge and medical studies of the healthy human eye. We conducted the first user study comparing the perception of light in a real-world low-light scene to a VR simulation. Our results show that the proposed combination of simulated visual effects is well received by users and also indicate that an individual adaptation is necessary, because perception of light is highly subjective.

<p>Objective Quantification of Image Quality and Optical Scatter Before and After Nd:YAG Capsulotomy Using a Double-Pass Technique</p>

Purpose

The purpose of this study is to evaluate and compare the correlation between changes in vision and HD Analyzer dual-pass metrics versus changes in vision and conventional subjective slit lamp gradings in pseudophakic patients with posterior capsular opacity undergoing neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy.

Patients and Methods

High contrast (HC) and low contrast (LC) best spectacle-corrected distance visual acuity (BCVA) and HD Analyzer evaluation were prospectively performed on patients with mild-to-moderate posterior capsular opacification (PCO) and monofocal and accommodating intraocular lens implants. Differences between pre- and post-operative measurements were calculated, along with the correlation of HD Analyzer metrics and slit lamp grading to changes in visual acuity.

Results

Following Nd:YAG capsulotomy (n=29), there was statistically significant improvement in HC-BCVA and LC-BCVA, decrease in optical scatter, and corresponding improvement in Strehl ratio and HD Analyzer values at all contrast levels tested (p≤0.05). Pearson test showed a high correlation between the improvement in HC-BCVA (r coefficient = 0.78) and LC-BCVA (r coefficient = 0.71) to the improvement in Objective Scatter Index (OSI). There was a higher correlation of change in HC-BCVA to pre-op OSI  (r²=0.61) than to the subjective PCO grading score (r² = 0.19). There was also a higher correlation of change in LC-BCVA to pre-op OSI (r² = 0.49) than to subjective grading (r² = 0.16).

Conclusion

The HD Analyzer provides objective measurements of forward light scatter (ie, light directed towards the retina) that can assist with both PCO grading and prediction of improvement of visual quality after YAG laser capsulotomy with higher accuracy than conventional slit lamp assessment based upon backscatter (ie, light traveling to the observer) in patients tested with monofocal and accommodating intraocular lens implants.

South American Values of the Optical Straylight Function

PURPOSE

To access retinal straylight in a Brazilian sample and to compare it with European norms.

METHODS

Absolute Straylight was assessed using C-Quant that uses an adaptive staircase based on a 2-Alternated Forced Choice task. A young (22.2 ± 2.4 yrs, n = 20) and an old group (53.8 ± 7.4 yrs, n = 21) of subjects were tested. All refractive errors were corrected in the C-Quant device, and no subjects had ocular diseases or vision-threatening conditions (e.g., diabetes, unregulated blood pressure, high intraocular pressure, visible cataract). Eighty-five percent of all subjects in each age group had dark-pigmented eyes. Each eye was tested 3 times, yielding 6 straylight values (s). Only data fulfilling C-Quant reliability criteria were included.

RESULTS

There were no statistical differences between the three attempts on each eye (ANOVA, F = 0.993, p > 0.936) and between the two groups (ANOVA, F = 0.893, p > 0.725). Straylight values (s) were fit with an empirical equation to compare to European norms. There were no statistical differences between Brazilian straylight values and European norms for either young or old age groups (ANOVA, F = 5.114, p > 0.993). However, there was a tendency for our s values to be higher than the European norms, consistent with young Brazilian eyes having more light-scattering than age-matched European eyes.

CONCLUSIONS

Consistent with European norms, light-scattering increases with age in the Brazilian sample. This increase is thought to be due, in large part, to age-related changes in lens structure and density. Although the differences between the populations are not significant, the tendency for Brazilian data to have higher s values than European values, especially at young subjects, is in the opposite direction from that expected from a dark-eyed population. This suggests the hypothesis that latitude-dependent (Sao Paulo, latitude 23° S, European latitudes between 40° N to 55° N) differences in the light environment could be associated with differences in s values.

Numerical model of the inhomogeneous scattering by the human lens

We present in this work a numerical model for characterizing the scattering properties of the human lens. After analyzing the scattering properties of two main scattering particles actually described in the literature through FEM (finite element method) simulations, we have modified a Monte Carlo's bulk scattering algorithm for computing ray scattering in non-sequential ray tracing. We have implemented this ray scattering algorithm in a layered model of the human lens in order to calculate the scattering properties of the whole lens. We have tested our algorithm by simulating the classic experiment carried out by Van der Berg et al for measuring "in vitro" the angular distribution of forward scattered light by the human lens. The results show the ability of our model to simulate accurately the scattering properties of the human lens.

