Spherical aberration after laser in situ keratomileusis and photorefractive keratectomy. Clinical results and theoretical models of etiology.
OBJECTIVE
To assess changes in corneal asphericity after laser refractive surgery and mathematically model possible causes of the changes.


METHODS
Cornea and Laser Eye Institute, Hersh Vision Group, Teaneck, New Jersey, USA.


METHODS
The corneal topography (EyeSys 2000) of 20 eyes was measured before and after laser in situ keratomileusis, laser-assisted subepithelial keratectomy, and photorefractive keratectomy for myopia. All preoperative and postoperative maps were analyzed using the CTView 4.0, a computer software program for determining quantitative corneal spherical aberration. To define possible mechanisms of asphericity change, 2 mathematical models of corneal ablation were constructed and theoretical postoperative corneal asphericities were determined over a range of corrections from -12.0 to +6.0 diopters. Model 1 assumes homogeneous beam fluence over the ablation zone, and model 2 accounts for a theoretical ablation rate drop off peripherally as a result of the angle of incidence of the laser beam on the cornea. Postoperative clinical corneal spherical aberration was compared to the theoretically predicted asphericity values.


RESULTS
After excimer laser procedures, all corneas had positive asphericity within the ablation zone, generally changing from a prolate to an oblate optical contour. The mean asphericity (Q) was -0.17 +/- 0.14 (SD) preoperatively and +0.92 +/- 0.70 postoperatively. The mean change in spherical aberration was +1.09 +/- 0.67 of positive asphericity; the range of asphericity change was +0.40 to +2.73 in the direction of a more oblate corneal profile. A trend toward greater change in asphericity and more oblateness was observed among eyes receiving higher correction. A mathematical model taking into account theoretical beam fluence changes across the ablation zone was highly predictive of the actual postoperative asphericity measurements.


CONCLUSIONS
The cornea within the ablation zone becomes more oblate after laser refractive surgery. A mathematical model of the change in asphericity, which accounts for the angle of incidence of the laser beam across the ablation area, predicted this change in spherical aberration. If the model is correct, possible changes in laser algorithms, delivering more ablation to the peripheral optical zone, may better retain the native corneal prolate conformation. Moreover, wavefront-guided ablations may have to consider the effects of fluence variability across the optical zone to fully correct spherical as well as other aberrations.
Hersh
Peter S
PS
Institute of Ophthalmology and Visual Science, UMDNJ-New Jersey Medical School, Newark, NJ, USA. phersh@vision-institute.com
Fry
Kristen
K
Blaker
J Warren
JW
D000328:Adult; D003315:Cornea / Q000503:physiopathology*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D008962:Models, Theoretical; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D018903:Photorefractive Keratectomy; D013524:Surgical Flaps