Overcoming presbyopia by manipulating the eyes’ optics

by Leonard A. Zheleznyak

Institution: University of Rochester
Degree: PhD
Year: 2015
Keywords: Adaptive optics; Intraocular lens; Neural plasticity; Presbyopia; Vision science; Wavefront aberrations
Record ID: 2057888
Full text PDF: http://hdl.handle.net/1802/29192


Presbyopia, the age-related loss of accommodation, is a visual condition affecting all adults over the age of 45 years. In presbyopia, individuals lose the ability to focus on nearby objects, due to a lifelong growth and stiffening of the eye’s crystalline lens. This leads to poor near visual performance and affects patients’ quality of life. The objective of this thesis is aimed towards the correction of presbyopia and can be divided into four aims. </br> First, we examined the characteristics and limitations of currently available strategies for the correction of presbyopia. A natural-view wavefront sensor was used to objectively measure the accommodative ability of patients implanted with an accommodative intraocular lens (IOL). Although these patients had little accommodative ability based on changes in power, pupil miosis and higher order aberrations led to an improvement in through-focus retinal image quality in some cases. To quantify the through-focus retinal image quality of accommodative and multifocal IOLs directly, an adaptive optics (AO) IOL metrology system was developed. Using this system, the impact of corneal aberrations in regard to presbyopia-correcting IOLs was assessed, providing an objective measure of through-focus retinal image quality and practical guidelines for patient selection. </br> To improve upon existing multifocal designs, we investigated retinal image quality metrics for the prediction of through-focus visual performance. The preferred metric was based on the fidelity of an image convolved with an aberrated point spread function. Using this metric, we investigated the potential of higher order aberrations and pupil amplitude apodization to increase the depth of focus of the presbyopic eye. </br> Thirdly, we investigated modified monovision, a novel binocular approach to presbyopia correction using a binocular AO vision simulator. In modified monovision, different magnitudes of defocus and spherical aberration are introduced to each eye, thereby taking advantage of the binocular visual system. Several experiments using the binocular AO vision simulator found modified monovision led to significant improvements in through-focus visual performance, binocular summation and stereoacuity, as compared to traditional monovision. </br> Finally, we addressed neural factors, affecting visual performance in modified monovision, such as ocular dominance and neural plasticity. We found that pairing modified monovision with a vision training regimen may further improve visual performance beyond the limits set by optics via neural plasticity. This opens the door to an exciting new avenue of vision correction to accompany optical interventions. </br> The research presented in this thesis offers important guidelines for the clinical and scientific communities. Furthermore, the techniques described herein may be applied to other fields of ophthalmology, such as childhood myopia progression. </br>