Wavelength-dependent scattering in human eye with cataracts

The gradual process in which the crystalline lens is cloudy due to the appearance of elements giving rise to variations in the refractive index is known as cataract. Clinical assessment is usually complicated because it considers patient's perception, and individuals with similar development have different visual deficits. This work presents a model which considers the fluctuations in the refractive index as spherical particles produce measurable scatter radial profiles patterns on the retina. Measurements for 2 different wavelengths simultaneously provide information on particle size and a quantitative assessment by measurement of the fluctuations of the refractive index.

Intraocular light scatter, reflections, fluorescence and absorption: what we see in the slit lamp

PURPOSE

Much knowledge has been collected over the past 20 years about light scattering in the eye- in particular in the eye lens- and its visual effect, called straylight. It is the purpose of this review to discuss how these insights can be applied to understanding the slit lamp image.

RESULTS

The slit lamp image mainly results from back scattering, whereas the effects on vision result mainly from forward scatter. Forward scatter originates from particles of about wavelength size distributed throughout the lens. Most of the slit lamp image originates from small particle scatter (Rayleigh scatter). For a population of middle aged lenses it will be shown that both these scatter components remove around 10% of the light from the direct beam. For slit lamp observation close to the reflection angles, zones of discontinuity (Wasserspalten) at anterior and posterior parts of the lens show up as rough surface reflections. All these light scatter effects increase with age, but the correlations with age, and also between the different components, are weak. For retro-illumination imaging it will be argued that the density or opacity seen in areas of cortical or posterior subcapsular cataract show up because of light scattering, not because of light loss. NOTES: (1) Light scatter must not be confused with aberrations. Light penetrating the eye is divided into two parts: a relatively small part is scattered, and removed from the direct beam. Most of the light is not scattered, but continues as the direct beam. This non-scattered part is the basis for functional imaging, but its quality is under the control of aberrations. Aberrations deflect light mainly over small angles (<1°), whereas light scatter is important because of the straylight effects over large angles (>1°), causing problems like glare and hazy vision. (2) The slit lamp image in older lenses and nuclear cataract is strongly influenced by absorption. However, this effect is greatly exaggerated by the light path lengths concerned. This obviates proper judgement of the functional importance of absorption, and hinders the appreciation of the Rayleigh nature of what is seen in the slit lamp image.

Measuring Forward Light Scatter by the Boston Keratoprosthesis in Various Configurations

PURPOSE

Light scatter results in degradation of visual function. An optical bench model was used to identify the origins of scatter in the setting of a Boston keratoprosthesis (KPro). The effect of various modifications in the device design and light-blocking configurations was explored.

METHODS

A KPro was mounted on a contact lens holder on a bench, and forward light scatter was recorded with a camera attached to a rotating goniometer arm. Scattered light was recorded at different angles for different KPro modifications, and the point-spread function (PSF) curves were recorded. The area under the curve (AUC) was calculated for each PSF curve.

RESULTS

The isolated KPro optical cylinder in a totally blackened holding lens had a tight PSF (AUC = 3.3). Additional blackening of the walls of the KPro stem did not further diminish forward scatter significantly. If the holding lens is made translucent by sandblasting (to simulate an in vivo carrier cornea) and the KPro is inserted without a backplate, forward scatter is substantial (AUC = 11.3). If a standard backplate (with holes) is added, light scatter is considerably reduced regardless of whether the backplate is made of polymethyl methacrylate or titanium (AUC = 5.3 and 4.4, respectively). Addition of an acrylic intraocular lens behind the KPro (the pseudophakic KPro setup) did not increase scatter.

CONCLUSIONS

Most of the scattered light in eyes implanted with a KPro originates from the surrounding hazy corneal graft. The standard addition of a backplate reduces light scatter. There was no difference in forward light scatter between the aphakic and the pseudophakic KPro.

The (lack of) relation between straylight and visual acuity. Two domains of the point-spread-function

PURPOSE

The effect of cataract and other media opacities on functional vision is typically assessed clinically using visual acuity. In both clinical and basic research, straylight (the functional result of light scattering in the eye) is commonly measured. The purpose of the present study was to determine the link between these two measures: is visual acuity in cataract and other media opacities related to straylight?

METHODS

Interdependence between acuity and straylight is addressed from three different points of view: (1) Methodological: can acuity differences affect the measurement value of straylight, and vice versa? (2) Basic optics: does the optical process of light scattering in the human eye affect both straylight and visual acuity? (3) Statistical: how strongly are acuity and straylight correlated in the practice of important clinical conditions? Experimental and theoretical aspects will be considered, with a focus on normal ageing and cataract formation.

