Abstract

In the recent years, keratoconus (KC) has increasingly gained attention due to its treatment options and to the popularity of keratorefractive surgery. This paper investigates the potential of identification of KC using photorefraction (PR), an optical technique that is similar to objective retinoscopy and is commonly used for large-scale ocular screening. Using personalized eye models of both KC and pre-LASIK patients, computer simulations were performed to achieve visualization of this ophthalmic measurement. The simulations are validated by comparing results to two sets of experimental measurements. These PR images show distinguishable differences between KC eyes and eyes that are either normal or ametropic. The simulation technique with personalized modeling can be extended to other ophthalmic instrument developments. It makes possible investigation with the least number of real human subjects. The application is also of great interest in medical training.

© 2006 Optical Society of America

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  1. E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
    [CrossRef] [PubMed]
  2. I. Chopra, and A. K. Jain, "Between eye asymmetry in keratoconus in an Indian population," Clin. Exp. Optom. 88, 146-152 (2005).
    [CrossRef] [PubMed]
  3. J. Kim, and M. V. Netto, "Keratoconus associated with hyperimmunoglobulin E syndrome," Cornea. 23, 93-96 (2004).
    [CrossRef] [PubMed]
  4. H. Howland, "Optics of photoretinoscopy: results from ray tracing," Am. J. Optom. Physiol. Opt. 62, 621-625 (1985).
    [CrossRef] [PubMed]
  5. W. Bobier, "Eccentric photorefraction: Optical analysis and empirical measures," Am. J. Optom. Physiol. Opt. 62, 614-620 (1985).
    [CrossRef] [PubMed]
  6. R. Navarro, L. Gonzalez, and J. L. Hernandez-Matamoros, "On the prediction of optical aberrations by personalized eye models," Optom. Vis. Sci. 83, 371-381 (2006).
    [CrossRef] [PubMed]
  7. C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).
  8. J. Castanera, A. Serra, and C. Rios, "Wavefront-guided ablation with Bausch and Lomb Zyoptix for retreatments after laser in situ keratomileusis for myopia," J. Refract. Surg. 20, 439-443 (2004).
    [PubMed]
  9. D. Y. Lin, and E. E. Manche, "Custom-contoured ablation pattern method for the treatment of decentered laser ablations," J. Cataract Refract. Surg. 30, 1675-1684 (2004).
    [CrossRef] [PubMed]
  10. J. B. Almeida, and A. M. Garcia, "Theoretical calculation of a contact lens thickness designed to correct the eye's monochromatic aberrations," Optom. Vis. Sci. 82, 59-63 (2005).
    [PubMed]
  11. J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
    [PubMed]
  12. W. N. Charman, "Wavefront technology: past, present and future," Cont. Lens Anterior Eye 28, 75-92. Epub 2005 Apr 26. Review (2005).
    [CrossRef] [PubMed]
  13. R. Navarro, J. Santamaria, and J. Bescos, "Accommodation-dependent model of the human eye with aspherics," J. Opt. Soc. Am. A 2, 1273-1281 (1985).
    [CrossRef] [PubMed]
  14. T. O. Salmon, and C. van de Pol, "Zernike coefficient norms - comparison of studies," presented at the American Academy of Optometry annual meeting, Tampa, Florida, 9 December, 2004.
  15. I. J. Hodgkinson, K. M. Chong, and A. C. B. Molteno, "Photorefraction of the living eye: a model for linear knife edge photoscreening," Appl. Opt. 30, 2263-2269 (1991).
    [CrossRef] [PubMed]
  16. J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)
  17. F. C. Delori and K. P. Pflibsen, "Spectral reflectance of human ocular fundus," Appl. Opt. 28, 1061-77 (1989)
    [CrossRef] [PubMed]

2006

R. Navarro, L. Gonzalez, and J. L. Hernandez-Matamoros, "On the prediction of optical aberrations by personalized eye models," Optom. Vis. Sci. 83, 371-381 (2006).
[CrossRef] [PubMed]

