Vision with spatial light modulator simulating multifocal contact lenses in an adaptive optics system

Improving the performance of multifocal diffractive lens designs by adding a peripheral piston

Peripheral piston modulation in diffractive multifocal lenses suggests potential improvements in distance vision quality. Five lens designs-bifocal (BF), bifocal with piston (BFP), trifocal (TF), trifocal with piston (TFP), and a commercial refractive (RCN)-were compared using an adaptive optics visual simulator. Optical simulations revealed enhanced optical quality for distant objects with peripheral pistons, without compromising near vision. Visual performance and quality were assessed in eight cycloplegic young subjects. The peripheral piston was associated with trends toward improved high- and low-contrast visual acuity and visual preference scores at distance, suggesting functional and perceptual benefits over non-piston designs.

Visual Quality and Accommodation With Novel Optical Designs for Myopia Control

Purpose

We evaluated through-focus visual performance and accommodative response in young subjects through three segmented multifocal designs for myopia control, mapped on the spatial light modulator of a monocular adaptive optics visual simulator (AOVS), and compared with single vision (SV).

Methods

The segmented multifocal patterns included a 4 mm diameter center distance zone and offset peripheral defocus (MP1), astigmatism and coma (MP2), or a combination (MP3). High-contrast logMAR visual acuity (VA) was measured with monochromatic stimuli (555 nm). Ocular aberrations were measured using the Hartmann-Shack aberrometry channel. Measurements were taken for distance viewing and five accommodative demands (AD, up to 4.5 D). Accommodative lag was calculated from the dioptric shift of the maximum retinal image quality metric from the corresponding wave aberrations.

Results

Best-corrected logMAR VA was -0.11 ± 0.02 (SV) and slightly reduced by multifocal patterns (-0.08 ± 0.03 [MP1], -0.07 ± 0.04 [MP2], -0.05 ± 0.04 [MP3]). Accommodative lag with SV was lower in emmetropes than myopes (by 0.43D for the largest demand). MP1 significantly decreased accommodative lag in myopes (P = 0.03), unlike MP2 or MP3. Multifocal patterns reduced pupil diameter in myopes at all distances. MP1 improved accommodative response in myopes without compromising distance vision.

Conclusions

AOVS helped to understand the interplay of physiological and lens design factors, potentially guiding custom corrections. A center distance with off-centered positive power in the lens periphery could feature suitable properties (peripheral focus and accommodative focus control) for myopia control.

Translational Relevance

We demonstrate a two-zone contact lens design that provides excellent visual quality and accommodative response, important properties for myopia control lenses.

Head-mounted adaptive optics visual simulator

Adaptive optics visual simulation is a powerful tool for vision testing and evaluation. However, the existing instruments either have fixed tabletop configurations or, being wearable, only offer the correction of defocus. This paper proposes a novel head-mounted adaptive optics visual simulator that can measure and modify complex ocular aberrations in real-time. The prototype is composed of two optical modules, one for the objective assessment of aberrations and the second for wavefront modulation, all of which are integrated into a wearable headset. The device incorporates a microdisplay for stimulus generation, a liquid crystal on silicon (LCoS) spatial light modulator for wavefront manipulation, and a Hartmann-Shack wavefront sensor. Miniature optical components and optical path folding structures, together with in-house 3D printed mounts and housing, were adapted to realize the compact size. The system was calibrated by characterizing and compensating the internal aberrations of the visual relay. The performance of the prototype was analyzed by evaluating the measurement and compensation of low-order and higher-order aberrations induced through trial lenses and phase masks in an artificial eye. The defocus curves for a simulated bifocal diffractive lens were evaluated in real eyes. The results show high accuracy while measuring and compensating for the induced defocus, astigmatism, and higher-order aberrations, whereas the MTF analysis shows post-correction resolution of up to 37.5 cycles/degree (VA 1.25). Moreover, the subjective test results show the defocus curves closely matched to a commercial desktop visual simulator.

Adaptive optics visual simulators: a review of recent optical designs and applications [Invited]

In their pioneering work demonstrating measurement and full correction of the eye's optical aberrations, Liang, Williams and Miller, [JOSA A14, 2884 (1997)10.1364/JOSAA.14.002884] showed improvement in visual performance using adaptive optics (AO). Since then, AO visual simulators have been developed to explore the spatial limits to human vision and as platforms to test non-invasively optical corrections for presbyopia, myopia, or corneal irregularities. These applications have allowed new psychophysics bypassing the optics of the eye, ranging from studying the impact of the interactions of monochromatic and chromatic aberrations on vision to neural adaptation. Other applications address new paradigms of lens designs and corrections of ocular errors. The current paper describes a series of AO visual simulators developed in laboratories around the world, key applications, and current trends and challenges. As the field moves into its second quarter century, new available technologies and a solid reception by the clinical community promise a vigorous and expanding use of AO simulation in years to come.

Accommodation through simulated multifocal optics

We evaluated the interaction of multifocal patterns with eye's accommodation. Seven patterns were mapped on the spatial light modulator and the deformable mirror of an adaptive optics visual simulator, and projected onto the subjects' eyes, representing different contact lens designs: NoLens, Bifocal Center Distance (+2.50D), Bifocal Center Near (+2.50D) and Multifocal Center Near-MediumAdd (+1.75D) and Center Near HighAdd (+2.50D), positive and negative spherical aberration (±1µm). The change in spherical aberration and the accommodative response to accommodative demands were obtained from Hartmann-Shack measurements. Positive spherical aberration and Center Distance designs are consistent with a higher accommodative response (p=0.001 & p=0.003): steeper shift of SA towards negative values and lower accommodative lag.