RESULTS

(1) Methodological: testing potential effects of acuity, artificially manipulated with positive trial lenses, showed no effect on measured straylight values. Since light scattering in the eye involves a low percentage of the light and has large angular spreading, contrast reduction due to straylight is limited, resulting in virtually absent acuity effects. (2) Basic optics: light scattering from the human donor eye lens is found to have virtually no effect in the centre of the point-spread-function, also for cataractous lenses, resulting in virtually absent acuity effects. (3) Statistical: literature data on straylight and visual acuity show a weak correlation for the important groups of normal ageing and cataract populations.

CONCLUSIONS

The point-spread-function of the normal ageing and cataractous human eye is built upon two rather independent basic parts. Aberrations control the central peak. Light scattering controls the periphery from about 1° onwards. The way acuity and straylight are measured ensures no confounding between them. Statistically within the normal ageing and cataract populations, visual acuity and straylight vary quite independently from each other. Visual acuity losses with cataract and other media opacities are not due to straylight, but caused by aberrations and micro-aberrations. Straylight defines disability glare, and causes symptoms of glare, haloes, hazy vision etc. Overall, visual acuity and straylight are rather independent aspects of quality of vision.

Validation of a spectral light scattering method to differentiate large from small particles in intraocular lenses

A psychophysical approach has been designed to measure straylight from intraocular lenses (IOLs) in vitro. This approach uses a clinical straylight meter (C-Quant) and an observer's eye as optical detector. Based on this, we introduced a method for study of straylight-wavelength dependency for IOLs. This dependency can be used to distinguish between 2 types of scattering particles (small and large) as defined by Mie theory. Validation was performed using a turbidity standard and scattering filters. Several IOLs were analyzed to identify potential scattering sources. Large particles were found to predominate in scattering from the studied lenses. This was confirmed by straylight-angular dependency found in these IOLs.

Ocular straylight in the normal pseudophakic eye

PURPOSE

To assess normal values for straylight in the pseudophakic eye as a function of age and to develop a model to predict the improvement in straylight after lens extraction based on preoperative straylight levels.

SETTING

Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands.

DESIGN

Review with retrospective cross-study analysis.

METHODS

A literature review was performed to identify relevant papers on straylight and pseudophakia with no patient comorbidities. Sixteen papers met the eligibility criteria and were included in the analysis. The postoperative results were used to define the norm for straylight in pseudophakia. Straylight improvement after lens replacement was assessed by evaluation of preoperative and postoperative values. The age effect was incorporated to determine a model for straylight improvement.

RESULTS

The mean postoperative straylight value derived from 16 studies (1869 eyes) was 1.21 log units ± 0.21 (SD). Age dependence could be assessed from 13 studies (1533 eyes), resulting in the straylight age-norm curve in pseudophakic eyes as follows: Straylight value = 0.0044 × age + 0.89 with ± 0.42 log units of 95% confidence interval. A strong correlation was observed between preoperative straylight and its improvement after lens extraction, yielding the following relationship: Straylight improvement = 1.04 × preoperative straylight value - 0.006 × age - 0.84.

CONCLUSION

A norm for straylight in the pseudophakic eye was developed that is considerably different from the previously published norm for the phakic eye. The new pseudophakic norm can be used clinically to predict the straylight value after lens replacement and as a reference criterion for clinical studies.

FINANCIAL DISCLOSURE

The Netherlands Academy of Arts and Sciences owns a patent on straylight measurement, with Dr. van den Berg as the inventor, and licenses that to Oculus Optikgeräte GmbH for the C-Quant instrument. No author has a financial or proprietary interest in any material or method mentioned.

Straylight and Visual Quality on Early Nuclear and Posterior Subcapsular Cataracts

PURPOSE

To measure log(s) and OSI parameters, both related to forward light scattering in the eye, in subjects with different kinds of early cataracts-nuclear or posterior subcapsular-and corrected visual acuity (CVA).

METHODS

34 eyes of 19 patients ranged between 50 and 75 years old with diagnosed nuclear (14 eyes) or posterior subcapsular cataract (20 eyes) were recruited. Only NO1, NO2, P1, and P2 opacity scores according to LOCS III were included. Observer examination included visual acuity, contrast threshold (Ct), and measurements performed by straylightmeter (straylight parameter log(s)) and double-pass instrument (objective scatter index (OSI)).

RESULTS

OSI and log(s) were correlated with LOCSIII in nuclear opacities (p = 0.015 and 0.004, respectively) and in the whole data (p = 0.027 and 0.019, respectively) but did not for posterior subcapsular opacities alone. OSI was strongly correlated with log(s) in nuclear (r = 0.885 and p < 0.001) but not in posterior subcapsular cases (r = 0.382 and p = 0.097). Ct was correlated with log(s) for both cataract types (p = 0.043 for nuclear and p= 0.005 for posterior subcapsular cataract) but not with OSI (p = 0.093 for nuclear and p = 0.064 for posterior subcapsular cataract).

