Journal of Refractive Surgery 

About: Journal of Refractive Surgery is an academic journal published by Slack Incorporated (United States). The journal publishes majorly in the area(s): LASIK & Keratomileusis. It has an ISSN identifier of 1081-597X. Over the lifetime, 4281 publications have been published receiving 116805 citations.

Proper method for calculating average visual acuity

Abstract: C alculating the average visual acuity and standard deviation on a series of patients is not difficult , but has been done incorrectly in most studies. 1 The basic problem relates to the difference between the arithmetic and geometric mean for a set of numbers. For the correct average visual acuity, the geometric mean must be used, which gives significantly different values than the arithmetic mean. Modern visual acuity charts are designed so that the letter sizes on each line follow a geometric progression (ie, change in a uniform step on a logarithmic scale). 2-4 The accepted step size has been chosen to be 0.1 log unit steps, which is equivalent to letter sizes changing by a factor of 1.2589 between lines. This standard gave rise to the LogMAR (log of the minimum angle of resolution) notation, as shown in Table 1. A geometric progression of lines on the visual acuity chart was chosen because it parallels the way our visual system functions. If patient #1 has a visual acuity of 20/20 and patient #2 has a visual acuity of 20/40, we conclude that patient #1 has two times better visual acuity than patient #2 because he or she can recognize a letter twice as small. Once we have chosen to compare vision as a ratio using a reference visual angle (20/20), a geometric progression results and a geometric mean must be calculated for a meaningful result. Notice in Table 1 that the only values that increase linearly are the line numbers and the LogMar notation. The Snellen acuity, decimal acuity, and visual angle all increase by the geometric factor of 1.2589. Once we decide that equal steps in visual acuity measurement are geometric and not arithmetic , we must use the appropriate geometric mean to compute the correct average (Figure). In Table 1 and the Figure, we see that line 0 is the 20/20 Snellen acuity that corresponds to the LogMAR value zero, since 20/20 is the standard. We also see that line 10 is the 20/200 Snellen visual acuity that corresponds to a LogMAR value of +1.00 (ten times or 1 log unit worse than 20/20). Intuitively, it would appear that halfway between line 0 and line 10 would be line 5, or 20/63. This is the correct average, because geometrically it is halfway between 20/200 and 20/20. The two incorrect methods would be to take the arithmetic …

History and Principles of Shack-Hartmann Wavefront Sensing

Abstract: developed out of a need to solve a problem. The problem was posed, in the late 1960s, to the Optical Sciences Center (OSC) at the University of Arizona by the US Air Force. They wanted to improve the images of satellites taken from earth. The earth's atmosphere limits the image quality and exposure time of stars and satellites taken with telescopes over 5 inches in diameter at low altitudes and 10 to 12 inches in diameter at high altitudes. Dr. Aden Mienel was director of the OSC at that time. He came up with the idea of enhancing images of satellites by measuring the Optical Transfer Function (OTF) of the atmosphere and dividing the OTF of the image by the OTF of the atmosphere. The trick was to measure the OTF of the atmosphere at the same time the image was taken and to control the exposure time so as to capture a snapshot of the atmospheric aberrations rather than to average over time. The measured wavefront error in the atmosphere should not change more than ␭/10 over the exposure time. The exposure time for a low earth orbit satellite imaged from a mountaintop was determined to be about 1/60 second. Mienel was an astronomer and had used the standard Hartmann test (Fig 1), where large wooden or cardboard panels were placed over the aperture of a large telescope. The panels had an array of holes that would allow pencils of rays from stars to be traced through the telescope system. A photographic plate was placed inside and outside of focus, with a sufficient separation, so the pencil of rays would be separated from each other. Each hole in the panel would produce its own blurry image of the star. By taking two images a known distance apart and measuring the centroid of the images, one can trace the rays through the focal plane. Hartmann used these ray traces to calculate figures of merit for large telescopes. The data can also be used to make ray intercept curves (H'-tan U'). When Mienel could not cover the aperture while taking an image of the satellite, he came up with the idea of inserting a beam splitter in collimated space behind the eyepiece and placing a plate with holes in it at the image of the pupil. Each hole would pass a pencil of rays to a vidicon tube (this was before …

Standards for reporting the optical aberrations of eyes.

Abstract: In response to a perceived need in the vision community, an OSA taskforce was formed at the 1999 topical meeting on vision science and its applications (VSIA-99) and charged with developing consensus recommendations on definitions, conventions, and standards for reporting of optical aberrations of human eyes. Progress reports were presented at the 1999 OSA annual meeting and at VSIA-2000 by the chairs of three taskforce subcommittees on (1) reference axes, (2) describing functions, and (3) model eyes.

Iatrogenic keratectasia after laser in situ keratomileusis.

Abstract: Background Lamellar refractive surgery reduces the biomechanical strength of the cornea which may lead to mechanical instability and keratectasia. Methods Three eyes had laser in situ keratomileusis (LASIK) for myopia from -10.00 to -13.50 D. The procedures were performed with two different wide-field excimer lasers and two different microkeratomes. The patients were followed up to 1 year after surgery. Results Central steep areas developed between 1 and 8 months after surgery. In contrast to conventional central steep islands, these showed rapid progression and were interpreted as keratectasia. Conclusion Iatrogenic keratectasia represents a complication after LASIK that may limit the range of myopia correction. Based on biomechanical considerations we recommend a residual corneal thickness of the stromal bed of at least 250 microm.

Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant.

Abstract: Purpose To evaluate early visual and refractive outcomes following treatment of corneal endothelial dysfunction with a corneal transplantation technique, Descemet's stripping with endothelial keratoplasty (DSEK). Methods Visual and refractive outcomes of the first 50 consecutive cases of DSEK performed by a single surgeon between December 2003 and July 2004 were analyzed retrospectively. The DSEK technique consisted of stripping Descemet's membrane and endothelium from a recipient cornea and transplanting the posterior stroma and endothelium of a donor cornea through a 5-mm incision. Results Results are reported for 50 eyes in 47 patients (30 women and 17 men). Mean patient age at surgery was 70 +/- 12 years (range: 34 to 89 years). Five eyes were treated for corneal edema or bullous keratopathy and 45 for Fuchs' endothelial dystrophy. Seven eyes were phakic and 43 were pseudophakic. Six months after surgery, mean manifest cylinder was 1.5 +/- 0.94 diopters (D), unchanged from preoperative cylinder of 1.5 +/- 1.0 D. Mean manifest spherical equivalent refraction was 0.15 +/- 1.5 D at 6-month follow-up compared with -0.36 +/- 1.4 D preoperatively (P = .10) At 3- and 6-month follow-up, significant improvement was noted in mean best spectacle-corrected visual acuity compared with the preoperative mean of 20/100 (P = .007). At 6-month follow-up, 31 (62%) eyes refracted to > or = 20/40 and 38 (76%) eyes saw > or = 20/50. Conclusions Compared to standard penetrating keratoplasty, DSEK causes minimal refractive change and provides rapid visual recovery for patients with endothelial dysfunction. This technique maintains the structural integrity of the cornea by preserving the recipient's epithelium, Bowman's layer, and entire stromal thickness.