Multifocal contact lens vision simulated with a clinical binocular simulator

PURPOSE

The purpose of this study is to compare the binocular visual perception of participants wearing multifocal contact lenses and these same lens designs viewed through a temporal multiplexing visual simulator.

METHODS

Visual performance and perceived visual quality at various distances were obtained in 37 participants wearing soft M-CLs and through the SimVis Gekko programmed with the same lenses. In a pilot study (n = 10) visual performance was measured in terms of LogMAR visual acuity (VA) at far (4 m), intermediate (64 cm) and near (40 cm) distances and through-focus VA (TFVA) curves with the simulated M-CLs. In the follow-up study (n = 27), LogMAR VA at far, intermediate and near distances were measured both with the actual and simulated M-CLs. Perceived visual quality was measured in both studies using the Multifocal Acceptance Score (MAS-2EV), and a Participants Reported Outcomes Vision questionnaire. Differences between the metrics obtained with simulated and actual lenses were obtained.

RESULTS

Both actual and simulated M-CLs increased depth-of-focus by a similar amount. Mean LogMAR VA differences with actual and simulated M-CLs ranged between 4 and 6 letters (0.08 ± 0.01, 0.12 ± 0.01 and 0.10 ± 0.01, for far, intermediate and near distances, respectively). MAS-2EV average score differences with actual and simulated M-CLs ranged between -1.00 and + 4.25. Average MAS-2EV scores were not correlated significantly with VA. However, MAS-2EV (average and individual scores) were highly correlated to visual quality questionnaire responses (p < 0.005).

CONCLUSIONS

A simultaneous vision simulator accurately represented vision with M-CLs both VA at various distances and perceived visual quality, as measured in a clinical setting. The MAS-2EV metric accurately captured participant reported outcomes of standard vision questionnaires. The combination of SimVis Gekko and MAS-2EV has the potential to largely reduce chair time in M-CLs fitting.

In situ measurement of the stiffness increase in the posterior sclera after UV-riboflavin crosslinking by optical coherence elastography

Scleral crosslinking may provide a way to prevent or treat myopia by stiffening scleral tissues. The ability to measure the stiffness of scleral tissues in situ pre and post scleral crosslinking would be useful but has not been established. Here, we tested the feasibility of optical coherence elastography (OCE) to measure shear modulus of scleral tissues and evaluate the impact of crosslinking on different posterior scleral regions using ex vivo porcine eyes as a model. From measured elastic wave speeds at 6 - 16 kHz, we obtained out-of-plane shear modulus value of 0.71 ± 0.12 MPa (n = 20) for normal porcine scleral tissues. After riboflavin-assisted UV crosslinking, the shear modulus increased to 1.50 ± 0.39 MPa (n = 20). This 2-fold change was consistent with the increase of static Young's modulus from 5.5 ± 1.1 MPa to 9.3 ± 1.9 MPa after crosslinking, which we measured using conventional uniaxial extensometry on tissue stripes. OCE revealed regional stiffness differences across the temporal, nasal, and deeper posterior sclera. Our results show the potential of OCE as a noninvasive tool to evaluate the effect of scleral crosslinking.

Visual performance with multifocal lenses in young adults and presbyopes

A better understanding of visual performance with Multifocal Contact Lenses (MCLs) is essential, both in young eyes, where MCLs may be prescribed to control the progression of myopia wherein the MCLs optics interact with accommodation, and in presbyopes, where MCLs are increasingly used to compensate the lack of accommodation. In this study, we evaluated the through focus visual acuity (TFVA) with center-near MCLs of three additions (low, medium and high) and without an addition (NoLens) in 10 young adults and 5 presbyopes. We studied the effect of accommodation, age and pupil diameter (in cyclopleged subjects) on visual performance. The MCLs produced a small but consistent degradation at far (by 0.925 logMAR, averaged across eyes and conditions) and a consistent benefit at near in young subjects with paralyzed accommodation (by 1.025 logMAR), and in presbyopes with both paralyzed and natural accommodation (by 1.071 logMAR, on average). TFVA in young adults with NoLens and all MCLs showed statistically significant differences (Wilcoxan, p<0.01) between natural and paralyzed accommodation, but not in presbyopes with MCLs. In young adults, VA improved with increasing pupil diameter with the HighAdd MCL (0.08 logMAR shift from 3 to 5-mm pupil size). Visual imbalance (standard deviation of VA across distances) was reduced with MCLs, and decreased significantly with increasing near add. The lowest imbalance occurred in young adults under natural accommodation and was further reduced by 13.33% with MCLs with respect to the NoLens condition. Overall, the visual performance with MCLs in young adults exceeds that in presbyopes at all distances, and was better than 0.00 logMAR over the dioptric range tested. In conclusion, the center-near lenses do not degrade the near high contrast visual acuity significantly but maintains the far vision in young adults, and produce some visual benefit at near in presbyopes.