Contrast sensitivity with soft contact lenses compensated for spherical aberration in high ametropia

CLEAR - Medical use of contact lenses

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.

Assessment of aberrations and visual quality differences between myopic and astigmatic eyes before and after contact lens application

OBJECTIVE:

To evaluate the aberration and visual quality differences between myopic and astigmatic eyes before and after contact lens application by using corneal aberrometer and low- contrast sensitivity chart.

METHODS:

Eighty eyes of 40 patients were included in this study. Patients were divided into two groups as myopic (40 eyes, n=20) and astigmatic groups (40 eyes, n=20). We used aspheric Balafilcon A (Purevision and Purevision Toric Bausch&Lomb, Rochester, USA) lenses for each group. Corneal aberrations and low-contrast sensitivity values were measured and compared for each patient in both groups.

RESULTS:

There were no statistically significant differences between myopic and astigmatic groups when we compared low-contrast sensitivity values for both on- and off-eyes. Mean total higher-order aberration (HOA) values for off-eye, were 0.29±0.10 μm, and 0.33±0.10 μm for on-eye in the myopic group, while they were 0.42±0.14 μm in off-eye and 0.37±0.23 μm in on-eye in the astigmatic group. Off-eye mean coma, irregular astigmatism and total higher-order aberration RMS (root-mean-square) values were significantly higher in the astigmatic group compared to the myopic group (p=0.006, p=0.001, p=0.001) but mean on-eye RMS values were not.

CONCLUSION:

Myopic and astigmatic patients differ in terms of high-order aberrations and these differences cannot be equalized after contact lens application, but visual quality can be improved in both patients by using contact lenses.

Influence of spherical aberration, stimulus spatial frequency, and pupil apodisation on subjective refractions

PURPOSE

To test competing hypotheses (Stiles Crawford pupil apodising or superior imaging of high spatial frequencies by the central pupil) for the pupil size independence of subjective refractions in the presence of primary spherical aberration.

METHODS

Subjective refractions were obtained with a variety of test stimuli (high contrast letters, urban cityscape, high and low spatial frequency gratings) while modulating pupil diameter, levels of primary spherical aberration and pupil apodisation. Subjective refractions were also obtained with low-pass and high-pass stimuli and using 'darker' and 'sharper' subjective criteria.

RESULTS

Subjective refractions for stimuli containing high spatial frequencies focus a near paraxial region of the pupil and are affected only slightly by level of Seidel spherical aberration, degree of pupil apodisation and pupil diameter, and generally focused a radius of about 1-1.5 mm from the pupil centre. Low spatial frequency refractions focus a marginal region of the pupil, and are significantly affected by level of spherical aberration, amount of pupil apodisation, and pupil size. Clinical refractions that employ the 'darker' or 'sharper' subjective criteria bias the patient to use lower or higher spatial frequencies, respectively.

CONCLUSIONS

In the presence of significant levels of spherical aberration, the pupil size independence of subjective refractions occurs with or without Stiles Crawford apodisation for refractions that optimise high spatial frequency content in the image. If low spatial frequencies are optimised by a subjective refraction, spherical refractive error varies with spherical aberration, pupil size, and level of apodisation. As light levels drop from photopic to scotopic, therefore, we expect a shift from pupil size independent to pupil size dependent subjective refractions. Emphasising a 'sharper' criterion during subjective refractions will improve image quality for high spatial frequencies and generate pupil size independent refractions.

Diurnal variations in visual performance for disposable contact lenses

PURPOSE

The purpose of this study is to compare the visual performance provided by different daily disposable contact lenses and to analyze its variation over time.

METHODS

Visual performance was evaluated in terms of visual acuity (VA) and contrast sensitivity (CS) in 15 myopic subjects (-0.50 to -4.00 diopters) who had been previously fitted with each one of the following seven types of soft contact lenses: DAILIES TOTAL1 (Alcon, Forth Worth, TX), DAILIES AquaComfort Plus (Alcon), 1-DAY ACUVUE TruEye (Johnson & Johnson Vision Care, Jacksonville, FL), 1-DAY ACUVUE MOIST (Johnson & Johnson Vision Care), SofLens daily disposable (Bausch & Lomb, Rochester, NY), Proclear 1 Day (CooperVision, Fairport, NY), and Clariti 1-Day (Sauflon, Twickenham, United Kingdom). We measured VA at three contrast levels (10%, 50%, and 100%) and CS for three spatial frequencies (10, 20, and 25 cycles/degree). These measurements were performed at 2-hr intervals during a 12-hr period of continuous wearing. Measurements were also performed with ophthalmic lenses before contact lens fitting.