CONCLUSIONS

OSI and log(s) discriminate early stages of nuclear cataracts when taking LOCS III as reference, so these opacities could be graded by any of those parameters. LOCSIII does not represent the visual condition for posterior subcapsular cataract. Straylightmeter measurements express the loss in contrast sensitivity caused by nuclear and posterior subcapsular opacities. Studies of lens opacities must be separated according to the type of opacity present in eyes.

Predicting the Incidence of Human Cataract through Retinal Imaging Technology

With the progress of science, technology and medicine, the proportion of elderly people in society has gradually increased over the years. Thus, the medical care and health issues of this population have drawn increasing attention. In particular, among the common medical problems of the elderly, the occurrence of cataracts has been widely observed. In this study, we developed retinal imaging technology by establishing a human eye module with ray tracing. Periodic hole arrays with different degrees were constructed on the anterior surface of the lens to emulate the eyesight decline caused by cataracts. Then, we successfully predicted the incidence of cataracts among people with myopia ranging from -3.0 D to -9.0 D. Results show that periodic hole arrays cause severe eyesight decline when they are centralized in the visual center. However, the wide distribution of these arrays on the anterior surface of the lens would not significantly affect one's eyesight.

Lens opacity based modelling of the age-related straylight increase

This work studies ethnic and geographical differences in the age-related straylight increase by means of a stochastic model and unpublished lens opacity data of 559 residents of Villa Maria (Argentina), as well as data of 912 Indonesian subjects published previously by Husain et al. For both cohorts the prevalence of each type and grade of lens opacity was determined as a function of age, from which a stochastic model was derived capable of simulating the lens opacity prevalence for both populations. These simulated lens opacity data were then converted to estimated straylight by means of an equation derived from previously recorded data of 107 eyes with varying degrees of cataract. Based on these opacity templates 2500 random sets of subject age and lens opacity data were generated by the stochastic model for each dataset, from which estimated straylight could be calculated. For the Argentinian data the estimated straylight was found to closely resemble the published models for age-related straylight increase. For younger eyes the straylight variation of the model was the same as what was previously published (in both cases ±0.200logunits), which doubled in size for older eyes. For the Indonesian data, however, this age-related straylight increase was found to be fundamentally different from the published age model. This suggests that current normative curves for age-related straylight increase may not always be appropriate for non-European populations, and that the inter-individual straylight variations in young, healthy eyes may possibly be due to variations in lens opacities.

Optical properties of the lens: an explanation for the zones of discontinuity

The structural basis of zones of discontinuity in the living human eye lens has not been elucidated, and there is no conclusive explanation for what relevance they may have to the structure and function of the lens. Newly developed synchrotron radiation based X-ray Talbot interferometry has enabled the detection of subtle fluctuations in the human eye lens which, when used in mathematical modelling to simulate reflected and scattered light, can recreate the image of the lens seen in the living human eye. The results of this study show that the zones of discontinuity may be caused by subtle fluctuations in the refractive index gradient as well as from random scattering in the central regions. As the refractive index contours are created by cell layers with progressively varying protein concentrations, the zones are linked to growth and will contain information about ageing and development. The index gradient is important for image quality and fluctuations in this gradient may add to quality optimisation and serve as models for designs of new generation implant lenses.

Comparison of the Retinal Straylight in Pseudophakic Eyes with PMMA, Hydrophobic Acrylic, and Hydrophilic Acrylic Spherical Intraocular Lens

Purpose. To investigate the intraocular straylight value after cataract surgery. Methods. In this study, 76 eyes from 62 patients were subdivided into three groups. A hydrophobic acrylic, a hydrophilic acrylic, and a PMMA IOL were respectively, implanted in 24 eyes, 28 eyes, and 24 eyes. Straylight was measured using C-Quant at 1 week and 1 month postoperatively in natural and dilated pupils. Results. The hydrophilic acrylic IOLs showed significantly lower straylight values than those of the hydrophobic acrylic IOLs in dilated pupils at 1 week and 1 month after surgery (P < 0.05). However, the straylight values of the hydrophilic acrylic IOLs were the lowest among the three IOL groups. No significant difference was observed in straylight between 1 week and 1 month postoperatively in each group with natural and dilated pupils (P > 0.05). Moreover, no significant difference was found in straylight between natural and dilated pupils in each group at 1 week and 1 month postoperatively (P > 0.05). Conclusions. Although the hydrophobic acrylic IOL induced more intraocular straylight, straylight differences among the 3 IOLs were minimal. Pupil size showed no effect on intraocular straylight; the intraocular straylight was stable 1 week after surgery.