2005

I. Chopra, and A. K. Jain, "Between eye asymmetry in keratoconus in an Indian population," Clin. Exp. Optom. 88, 146-152 (2005).
[CrossRef] [PubMed]

J. B. Almeida, and A. M. Garcia, "Theoretical calculation of a contact lens thickness designed to correct the eye's monochromatic aberrations," Optom. Vis. Sci. 82, 59-63 (2005).
[PubMed]

2004

J. Kim, and M. V. Netto, "Keratoconus associated with hyperimmunoglobulin E syndrome," Cornea. 23, 93-96 (2004).
[CrossRef] [PubMed]

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

J. Castanera, A. Serra, and C. Rios, "Wavefront-guided ablation with Bausch and Lomb Zyoptix for retreatments after laser in situ keratomileusis for myopia," J. Refract. Surg. 20, 439-443 (2004).
[PubMed]

D. Y. Lin, and E. E. Manche, "Custom-contoured ablation pattern method for the treatment of decentered laser ablations," J. Cataract Refract. Surg. 30, 1675-1684 (2004).
[CrossRef] [PubMed]

2002

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

2001

E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
[CrossRef] [PubMed]

1991

1989

1986

J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)

1985

R. Navarro, J. Santamaria, and J. Bescos, "Accommodation-dependent model of the human eye with aspherics," J. Opt. Soc. Am. A 2, 1273-1281 (1985).
[CrossRef] [PubMed]

H. Howland, "Optics of photoretinoscopy: results from ray tracing," Am. J. Optom. Physiol. Opt. 62, 621-625 (1985).
[CrossRef] [PubMed]

W. Bobier, "Eccentric photorefraction: Optical analysis and empirical measures," Am. J. Optom. Physiol. Opt. 62, 614-620 (1985).
[CrossRef] [PubMed]

Almeida, J. B.

J. B. Almeida, and A. M. Garcia, "Theoretical calculation of a contact lens thickness designed to correct the eye's monochromatic aberrations," Optom. Vis. Sci. 82, 59-63 (2005).
[PubMed]

Bescos, J.

Bobier, W.

W. Bobier, "Eccentric photorefraction: Optical analysis and empirical measures," Am. J. Optom. Physiol. Opt. 62, 614-620 (1985).
[CrossRef] [PubMed]

Castanera, J.

J. Castanera, A. Serra, and C. Rios, "Wavefront-guided ablation with Bausch and Lomb Zyoptix for retreatments after laser in situ keratomileusis for myopia," J. Refract. Surg. 20, 439-443 (2004).
[PubMed]

Chong, K. M.

Chopra, I.

I. Chopra, and A. K. Jain, "Between eye asymmetry in keratoconus in an Indian population," Clin. Exp. Optom. 88, 146-152 (2005).
[CrossRef] [PubMed]

Delori, F. C.

F. C. Delori and K. P. Pflibsen, "Spectral reflectance of human ocular fundus," Appl. Opt. 28, 1061-77 (1989)
[CrossRef] [PubMed]

J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)

Donitzky, C.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Fitch, K. A.

J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)

Gabler, B.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Garcia, A. M.

J. B. Almeida, and A. M. Garcia, "Theoretical calculation of a contact lens thickness designed to correct the eye's monochromatic aberrations," Optom. Vis. Sci. 82, 59-63 (2005).
[PubMed]

Gonzalez, L.

R. Navarro, L. Gonzalez, and J. L. Hernandez-Matamoros, "On the prediction of optical aberrations by personalized eye models," Optom. Vis. Sci. 83, 371-381 (2006).
[CrossRef] [PubMed]

Hernandez-Matamoros, J. L.

R. Navarro, L. Gonzalez, and J. L. Hernandez-Matamoros, "On the prediction of optical aberrations by personalized eye models," Optom. Vis. Sci. 83, 371-381 (2006).
[CrossRef] [PubMed]

Herrmann, W.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Hodgkinson, I. J.

