Pupil size and the ablation zone in laser refractive surgery: considerations based on geometric optics.
OBJECTIVE
To determine whether the currently accepted method of selecting a minimum ablation zone size for refractive surgery based on dark-adapted pupil diameter is substantiated by geometric optical analysis.


METHODS
Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.


METHODS
An optical model of the anterior segment was developed to calculate the effective corneal refractive diameter (ECRD), which is the diameter of the area of cornea that refracts all incident light rays arising from objects along the line of sight though the physical pupil (PP). The concept of the entrance pupil (EP) was reexamined and developed, and the ECRD was calculated over a range of corneal curvatures (K), anterior chamber depths (ACDs), and EP sizes. The model was generalized to include oblique light rays. Calculations were performed using MatLab Optimization Toolbox software (The MathWorks).


RESULTS
For a given EP size, the ECRD was significantly influenced by K and slightly influenced by ACD.


CONCLUSIONS
For objects on the line of sight, the ECRD was smaller than the EP in all cases. Regarding rays from objects in the periphery, the ECRD expanded rapidly as the angle of oblique incidence increased. For objects on the line of sight, the ECRD is always smaller than the clinically measured pupil (EP) because the EP is substantially magnified relative to the PP. Ablation zones larger than the EP should, in theory, prevent scattered or defocused light rays from contributing to the foveal image. When considering objects in the periphery, the increase in ECRD is sufficiently rapid that current refractive procedures cannot stop scattered light from these objects from contributing to the retinal image.
Freedman
Kenn A
KA
Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Brown
Sandra M
SM
Mathews
Steven M
SM
Young
Rockefeller S L
RS
D003315:Cornea / Q000502:physiology* / Q000601:surgery*; D003623:Dark Adaptation; D006801:Humans; D007498:Iris / Q000033:anatomy & histology*; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer; D008027:Light; D008962:Models, Theoretical; D055095:Optics and Photonics; D018903:Photorefractive Keratectomy; D011680:Pupil / Q000502:physiology*; D012029:Refraction, Ocular / Q000502:physiology; D054140:Refractive Surgical Procedures; D012542:Scattering, Radiation