Computational model of the effect of light scattering from cataracts in the human eye

A model of the human eye has been developed, including scattering from cataracts inside the nucleus of the lens. The cataracts are modeled as spherical particles with refractive index different from that of the surrounding lens medium. Scattering from the retina is also included in the simulations. Variations of scattering particle diameter, number of particles, and wavelength of the illuminating light are investigated. It is shown that particle size is the most important parameter affecting the scattered light, and that the scattering from the retina can mask the effect of the scattering particles, for some range of the parameters.

Changes in Forward and Backward Light Scatter in Keratoconus Resulting From Corneal Cross-Linking

PURPOSE

To study the forward and backward light scatter in keratoconic corneas before and after cross-linking.

DESIGN

An institutional, prospective, cross-sectional study was conducted.

METHODS

This study includes 35 eyes of 25 patients with keratoconus scheduled for either standard corneal collagen cross-linking with riboflavin (CXL) or transepithelial corneal cross-linking (TE-CXL). A group of 26 healthy myopic eyes from 26 prerefractive patients was included as normal reference. Before and 6 months after cross-linking, forward light scatter was measured using the compensation comparison method, whereas backward light scatter was measured using Scheimpflug imaging.

RESULTS

In keratoconic eyes, backward light scatter originating from the corneal stroma was [mean (SD)] 27.2% (8.2%) higher than in the normal eyes (P < 0.001). In the anterior stroma, this increased backscatter was significantly correlated with the maximum corneal curvature Kmax as a measure of keratoconus severity (Pearson ρ = 0.582, P = 0.003). For forward light scatter, no significant difference was seen between the normal and keratoconus groups, nor was there any correlation with keratoconus severity. After CXL, the backscatter increased significantly by [mean (SD)] 33.0% (9.5%) in the entire corneal stroma (P = 0.001), whereas for TE-CXL, no significant increase was seen. Forward scatter increased significantly by [mean (SD)] 0.10 (0.10) log units (P = 0.009) and 0.09 (0.10) log units (P = 0.003) for CXL and TE-CXL, respectively, which is near the detection limit for an average patient.

CONCLUSIONS

Unlike TE-CXL, CXL increases the already-elevated stromal backscatter in keratoconus. Forward scatter increases equally for both techniques.

History of ocular straylight measurement: A review

The earliest studies on 'disability glare' date from the early 20(th) century. The condition was defined as the negative effect on visual function of a bright light located at some distance in the visual field. It was found that for larger angles (>1 degree) the functional effect corresponded precisely to the effect of a light with a luminosity equal to that of the light that is perceived spreading around such a bright source. This perceived spreading of light was called straylight and by international standard disability glare was defined as identical to straylight. The phenomenon was recognized in the ophthalmological community as an important aspect of the quality of vision and attempts were made to design instruments to measure it. This must not be confused with instruments that assess light spreading over small distances (<1 degree), as originating from (higher order) aberrations and defocus. In recent years a new instrument has gained acceptance (C-Quant) for objective and controllable assessment of straylight in the clinical setting. This overview provides a sketch of the historical development of straylight measurement, as well as the results of studies on the origins of straylight (or disability glare) in the normal eye, and on findings on cataract (surgery) and corneal conditions.

Backscattered light from the cornea before and after laser-assisted subepithelial keratectomy for myopia

PURPOSE

To study corneal backscatter changes after laser-assisted subepithelial keratectomy (LASEK) and to search for correlations between the changes in forward and backward corneal light scatter.

SETTING

Antwerp University Hospital, Edegem, Belgium.

DESIGN

Prospective interventional case series.

METHOD

Corneal backscatter was determined with a commercial Scheimpflug device and purpose-written image-analysis software. The mean backscatter profile and gray value distributions of the images for a 1.0 mm zone around the corneal apex were obtained preoperatively and 6 months after LASEK for myopia. This was compared with forward light scatter (or straylight) using measurements obtained with the compensation comparison method.

RESULTS

The study enrolled 80 eyes (40 patients; mean age 34.2 years ± 10.4 [SD]). Very strong correlations were found between the backscatter profiles of right eyes and left eyes preoperatively. Hence, only right eyes were used for further calculations. The epithelial-Bowman peak of the backscatter profile decreased significantly after LASEK (mean decrease -2.2 ± 4.7 grayscale units) (P=.002, paired t test), which corresponded to the ablation of Bowman layer. Significant changes in the gray-value distribution were observed postoperatively, corresponding to the decreases in the epithelium-Bowman peak. Forward light scatter decreased significantly after LASEK (mean decrease -0.10 ± 0.13) (P<.001); however, no significant correlation with corneal backscatter was observed.

