Increased internal higher-order aberrations as a useful parameter for indication of vitrectomy in three asteroid hyalosis cases

Spherical aberrations and their role in modern ophthalmology

Spherical aberration is an imperfection of the optical system of the human eye. The role of spherical aberration of the human eye in the quality of vision and pseudoaccommodation is reviewed. Spherical aberration is an imperfection of the optical system of the human eye. In most cases, due to well-developed neuroadaptation, it is insignificant for the perception of the image. Nevertheless, its role in modern ophthalmology is far from straightforward. On the one hand, there are clinical scenarios in which an excess of spherical aberration degrades the retinal image and leads to a high dissatisfaction rate among patients.©Recently, there is a growing interest in the modulation of spherical aberration in the clinical setting. Modern intraocular lenses as well as laser refractive procedures are aimed at interfering with spherical aberrations of the optical system in order to increase range of pseudoaccommodation. Here, we review the role of spherical aberration of the human eye in the quality of vision and pseudoaccommodation.

Asteroid Hyalosis: An Update on Prevalence, Risk Factors, Emerging Clinical Impact and Management Strategies

Asteroid hyalosis (AH) is a benign clinical entity characterized by the presence of multiple refractile spherical calcium and phospholipids within the vitreous body. First described by Benson in 1894, this entity has been well documented in the clinical literature and is named due to the resemblance of asteroid bodies on clinical examination to a starry night sky. Today, a growing body of epidemiologic data estimates the global prevalence of asteroid hyalosis to be around 1%, and there is a strong established association between AH and older age. While pathophysiology remains unclear, a variety of systemic and ocular risk factors for AH have recently been suggested in the literature and may provide insight into possible mechanisms for asteroid body (AB) development. As vision is rarely affected, clinical management is focused on differentiation of asteroid hyalosis from mimicking conditions, evaluation of the underlying retina for other pathology and consideration of vitrectomy in rare cases with visual impairment. Taking into account the recent technologic advances in large-scale medical databases, improving imaging modalities, and the popularity of telemedicine, this review summarizes the growing body of literature of AH epidemiology and pathophysiology and provides updates on the clinical diagnosis and management of AH.

Impact of asteroid hyalosis on internal higher-order aberrations in eyes with cataract accompanied by acoustic shadows on swept-source optical coherence tomography examination

Increased internal higher-order aberrations (HOAs) have been reported in eyes with asteroid hyalosis, which is usually asymptomatic. This report describes 2 patients with cataract and concurrent asteroid hyalosis. In the first case, internal HOAs were within the normal range, and swept-source optical coherence tomography (SS-OCT) did not show acoustic shadows. After cataract surgery, visual acuity improved and internal HOAs remained within normal limits. However, in the second case, SS-OCT revealed multiple acoustic shadows, presumably due to asteroid hyalosis, and internal HOAs increased in both eyes. After combined vitrectomy and cataract surgery, visual acuity and the internal HOA values improved in both eyes, and acoustic shadows disappeared on SS-OCT. Phacovitrectomy should be considered if the cause of visual impairment is cataract and asteroid hyalosis. Objective assessment of internal HOAs by a wavefront sensor and checking for acoustic shadows on SS-OCT might be useful in detecting this combination of ophthalmic conditions.

Spotlight on Asteroid Hyalosis: A Clinical Perspective

Asteroid hyalosis is a benign degenerative condition of the vitreous that is often asymptomatic. Our purpose with this narrative review is to provide a current overview of asteroid hyalosis from a clinical perspective. We review the epidemiology and risk factors, the clinical diagnosis and differential diagnoses, clinical challenges in eyes with asteroid hyalosis, and the treatment of asteroid hyalosis. Many clinical questions remain unanswered, and the current evidence to guide clinical practice is largely based on anecdotal evidence and clinical experience. More studies on asteroid hyalosis from a clinical perspective are warranted.