RESULTS

Two-way analysis of variance (ANOVA) results revealed significant differences across the lens types and over time for low-contrast VA only. For high- and medium-contrast VA, ophthalmic lens performed better than the contact lenses after 12 hr of use (without statistical differences among the contact lenses). Contrast sensitivity values also showed differences across lenses for the three spatial frequencies under analysis. For each particular lens type, no CS variations were observed with wearing time. Although some of the differences were not statistically significant, we found that, for many of the VA and CS measures, ophthalmic lens and DAILIES TOTAL1 yielded better values than the 1-DAY ACUVUE TruEye and Clariti 1-Day.

CONCLUSIONS

Assessing VA at different contrasts and CS measurements allowed us to perform a visual function evaluation. Contact lens characteristics such as material and water content, among others, may be the cause of the differences in visual performance that emerged from this study. Our findings provide useful information for contact lens practitioners.

A Comparison of Wavefront Aberrations in Eyes Wearing Different Types of Soft Contact Lenses

PURPOSE

The purpose of this study is to investigate the optical quality of eyes wearing different types of soft contact lenses (sCLs) using wavefront aberrometry.

METHOD

A psychophysical aberrometer (WFA1000B; BriteEye, SuZhou, China) was used to measure wavefront aberrations for 56 eyes of 28 subjects under four conditions: 1) without contact lenses (non-CL), 2) with lathe-cut contact lenses (lathe-cut CL; Shuliang, Weicon Optics, Shanghai, China), 3) with cast-molded contact lenses (cast-molded CL; Vistavue, J&J Vision Care, U.S.), and 4) with spun-cast contact lenses (spun-cast CL; Lanfenzhiji, Justcome Optics, Beijing, China). The three types of sCLs were made from different materials and lens design. The root mean square (RMS) values of the wavefront aberrations and individual Zernike aberrations were calculated and compared among the CL-wearing conditions.

RESULTS

Astigmatism was not significantly changed by any of the three soft contact lenses when compared with the non-CL condition. However, a significant difference in the RMS values of higher-order aberrations was observed between the lens types (F=8.29, p<0.0001). Induced higher-order aberrations were found for both the cast-molded CL and the spun-cast CL conditions. There were significant differences in the aberrations in each of the higher orders between the CL conditions (F=3.77, p=0.011 for third order; F=5.31, p=0.002 for fourth order; F=13.86, p<0.0001 for fifth and higher orders). More higher-order Zernike aberrations such as coma and spherical aberration were induced by cast-molded CLs and/or the spun-cast CLs.

CONCLUSION

Wavefront aberrations in the eyes with soft contact lenses vary from one individual lens type to another. Although the variation in wavefront aberrations could be attributed to the differences in the methods of manufacture, influences from other factors such as the lens material and lens design could not be excluded and deserve further investigation.

Corneal Asphericity and Visual Function After Wavefront-Guided LASIK

PURPOSE

In recent years, a theory has been advanced that corneal asphericity in and of itself determines visual function; that the natural, optimal shape of the cornea is prolate; and that changing the cornea from prolate to oblate negatively impacts visual results. This article presents an analysis of the impact of corneal asphericity on wavefront-guided LASIK.

METHOD

A retrospective analysis was conducted of 160 myopic eyes that had undergone wavefront-guided LASIK. Surgical procedures and data collection were conducted at six clinical sites. Corneal topography, visual acuity, and contrast sensitivity data were collected before and 6 months after surgery. The topographically measured corneal surface of each eye was fitted to a conic, and a Q-value was computed for a 5.5-mm pupil. Multivariate regression analysis was performed to evaluate the correlation between Q-value and visual function. The relationship of changes in the corneal surfaces to visual performance was also investigated.

RESULTS

Preoperative corneas exhibited negative (prolate) conic shape constants. Postoperative corneas were about equally divided between positive (oblate) and negative conics. There was no statistically significant correlation between corneal shape and visual acuity or contrast sensitivity function. Changes in corneal asphericity after surgery had no significant correlation with changes in visual acuity or contrast sensitivity.

