Purpose

To demonstrate the necessity of aligning a wavefront-guided scleral lens (WGSL) optical correction to the eye’s effective pupil, with misalignments leading to reduced performance.

Case report

A 34 year old subject with a history of failed LASIK in the left eye, leading to penetrating keratoplasty, extracapsular extraction of the crystalline lens and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy, enrolled in a study examining WGSL performance. Habitual logMAR acuity OS (aided with a scleral lens) was +0.04. Residual higher order root mean square (HORMS) wavefront error (WFE) was 0.28 μm (Φ =4.75 mm, mean age-matched norm =0.17 μm), and objective over-refraction was –0.30 –0.54 × 008. When a WGSL (targeting aberrations up to the 5 th radial order) was manufactured with the wavefront-guided optics aligned to the center of the dilated pupil, logMAR acuity worsened to +0.15, residual HORMS WFE worsened to 0.44 μm (Φ =4.75 mm), and objective over-refraction increased to +1.19 –0.30 × 122. Slit lamp imagery revealed that the effective pupil was no longer defined by the iris of the eye, but rather the capsular opening created by the capsulotomy. When the WGSL was redesigned to align the wavefront-guided optics to the center of the capsular opening, logMAR acuity improved to –0.14, residual HORMS WFE reduced to 0.17 μm (Φ =4.75 mm) and objective over-refraction reduced to +0.20 –0.15 × 111.

Conclusion

WGSLs are an emerging option for patients with highly aberrated, ectatic and post-surgical corneas whose visual symptoms cannot be alleviated with conventional corrections. However, alignment of the optics of the WGSL to the underlying optics of the eye over the effective pupil is critical in achieving good optical and visual performance.

中文翻译：

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在存在晶状体囊切开术的情况下对齐波前引导的巩膜晶状体矫正。

目的

证明将波前引导的巩膜透镜 (WGSL) 光学校正与眼睛的有效瞳孔对齐的必要性，未对齐会导致性能降低。

案例报告

一名 34 岁的受试者曾在左眼进行过 LASIK 手术失败，导致穿透性角膜移植术、晶状体囊外提取和钕：钇铝石榴石（Nd：YAG）激光后囊切开术，参加了一项检查 WGSL 的研究表现。习惯性 logMAR 视力 OS（用巩膜镜辅助）为 +0.04。残余高阶均方根 (HORMS) 波前误差 (WFE) 为 0.28 μm（Φ =4.75 mm，平均年龄匹配范数 =0.17 μm），客观过度折射为 –0.30 –0.54 × 008。当 WGSL (瞄准高达 5 阶径向像差）制造，波前引导光学器件对准散瞳中心，logMAR 视力恶化至 +0.15，残余 HORMS WFE 恶化至 0.44 μm (Φ =4.75 mm)，物镜过度折射增加到 +1.19 –0.30 × 122。裂隙灯图像显示有效瞳孔不再由眼睛的虹膜定义，而是由囊切开术产生的囊开口定义。当重新设计 WGSL 以将波前引导光学器件对准囊开口中心时，logMAR 敏锐度提高至 –0.14，残余 HORMS WFE 降低至 0.17 μm (Φ =4.75 mm)，物镜过度折射降低至 +0.20 – 0.15 × 111。

结论

WGSL 是一种新兴的选择，适用于高度畸变、扩张和手术后角膜的患者，其视觉症状无法通过常规矫正得到缓解。然而，WGSL 的光学器件与有效瞳孔上方的眼睛底层光学器件的对齐对于实现良好的光学和视觉性能至关重要。