Howland, H.

H. Howland, "Optics of photoretinoscopy: results from ray tracing," Am. J. Optom. Physiol. Opt. 62, 621-625 (1985).
[CrossRef] [PubMed]

Huber, A.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Jain, A. K.

I. Chopra, and A. K. Jain, "Between eye asymmetry in keratoconus in an Indian population," Clin. Exp. Optom. 88, 146-152 (2005).
[CrossRef] [PubMed]

Kempe, A.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Kim, J.

J. Kim, and M. V. Netto, "Keratoconus associated with hyperimmunoglobulin E syndrome," Cornea. 23, 93-96 (2004).
[CrossRef] [PubMed]

Leach, N.

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

Lin, D. Y.

D. Y. Lin, and E. E. Manche, "Custom-contoured ablation pattern method for the treatment of decentered laser ablations," J. Cataract Refract. Surg. 30, 1675-1684 (2004).
[CrossRef] [PubMed]

Lohmann, C..P.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Ludwig, H.

E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
[CrossRef] [PubMed]

Manche, E. E.

D. Y. Lin, and E. E. Manche, "Custom-contoured ablation pattern method for the treatment of decentered laser ablations," J. Cataract Refract. Surg. 30, 1675-1684 (2004).
[CrossRef] [PubMed]

Marsack, J.

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

Milner, T.

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

Molteno, A. C. B.

Navarro, R.

R. Navarro, L. Gonzalez, and J. L. Hernandez-Matamoros, "On the prediction of optical aberrations by personalized eye models," Optom. Vis. Sci. 83, 371-381 (2006).
[CrossRef] [PubMed]

R. Navarro, J. Santamaria, and J. Bescos, "Accommodation-dependent model of the human eye with aspherics," J. Opt. Soc. Am. A 2, 1273-1281 (1985).
[CrossRef] [PubMed]

Netto, M. V.

J. Kim, and M. V. Netto, "Keratoconus associated with hyperimmunoglobulin E syndrome," Cornea. 23, 93-96 (2004).
[CrossRef] [PubMed]

Pflibsen, K. P.

Rios, C.

J. Castanera, A. Serra, and C. Rios, "Wavefront-guided ablation with Bausch and Lomb Zyoptix for retreatments after laser in situ keratomileusis for myopia," J. Refract. Surg. 20, 439-443 (2004).
[PubMed]

Roorda, A.

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

Roth, E. H.

E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
[CrossRef] [PubMed]

Rylander, G.

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

Santamaria, J.

Schmitz, F.

E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
[CrossRef] [PubMed]

Serra, A.

J. Castanera, A. Serra, and C. Rios, "Wavefront-guided ablation with Bausch and Lomb Zyoptix for retreatments after laser in situ keratomileusis for myopia," J. Refract. Surg. 20, 439-443 (2004).
[PubMed]

Weiter, J. J.

J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)

Werner, W.

E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
[CrossRef] [PubMed]

Wing, G. L.

J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)

Winkler von Mohrenfels, C.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

Am. J. Optom. Physiol. Opt.

H. Howland, "Optics of photoretinoscopy: results from ray tracing," Am. J. Optom. Physiol. Opt. 62, 621-625 (1985).
[CrossRef] [PubMed]

W. Bobier, "Eccentric photorefraction: Optical analysis and empirical measures," Am. J. Optom. Physiol. Opt. 62, 614-620 (1985).
[CrossRef] [PubMed]

Appl. Opt.

Biomed. Sci. Instrum.

J. Marsack, T. Milner, G. Rylander, N. Leach, and A. Roorda, "Applying wavefront sensors and corneal topography to keratoconus," Biomed. Sci. Instrum. 38, 471-476 (2002).
[PubMed]

Clin. Exp. Optom.

I. Chopra, and A. K. Jain, "Between eye asymmetry in keratoconus in an Indian population," Clin. Exp. Optom. 88, 146-152 (2005).
[CrossRef] [PubMed]

Cornea.

