title: Operator-induced errors in Hartmann-Shack wavefront sensing: model eye study.
abstract: OBJECTIVE
  To evaluate the effects of instrument realignment and angular misalignment during the clinical determination of wavefront aberrations by simulation in model eyes.
  
  
  METHODS
  Aston Academy of Life Sciences, Aston University, Birmingham, United Kingdom.
  
  
  METHODS
  Six model eyes were examined with wavefront-aberration-supported cornea ablation (WASCA) (Carl Zeiss Meditec) in 4 sessions of 10 measurements each: sessions 1 and 2, consecutive repeated measures without realignment; session 3, realignment of the instrument between readings; session 4, measurements without realignment but with the model eye shifted 6 degrees angularly. Intersession repeatability and the effects of realignment and misalignment were obtained by comparing the measurements in the various sessions for coma, spherical aberration, and higher-order aberrations (HOAs).
  
  
  RESULTS
  The mean differences between the 2 sessions without realignment of the instrument were 0.020 microm +/- 0.076 (SD) for Z(3)(-1)(P = .551), 0.009 +/- 0.139 microm for Z(3)(1)(P = .877), 0.004 +/- 0.037 microm for Z(4)(0) (P = .820), and 0.005 +/- 0.01 microm for HO root mean square (RMS) (P = .301). Differences between the nonrealigned and realigned instruments were -0.017 +/- 0.026 microm for Z(3)(-1)(P = .159), 0.009 +/- 0.028 microm for Z(3)(1) (P = .475), 0.007 +/- 0.014 microm for Z(4)(0)(P = .296), and 0.002 +/- 0.007 microm for HO RMS (P = 0.529; differences between centered and misaligned instruments were -0.355 +/- 0.149 microm for Z(3)(-1) (P = .002), 0.007 +/- 0.034 microm for Z(3)(1)(P = .620), -0.005 +/- 0.081 microm for Z(4)(0)(P = .885), and 0.012 +/- 0.020 microm for HO RMS (P = .195). Realignment increased the standard deviation by a factor of 3 compared with the first session without realignment.
  
  
  CONCLUSIONS
  Repeatability of the WASCA was excellent in all situations tested. Realignment substantially increased the variance of the measurements. Angular misalignment can result in significant errors, particularly in the determination of coma. These findings are important when assessing highly aberrated eyes during follow-up or before surgery.
authors.affiliation: School of Life and Health Sciences, Aston University, United Kingdom.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cervino
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Hosking
authors.forename: Mark C M
authors.initials: MC
authors.lastname: Dunne
mesh_terms: D002138:Calibration; D003951:Diagnostic Errors; D006801:Humans; D008954:Models, Biological; D015588:Observer Variation; D012030:Refractive Errors / Q000175:diagnosis*; D015203:Reproducibility of Results; D015351:Vision Screening / Q000295:instrumentation*