CONCLUSION

Visual acuity and contrast sensitivity after wavefront-guided LASIK are not dependent on corneal asphericity. Neither preserving nor inducing asphericity ensures better visual outcome. Better visual outcomes are more likely to result from the application of a customized shape than a standard conic shape.

Inefficacy of Aspheric Soft Contact Lenses for the Correction of Low Levels of Astigmatism

PURPOSE

The purpose of this article is to compare the visual performance of a toric soft (TS) contact lens (SofLens 66 Toric; Bausch & Lomb, Rochester, NY), an aspheric soft (AS) contact lens (Frequency Aspheric; CooperVision, Fairport, NY) and a spectacle correction (SC) in subjects with low levels of astigmatism.

METHODS

One eye of 30 subjects with refractive astigmatism of -0.75 DC or -1.00 DC was tested. After pupil dilation, each subject was fitted with all three forms of correction in random order. Subjects were masked from the contact lens type. High-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA) were recorded for each correction using 2-mm, 4-mm, and 6-mm artificial pupils.

RESULTS

With a 2-mm pupil, HCVA was similar for the TS lens and the SC (p = 0.13); better HCVA was demonstrated with the TS lens than with the AS lens (p = 0.001). With 4-mm and 6-mm pupils, HCVA was poorer with the AS lens than with the SC (p < 0.002) and TS lenses (p < 0.0001). The difference in HCVA between the TS and AS lenses was two letters, three letters, and one line with pupil sizes of 2 mm, 4 mm, and 6 mm, respectively. LCVA was similar for the three refractive conditions with the 2-mm pupil size. With 4-mm and 6-mm pupils, LCVA was similar for the TS lens and SC, but better than the AS lens by approximately one line in each case (all p < 0.0001).

CONCLUSIONS

For small pupil sizes, there is little difference in HCVA and LCVA between various refractive corrections. However, for larger pupils, HCVA and LCVA are superior with TS contact lenses and SC versus AS contact lenses by approximately a half-line or more, which is considered to be clinically significant. Superior vision can be achieved for low astigmatic contact lens wearers using TS rather than AS contact lenses.

Correcting ocular spherical aberration with soft contact lenses

Following aberroscopy, aspheric front surface soft contact lenses (SCLs) were custom-made to correct spherical refractive error and ocular spherical aberration (SA) of 18 myopic and five hypermetropic subjects (age, 20.5 +/- 5 yr). On-eye residual aberrations, logMAR visual acuity, and contrast sensitivity were compared with the best-correcting spectacle lens, an equally powered standard SCL, and an SCL designed to be aberration free in air. Custom-made and spherical SCLs reduced SA (p < 0.001; p < 0.05) but did not change total root-mean-square (rms) wave-front aberration (WFA). Aberration-free SCLs increased SA (p < 0.05), coma (p < 0.05), and total rms WFA. Visual acuity remained unchanged with any of the SCL types compared with the spectacle lens correction. Contrast sensitivity at 6 cycles/degree improved with the custom-made SCLs (p < 0.05). Increased coma with aspheric lens designs and uncorrected astigmatism limit the small possible visual benefit from correcting ocular SA with SCLs.

Simulated optical performance of custom wavefront soft contact lenses for keratoconus

PURPOSE

Outstanding improvements in vision can theoretically be expected using contact lenses that correct monochromatic aberrations of the eye. Imperfections in such correction inherent to contact lenses are lens flexure, translation, rotation, and tear layer effects. The effects of pupil size and accommodation on ocular aberration may cause further difficulties. The purpose of this study was to evaluate whether nonaxisymmetric soft contact lenses could efficiently compensate for higher-order aberrations induced by keratoconus and to what extent rotation and translation of the lens would degrade this perfect correction.

METHODS

Height topography data of nine moderate to severe keratoconus corneas were obtained using the Maastricht Shape Topographer. Three-dimensional ray tracing was applied to each elevation topography to calculate aberrations in the form of a phase error mapping. The effect of a nonaxisymmetric soft contact lens tailored to the corneal aberrations was simulated by adding an opposite phase error mapping that would theoretically compensate all corneal-induced optical aberrations of the keratoconus eyes. Translation (0.25, 0.5, 0.75, and 1.0 mm) and rotation (2.5 degrees, 5.0 degrees, 7.5 degrees, and 10 degrees ) mismatches were introduced. The modulation transfer function (MTF) of each eye with each displaced correction and with various pupil sizes (3, 5, and 7 mm) was deduced from the residual phase error mapping. A single performance criterion (mtfA) was calculated as the area under the MTF over a limited spatial frequency range (5 to 15 periods per degree). Finally, the ratio (RmtfA) of corrected mtfA over uncorrected mtfA provided an estimate of the global enhancement in contrast sensitivity with the customized lens.