J. Kim, and M. V. Netto, "Keratoconus associated with hyperimmunoglobulin E syndrome," Cornea. 23, 93-96 (2004).
[CrossRef] [PubMed]

Invest. Opthalmol. Vis. Sci.

J. J. Weiter, F. C. Delori, G. L. Wing, and K. A. Fitch, "Retinal pigment epithelium lipofuscin and melanin and choroidal melanin in human eyes," Invest. Opthalmol. Vis. Sci. 27, 145-52 (1986)

J. Cataract Refract. Surg.

D. Y. Lin, and E. E. Manche, "Custom-contoured ablation pattern method for the treatment of decentered laser ablations," J. Cataract Refract. Surg. 30, 1675-1684 (2004).
[CrossRef] [PubMed]

J. Opt. Soc. Am. A

J. Refract. Surg.

C. Winkler von Mohrenfels, A. Huber, B. Gabler, W. Herrmann, A. Kempe, C. Donitzky, and C..P. Lohmann, "Wavefront-guided laser epithelial keratomileusis with the wavelight concept system 500," J. Refract. Surg. 20, S565-569 (2004).

J. Castanera, A. Serra, and C. Rios, "Wavefront-guided ablation with Bausch and Lomb Zyoptix for retreatments after laser in situ keratomileusis for myopia," J. Refract. Surg. 20, 439-443 (2004).
[PubMed]

Ophthalmologe.

E. H. Roth, H. Ludwig, F. Schmitz, and W. Werner, "Retinoscopy. A multi-media teaching program on CD," Ophthalmologe. 98, 964-967 (2001).
[CrossRef] [PubMed]

Optom. Vis. Sci.

J. B. Almeida, and A. M. Garcia, "Theoretical calculation of a contact lens thickness designed to correct the eye's monochromatic aberrations," Optom. Vis. Sci. 82, 59-63 (2005).
[PubMed]

R. Navarro, L. Gonzalez, and J. L. Hernandez-Matamoros, "On the prediction of optical aberrations by personalized eye models," Optom. Vis. Sci. 83, 371-381 (2006).
[CrossRef] [PubMed]

Other

T. O. Salmon, and C. van de Pol, "Zernike coefficient norms - comparison of studies," presented at the American Academy of Optometry annual meeting, Tampa, Florida, 9 December, 2004.

W. N. Charman, "Wavefront technology: past, present and future," Cont. Lens Anterior Eye 28, 75-92. Epub 2005 Apr 26. Review (2005).
[CrossRef] [PubMed]

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Figures (4)

Fig. 1.
Fig. 1.

PR simulation results (left) and measured and filled corneal topographies (upper and lower right) of model eyes from 5 KC patients. The lower (blue) to upper (red) scales in each color bar of the 5 KC topographies are -14 to +80 µm, -40 to 100 µm, 180 to 380 µm, -20 to 120 µm, and -20 to 140 µm respectively. KC_5 simulation was performed for eccentricities of 0 (coaxial), 6.5, 9 (knife-edge), and 11.5 mm. Camera entrance pupil is 18 mm as indicated with red dashed lines.

Fig. 2.
Fig. 2.

Corneal topographies (right) and PR simulation results (left) of 4 myopic eyes. The lower (blue) to upper (red) scales in each color bar of the 4 myopic topographies are -10 to +40 µm, -10 to 30 µm, -10 to 50 µm, and -20 to 70 µm respectively.

Fig. 3.
Fig. 3.

Corneal topography (right) and PR simulation results of a mild myopia and 3 hyperopic eyes. The lower (blue) to upper (red) scales in each color bar of the 4 topographies are 0 to 70 µm, 0 to 40 µm, 0 to 50 µm, and -5 to 15 µm respectively.

Fig. 4.
Fig. 4.

Experiment measured PR images from KC_5 (compared to simulation result in Fig. 1) and MY_3 eyes (compared to simulated images in Fig. 2). Near the center of the pupil in each image is the cornea reflection.

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