title: Dependence of wave front refraction on pupil size due to the presence of higher order aberrations.
abstract: OBJECTIVE
  Propagation of light through the optical pathway within the eye can lead to a deformation of the wave front that might affect objective but also subjective refraction depending on pupil size. The aim of this study was to investigate the change in wave front refraction that is calculated on the basis of second order Zernike polynomials when varying the pupil size from 6 mm to 3 mm. The change was correlated with the amount of fourth and sixth order spherical aberration and fourth and sixth order astigmatism.
  
  
  METHODS
  Wave front aberrations were measured in 130 eyes by means of a Tscherning wave front sensor at a pupil size of 6 mm. Wave front aberrations in terms of Zernike coefficients up to sixth order were approximated for 6 mm and 3 mm pupil size. The wave front refraction was calculated based on the second order Zernike coefficients for both pupil diameters. Resulting differences in wave front refraction (sphere or cylinder) due to the change in pupil size were correlated with the initial higher order aberrations determined for the 6.0 mm pupil by means of a linear regression (Spearman rank correlation coefficient).
  
  
  RESULTS
  The correlation between the change in sphere and cylinder on one hand and the spherical aberration and higher order astigmatism on the other hand was found to be highly significant (p<0.001), with a correlation coefficient of R = 0.96 for sphere and R = 0.85 for cylinder.
  
  
  CONCLUSIONS
  Calculating the wave front refraction on the basis of second order Zernike polynomials is plagued with the influence of the higher order aberration preexisting in the individual eye. This is one reason why this method does not represent precisely enough subjective refraction. Other methods that calculate the refraction based on wave front measurement independent from the pupil size should be established in the ophthalmic community.
authors.affiliation: IROC Institute of Refractive and Ophthalmic Surgery, Zurich, Switzerland. hanspeter.iseli@iroc.ch
authors.forename: H P
authors.initials: HP
authors.lastname: Iseli
authors.forename: M
authors.initials: M
authors.lastname: Bueeler
authors.forename: F
authors.initials: F
authors.lastname: Hafezi
authors.forename: T
authors.initials: T
authors.lastname: Seiler
authors.forename: M
authors.initials: M
authors.lastname: Mrochen
mesh_terms: D000293:Adolescent; D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011680:Pupil / Q000502:physiology*; D012029:Refraction, Ocular / Q000502:physiology*; D012030:Refractive Errors / Q000503:physiopathology*