CONCLUSIONS

The anterior part of the corneal backscatter profile decreased significantly after LASEK. A significant reduction in forward light scatter was also seen, although it was not correlated to backward light scatter.

Posterior capsule opacification assessment and factors that influence visual quality after posterior capsulotomy

PURPOSE

To study the correlation between posterior capsule opacification (PCO) and intraocular straylight and visual acuity.

DESIGN

Prospective noninterventional study.

METHODS

We measured visual acuity (VA), logarithm of minimal angle of resolution (logMAR) and intraocular straylight (C-Quant straylight parameter log[s]) under photopic conditions before and 2 weeks after YAG capsulotomy in 41 patients (53 eyes) from the Centro de Oftalmología Barraquer in Barcelona and the University Eye Clinic, Paracelsus Medical University in Salzburg. Photopic pupil diameter was also measured. To document the level of opacification, pupils were dilated and photographs were taken with a slit lamp, using retroillumination and the reflected light of a wide slit beam at an angle of 45 degrees. PCO was subjectively graded on a scale of 0 to 10 and using the POCOman system. A multiple regression analysis was performed to evaluate factors that influence straylight after capsulotomy.

RESULTS

Straylight correlated well with retroillumination and reflected-light PCO scores, whereas VA only correlated with retroillumination. Both VA and straylight improved after capsulotomy. Straylight values varied widely after capsulotomy. Multiple regression analysis showed that older age, large ocular axial length, hydrophobic acrylic intraocular lenses (IOLs), and small capsulotomies are factors that increased intraocular straylight.

CONCLUSION

Intraocular straylight is a useful tool in the assessment of PCO. It correlates well with PCO severity scoring methods. When performing a posterior capsulotomy, factors such as age, IOL material, axial length, and capsulotomy size must be taken into consideration, as they influence intraocular straylight.

Morphology of age-related cuneiform cortical cataracts: the case for mechanical stress

We evaluated the gross morphology, location, and fiber cell architecture of equatorial cortical opacities in the aging human lens. Using dark-field stereomicroscopy, we photographed donor lenses in toto and as thick slices. In addition, we investigated the details of the fiber cell architecture using fluorescent staining for membranes and by scanning electron microscopy. We then combined our data with data from recent studies on lens viscoelasticity. We found that small cortical and cuneiform opacities are accompanied by changes in fiber structure and architecture mainly in the equatorial border zone between the lens nucleus and cortex. Because the lens cortex and nucleus have different viscoelastic properties in young and old lenses, we hypothesize that external forces during accommodation cause shear stress predominantly in this border zone. The location of the described changes suggests that these mechanical forces may cause fiber disorganization, small cortical opacities, and ultimately, cuneiform cataracts.

Straylight effects with aging and lens extraction

PURPOSE

To assess possible gains and losses in straylight values among the population to consider straylight as added benefit of lens extraction.

DESIGN

In this cross-sectional design, data from a multicenter study on visual function in automobile drivers were analyzed.

METHODS

On both eyes of 2,422 subjects, visual acuity (logarithm of the minimum angle of resolution [logMAR] in steps of 0.02 log units), straylight on the retina (psychophysical compensation comparison method), and lens opacity (slit-lamp scoring using the Lens Opacities Classification System III [LOCS III] system) were determined. Three groups were defined: 220 pseudophakic eyes, 3,182 noncataractous eyes (average LOCS III score, <1.5), and 134 cataractous eyes (average LOCS III score, >3.0).

RESULTS

Noncataractous straylight values increases strongly with age as: log(s) = constant + log(1 + (age / 65)(4)), doubling by the age of 65 years, and tripling by the age of 77 years. Population standard deviation around this age norm was approximately 0.10 log units. The cataract eyes (in this active driver group) had relatively mild straylight increase. In pseudophakia, straylight values may be very good, better even than in the noncataract group. Visual acuity and straylight were found to vary quite independently.

CONCLUSIONS

Lens extraction holds promise not only to improve on the condition of the cataract eye, but also to improve on the age-normal eye. Lens extraction potentially reverses the strong age increase in straylight value, quite independently from visual acuity.