RESULTS

The contrast improvement ratios RmtfA with perfectly located lenses were for an average pupil size of 4.5 mm between 6.5 and 200. For small translation errors (0.25 mm), RmtfA ranged between 2 and 7. The largest lens translation tested (1 mm) often resulted in poorer performance than without correction (RmtfA <1). More than threefold improvements were achieved with any of the angular errors experimented. RmtfA values showed significant variations for pupil diameters between 3 and 7 mm.

CONCLUSIONS

Three-dimensional aberration-customized soft contact lenses may drastically improve visual performance in patients with keratoconus. However, such lenses should be well positioned on the cornea. In particular, translation errors should not exceed 0.5 mm. Angular errors appeared to be less critical. It is further questioned whether the visual system is able to adapt to variations in optical performance of the correction in situ due to lens positioning and pupil size.

The prospects for super-acuity: limits to visual performance after correction of monochromatic ocular aberration

It has recently been suggested that correction of the monochromatic aberration of the eye could lead to substantial improvements in visual acuity and contrast sensitivity function. After consideration of the best-corrected visual acuity of normal eyes, the optical and neural limits to visual performance are reviewed. It is concluded that, even if current problems with the accuracy of the suggested techniques of aberration correction, through corneal excimer laser ablation or customised contact lenses, can be overcome, changes in monochromatic ocular aberration over time, the continuing presence of chromatic aberration, errors of focus associated with lags and leads in accommodation, and other factors, are likely to result in only minor improvements in the high-contrast acuity performance of most normal eyes being produced by attempted aberration control. Significant gains in contrast sensitivity might, however, be achievable, particularly under mesopic and scotopic conditions when the pupil is large, provided that correct focus can be maintained. In the immediate future, reduction of the high levels of aberration that are currently found in eyes that have undergone refractive surgery and in some abnormal eyes should bring useful benefits.

High- and low-contrast visual acuity measurements in spherical and aspheric soft contact lens wearers

Visual reduction produced by spherical aberration is not always apparent with high-contrast optotypes, therefore, a measure of low-contrast visual acuity (LCVA) may be more revealing. In theory, by applying a series of curves to produce an aspheric surface, one should be able to reduce the defocus resulting from spherical aberration. This clinical investigation sought to evaluate high- and low-contrast visual acuity under natural conditions using the CooperVision Frequency 55 spherical and aspheric planned replacement soft contact lenses (CLs). The objective outcome showed no statistically significant difference between the spherical or aspheric design lenses for high- or low-contrast visual acuity. However, based on subjective outcomes, this study implies a 2:1 preference for the aspheric design lens, suggesting the consideration of individual corneal topography and the importance of diagnostic lens fitting for patient satisfaction.

Monochromatic wavefront aberrations in the human eye with contact lenses

PURPOSE

The aim of this study was to investigate the effect of contact lenses on the optical performance of the eye by measuring wavefront aberrations for the eyes with or without contact lenses.

METHOD

A sensitive aberrometer was used to measure wavefront aberrations for 54 eyes in 27 subjects for three conditions: with no contact lens (non-CL), with soft-contact lenses (soft-CL) and with rigid gas permeable contact lenses (RGP-CL). The root mean square (RMS) value of the wavefront aberrations and Zernike aberrations were calculated.

RESULTS

A change in the RMS values of wavefront aberrations with CL wear was observed for every eye. The change in wavefront aberrations with CL wearing was found to vary substantially from individual to individual. Relative to the mean RMS value of the group for the non-CL condition, the mean RMS value was increased for the soft-CL condition and was significantly reduced for the RGP-CL condition. A significant increase in mean RMS for the soft-CL condition was found when astigmatisms were removed. Although soft-CL wearing resulted in significant increases in higher orders of Zernike aberrations (fourth, fifth, and higher), the RGP-CL condition led to a significant decrease in second-order Zernike aberrations. For the eyes with low wavefront aberrations in the non-CL condition, either soft-CL wearing or RGP-CL wearing results in increases in the RMS values.

