title: Variability of wavefront aberration measurements in small pupil sizes using a clinical Shack-Hartmann aberrometer.
abstract: BACKGROUND
  Recently, instruments for the measurement of wavefront aberration in the living human eye have been widely available for clinical applications. Despite the extensive background experience on wavefront sensing for research purposes, the information derived from such instrumentation in a clinical setting should not be considered a priori precise. We report on the variability of such an instrument at two different pupil sizes.
  
  
  METHODS
  A clinical aberrometer (COAS Wavefront Scienses, Ltd) based on the Shack-Hartmann principle was employed in this study. Fifty consecutive measurements were performed on each right eye of four subjects. We compared the variance of individual Zernike expansion coefficients as determined by the aberrometer with the variance of coefficients calculated using a mathematical method for scaling the expansion coefficients to reconstruct wavefront aberration for a reduced-size pupil.
  
  
  RESULTS
  Wavefront aberration exhibits a marked variance of the order of 0.45 microns near the edge of the pupil whereas the central part appears to be measured more consistently. Dispersion of Zernike expansion coefficients was lower when calculated by the scaling method for a pupil diameter of 3 mm as compared to the one introduced when only the central 3 mm of the Shack - Hartmann image was evaluated. Signal-to-noise ratio was lower for higher order aberrations than for low order coefficients corresponding to the sphero-cylindrical error. For each subject a number of Zernike expansion coefficients was below noise level and should not be considered trustworthy.
  
  
  CONCLUSIONS
  Wavefront aberration data used in clinical care should not be extracted from a single measurement, which represents only a static snapshot of a dynamically changing aberration pattern. This observation must be taken into account in order to prevent ambiguous conclusions in clinical practice and especially in refractive surgery.
authors.affiliation: Vardinoyiannion Eye Institute of Crete (VEIC), Department of Ophthalmology, School of Medicine, University of Crete, Heraklion, Crete, Greece. ginis@med.uoc.gr
authors.forename: Harilaos S
authors.initials: HS
authors.lastname: Ginis
authors.forename: Sotiris
authors.initials: S
authors.lastname: Plainis
authors.forename: Aristophanis
authors.initials: A
authors.lastname: Pallikaris
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods; D009216:Myopia / Q000175:diagnosis* / Q000601:surgery; D011680:Pupil; D015203:Reproducibility of Results