Double-pass versus aberrometric modulation transfer function in green light

Intraocular scattering can become an important source of optical degradation in the aging eye. To evaluate its relative contribution to the ocular modulation transfer function (MTF), a compact, dual experimental system comprising a laser ray tracing (LRT) wavefront sensor and a double-pass setup is used. An aberrometric MTF is estimated from aberration measurements, whereas a second MTF is derived from the double-pass point-spread function. While the former only accounts for the effect of aberrations (up to seventh order), the double-pass MTF includes the combined effect of both scattering and aberrations. A 532-nm laser light source is used to minimize choroidal scattering. Measurements are done on 19 normal, healthy eyes from three groups of subjects of different ages. The two MTFs are obtained for a 6-mm pupil diameter and partial refractive compensation. Intraocular scattering is modeled as a random wavefront aberration characterized by its variance and correlation length. These parameters are fitted from the differences between both MTFs. Our results show that double-pass and LRT techniques provide similar MTFs for most normal eyes, although small amounts of scattering, or high-order aberrations, could be measured in some eyes. A gradual increase in intraocular scattering with age is also observed.

Intensity analysis of Hartmann-Shack images in cataractous, keratoconic, and normal eyes to investigate light scattering

PURPOSE

A clinical investigation of novel methods for evaluating light scattering using a Hartmann-Shack aberrometer.

METHODS

Aberrometry was performed on normal eyes (n=7; patient age, 26.7+/-2.5 years, mean+/-SD), eyes with keratoconus (n=22; patient age, 26.1+/-8.1 years), and eyes with cataract (n=17; patient age, 56.5+/-16.9 years) using a Hartmann-Shack wavefront aberrometer. We introduced two methods: (1) a contrast method, in which we calculated the inverse of contrast of the local images around 12 spots in a Hartmann-Shack image, and (2) a difference of point spread function (PSF) method, in which we analyzed the difference between the width of the PSF computed with aberration information and the width of the measured PSF, which contains both aberration and light scattering information.

RESULTS

The inverse contrast in cataractous eyes (5.04+/-3.06 inverse contrast units) was significantly larger than that in normal eyes (1.57+/-0.56) or keratoconic eyes (1.83+/-0.79). The difference of PSF in cataractous eyes (81.8+/-65.2 microm) was also significantly larger than that in normal eyes (9.3+/-4.3 microm) or keratoconic eyes (30.0+/-20.1 microm). The inverse contrast and the difference in the PSF were highly correlated (r=0.89, P<0.0001).

CONCLUSIONS

The two methods introduced here successfully distinguished cataractous eyes from normal and keratoconic eyes. After the results were analyzed by a discriminant analysis, the separation of the three categories proved to be excellent.

Wavelength dependence of intraocular straylight

Wavelength dependence of retinal straylight has been a mystery since Stiles in 1929 [Stiles,W.S., 1929. The scattering theory of the effect of glare on the brightness difference threshold. Proc. R. Soc. Lond. (Biol.) 105, 131-41.] supposed it to have the strong Rayleigh type lambda(-4) dependence, typical for small particle light scattering, but which was never found. Using the accurate 'compensation comparison' approach, retinal straylight was measured from 625 to 457 nm. Subjects with a large variety of ocular pigmentation were included. Straylight was found to depend strongly on pigmentation of the eye, in addition to age. Young and well-pigmented eyes (young negroids) show nearly perfect lambda(-4) dependence. With less pigmentation (blue-eyed Caucasians), a red dominated component is added, negating the lambda(-4) dependence.

Distribution, spherical structure and predicted Mie scattering of multilamellar bodies in human age-related nuclear cataracts

PURPOSE

To characterize multilamellar bodies (MLBs), determine their distribution along the optic axis and predict their potential Mie scattering within human age-related nuclear cataracts. Previous studies restricted to the equatorial plane have shown that MLBs are rare spherical objects that are 1-4 microm in diameter and covered by multiple layers of thin lipid-rich membranes.

METHODS

Eight human aged transparent lenses were obtained from eye bank donors and eight human age-related nuclear cataracts were obtained immediately after extracapsular extraction. Each sample was Vibratome sectioned fresh into 200 microm thick sections that were fixed and embedded for light or electron microscopy. Light micrograph montages of the optic axis containing the juvenile, fetal and embryonic nuclei were examined. Mie scattering for random coated spherical particles was calculated based on assumed and measured particle parameters.

RESULTS

Cells along the optic axis of the cataract contained approximately 7.5 times more MLBs as similar regions of the aged transparent lens, although these MLBs occurred with extremely low frequency. Cells of the aged transparent lens contained 1.3 MLBs mm(-2), while those of the cataract contained 9.6 MLBs mm(-2), which are equivalent to calculated densities of 5.6 x 10(2) and 4.1 x 10(3)mm(-3), respectively. While some MLBs were located within the cytoplasm near cell membranes, others were found away from membranes. The MLBs are distinct from circular profiles resulting from finger-like projections between adjacent cells. MLBs displayed varying geometries and cytoplasmic textures, although predominately spherical with interiors similar to adjacent fiber cell cytoplasm. These results are in agreement with previous theoretical analysis of light scattering from human lenses and with previous morphological studies examining the equatorial plane of the lens. Potential Mie scattering of spherical particles with the average properties of the observed MLBs and assumed refractive index properties was calculated to be forward scattering of as much as 20% of the incident light.