CONCLUSION

Contact lens wearing, either with soft lenses or the RGP lenses, causes changes in the wavefront aberrations of the eye. The changes in wavefront aberrations vary substantially from eye to eye. Although soft-CL wearing tends to induce more higher-order aberrations, RGP-CL effectively reduces the astigmatisms. Both soft-CL and RGP-CL induce more aberrations for the eyes that have low wavefront aberrations. The change in wavefront aberrations due to contact lens wearing may explain the changes in visual performance for contact lens wearers reported previously.

On- and off-eye spherical aberration of soft contact lenses and consequent changes of effective lens power

BACKGROUND

Soft contact lenses produce a significant level of spherical aberration affecting their power on-eye. A simple model assuming that a thin soft contact lens aligns to the cornea predicts that these effects are similar on-eye and off-eye.

METHODS

The wavefront aberration for 17 eyes and 33 soft contact lenses on-eye was measured with a Shack-Hartmann wavefront sensor. The Zernike coefficients describing the on-eye spherical aberration of the soft contact lens were compared with off-eye ray-tracing results. Paraxial and effective lens power changes were determined.

RESULTS

The model predicts the on-eye spherical aberration of soft contact lenses closely. The resulting power change for a +/- 7.00 D spherical soft contact lens is +/- 0.5 D for a 6-mm pupil diameter and +/- 0.1 D for a 3-mm pupil diameter. Power change is negligible for soft contact lenses corrected for off-eye spherical aberration.

CONCLUSIONS

For thin soft contact lenses, the level of spherical aberration and the consequent power change is similar on-eye and off-eye. Soft contact lenses corrected for spherical aberration in air will be expected to be aberration-free on-eye and produce only negligibly small power changes. For soft contact lenses without aberration correction, for higher levels of ametropia and large pupils, the soft contact lens power should be determined with trial lenses with their power and p value similar to the prescribed lens. The benefit of soft contact lenses corrected for spherical aberration depends on the level of ocular spherical aberration.

Optical considerations in the contact lens correction of infant aphakia

BACKGROUND

Correction of infant aphakia with conventional soft and rigid designs induces significant amounts of positive spherical aberration.

METHODS

Different levels of positive spherical aberration were induced by rigid lenses positioned close to the eye. Visual acuity and depth of focus were measured for twelve young adult subjects.

RESULTS

Positive spherical aberration acts to produce an increase in relative depth of focus, but because of the reduction of best visual acuity, there is a concurrent decrease in absolute depth of focus. As the spherical aberration increases, there is a progressive loss of best-corrected visual acuity.

CONCLUSIONS

The correction of spherical aberration in contact lenses for infant aphakia provides the best theoretical optical conditions for normal ocular growth and visual development. We provide examples of the optimal aspheric surfaces to minimize spherical aberration in contact lenses for infant aphakes.

On-eye evaluation of optical performance of rigid and soft contact lenses

A Shack-Hartmann aberrometer was used to assess the optical performances of eyes corrected with rigid or soft contact lenses compared with spectacles. Metrics of optical quality derived from the measured wave aberrations were consistent with the subjective rating of visual clarity by subjects. Optical aberration analysis illustrated the differences in aberration structures of eyes wearing different optical corrections. For our subjects, correction with a rigid gas-permeable lens yielded significantly better optical quality than did the soft contact lens or spectacle lens. This was due to a reduction in the eye's asymmetric (odd-order) aberrations and a reduction in the amount of the eye's positive spherical aberration. These observations can be explained by theoretical calculations of the aberrations of the eye plus lens optical system. We conclude that aberrometry provides a better understanding of the optical effects of contact lenses in situ and could be useful for optimizing future designs of contact lenses.

Influence of myopia and aging on the optimal spherical aberration of soft contact lenses

Soft contact lenses with different levels of third-order spherical aberration were tested in two samples of subjects aged between 20 and 45 years: 18 emmetropes and 19 myopes. Contrast sensitivity was measured at 12 cycles/degree to determine the optimal lens spherical aberration required by each individual. The optimal third-order coefficient was found to be negative on average in both refractive error groups. Myopic subjects required contact lenses with more negative spherical aberration than did emmetropes. The optimal aberration was also found to become increasingly negative with aging. The rate of this age-related change was faster in the myopic group. In comparison with aberration-free soft contact lenses, an improvement in contrast detection threshold of more than 25% was observed with optimal spherical aberration in half of the myopic subjects.