CONCLUSIONS

The observed low frequency and absence of clustering of MLBs in the equatorial plane and along the optic axis suggests that MLBs are most likely uniformly distributed throughout the embryonic, fetal and juvenile nuclei of age-related cataracts. Because of their size, distribution, textured cytoplasm and calculated Mie scattering, MLBs probably cause local fluctuations in refractive index in human lens nuclei and, therefore, are potential sources of low-angle, forward light scattering that could impair image formation.

Changes in the internal structure of the human crystalline lens with age and accommodation

Scheimpflug images were made of the unaccommodated and accommodated right eye of 102 subjects ranging in age between 16 and 65 years. In contrast with earlier Scheimpflug studies, the images were corrected for distortion due to the geometry of the Scheimpflug camera and the refraction of the cornea and the lens itself. The different nuclear and cortical layers of the human crystalline lens were determined using densitometry and it was investigated how the thickness of these layers change with age and accommodation. The results show that, with age, the increase in thickness of the cortex is approximately 7 times greater than that of the nucleus. The increase in thickness of the anterior cortex was found to be 1.5 times greater than that of the posterior cortex. It was also found that specific parts of the cortex, known as C1 and C3, showed no significant change in thickness with age, and that the thickening of the cortex is entirely due to the increase in thickness of the C2 zone. With age, the distance between the sulcus (centre of the nucleus) and the cornea does not change. With accommodation, the nucleus becomes thicker, but the thickness of the cortex remains constant.

Changes in the refractive index of lens fibre membranes during maturation--impact on lens transparency

PURPOSE

Local variations in refractive index are the physical cause of light scattering in a material or tissue and also induce phase changes of propagating light waves. The goal of this study was to analyse local differences in refractive index by phase contrast microscopy of sections of human lenses.

METHODS

Refractive index was estimated by immersion refractometry. Cryo-sections of quick-frozen human donor lenses were embedded in a graded series of bovine serum albumin solutions, and in immersion oil, ranging in refractive index from 1.34 to 1.52.

RESULTS

Fibre membranes in the lens cortex prove to have a refractive index considerably above that of fibre cytoplasm at the same location. Fibre membranes in the lens nucleus have a refractive index approximately the same as that of fibre cytoplasm at the same location.

CONCLUSION

In the lens cortex, transparency is obtained by a high spatial order of the lens fibre lattice to compensate for the light scattering caused by differences in refractive index between fibre membranes and cytoplasm. In the lens nucleus, high spatial order is less important, because the minor differences in the refractive index between fibre membranes and fibre cytoplasm lead only to minimal scattering.

Fourier analysis of cytoplasmic texture in nuclear fiber cells from transparent and cataractous human and animal lenses

Comparisons were made of the cytoplasmic textures in electron microscope images of nuclear fiber cells from a variety of human and animal lenses. The goals were to establish the optimal conditions for quantifying the textural features and for relating the extent of roughness with the observed extent of nuclear opacification. Freshly cut Vibratome sections were fixed and processed for thin-section electron microscopy. Normal human donor lenses, human age-related cataracts from surgery, and rat, guinea pig, and canine lenses were analyzed using density linescans, Fourier transforms, and autocorrelation analysis. Normal and control lenses were compared to lenses with varying degrees of scattering including fully opaque nuclear cataract. Images were recorded at 21,000 x, giving structural information in the critical range of 2-300 nm. Human normal and nuclear cataractous lens cytoplasm produce Fourier transforms with relatively high intensity in the range 10-50 nm (equivalent spacing) and relatively low intensity greater than 100 nm. This is consistent with the smooth image appearance, linescans with small fluctuations and autocorrelation functions indicating that the images are nearly homogeneous. Images of the transparent animal lenses were very smooth and produced Fourier transforms that showed less intensity in the range 10-50 nm and less intensity greater than 100 nm compared to the human lenses. Animal lenses with progressively enhanced light scattering showed a strong correlation between increased textural roughness and increased Fourier intensity greater than 100 nm. These analytical image analysis techniques readily documented the wide range of cytoplasmic textural variations in human and animal lenses and cataracts. Consistent comparisons were possible only when well-preserved tissues were examined with high-resolution images. The cytoplasm with the greatest roughness correlated with the greatest light scattering suggests that redistribution and/or loss of cytoplasmic proteins contribute to cataract formation.