GB2428813A

GB2428813A - Vision test chart

Info

Publication number: GB2428813A
Application number: GB0619264A
Authority: GB
Inventors: Michel Guillon; Marine Emmanuelle Gobbe
Original assignee: Individual
Current assignee: Individual
Priority date: 2003-02-12
Filing date: 2004-02-12
Publication date: 2007-02-07
Anticipated expiration: 2024-02-12
Also published as: GB2428813B

Abstract

A test chart suitable for measuring the effects of higher order aberrations, having images that are deformed with higher order aberrations.

Description

METHODS & LENS The present invention relates to a method for designing

lenses, particularly contact lenses, to correct vision. The method is also applicable to designing appropriate refractive surgery to correct vision. In a further aspect it relates to lenses to correct vision that may include corneal onlay lenses, corneal inlay lenses and intra-ocular lenses and in a still further aspect, the present invention relates to a method of surgery to correct vision.

Correction of vision includes an improvement in vision when measured quantitatively by known techniques and/or to the qualitative improvement of "seeing better" as described by the subject.

A large proportion of the population has vision that is less than optimum due to the presence of refractive abnormalities (known as aberrations) in the eye. In the absence of aberrations, all rays of light from any point in object space that are refracted by the optical system of the eye, will focus at one point in the image plane. However, in the presence of aberrations, some of the rays do not focus at the expected image point but intersect the image plane in a spread-out pattern such that the quality of the image is degraded.

The most well known of these aberrations are defocus and astigmatism which are collectively referred to as refractive errors. These are known as second-order aberrations and are conventionally corrected by the use of spectacles, contact lenses, intra-ocular lenses, inlays, onlays and the like. Surgical procedures, which may be used to correct the second order aberrations, include cataract removal, keratoplasty (corneal replacement), laser assisted in-site keratomileusis (LASIK), laser epithelial keratomileusis (LASEK), photorefractive keratectomy (PRK) and the like. LASIK and LASEK involve sculpting the cornea using an excimer laser.

Whilst these devices and surgical methods are able to assist and often correct these second-order aberrations, the eye may additionally include higher-order forms of aberrations which go beyond refractive error and which degrade the quality of the retinal image. It has been suggested that after defocus and astigmatism have been corrected it is these residual higher order aberrations that most affect visual performance.

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These higher order aberrations include spherical aberrations and coma aberrations. Spherical aberrations occur where the lens does not focus parallel rays to a point but instead focuses them along a line and as such is described as the failure of rays of light to unite at the paraxial focus.

The further a ray of light is from the optical axis, the further its axial crossing point is from the image plane. Coma aberrations occur because off-axis rays do not converge at the focal plane.

Thus they are present at the fovea and are due to the lack of rotational symmetry of the eye about an appropriate reference axis. Other higher order aberrations may be present including secondary astigmatism, trefoil aberrations, tetrafoil aberrations and the like. These higher order aberrations may occur naturally or may be introduced during surgical techniques such as LASIK or LASEK or by pathological conditions such as keratoconus.

Many studies have been carried out to try to measure and analyse the monochromatic aberrations in the human eye. All authors are agreed that the aberrations differ greatly between patients and that they are dependant on the size of the pupil. With a view to improving treatments for patients and improving their vision, methods have been developed for correcting these higher order aberrations and it has been shown in the laboratory that contrast sensitivity and resolution can be improved. Recently customised refractive procedures have been used to correct individual aberrations. In general, these methods involve the measurement of higher order aberrations and the transfer of the data relating to the aberrations to either the machines which produce, for example, contact lenses or intra ocular lenses or to the laser software which is used in surgery to correct the eye. In this later example the transfer of data enables the corneal ablation profile to take into account not only the sphere and cylinder aberrations but also the higher-order aberrations such that the use of a small computer-controlled excimer spot laser enables local areas of the cornea to be ablated as required to correct the aberrations of the eye.

One example of the technique of measuring higher order aberrations and utilising the data to design lenses can be found in US 6499843 which is incorporated herein by reference. In the described processes, the aberrations present in a patient's eye are measured using ocular wavefront aberration measurement techniques. This data is then transmitted to custom contact lens manufacturing facility which produces lenses to the required specification. The measured wavefront aberrations are preferably third and higher order aberrations and more preferably up to a fourth to tenth order aberrations.

Other examples of processes which measure these higher order aberrations include US 6086204, US 6338559 and US 6305802 which are additionally incorporated herein by reference.

Whilst these methods offer appropriate methods for treating such higher order aberrations, they do not recognise that different types of higher order monochromatic aberrations produce different effects on visual performance.

The effects of defocus and astigmatism, which are reported in diopters, are well known to the clinician. However, unlike defocus, the effect of higher order aberrations, which are described in micrometers, on visual performance has not, to date, been known. The amount of higher order aberrations in the human eye is usually described by a single number known as the Root Mean Square (RMS) wavefront error. The RMS is calculated from individual Zemike coefficients.

The aberrations of a general optical system can bc represented by a wavefront aberration polynomial: W (p,O), which value depends on the coordinates (p,O) in the pupil plane. Zernike polynomials are used to describe aberrations, as they facilitate the description of higher order aberrations; they are a set of complete orthogonal polynomials defined on a unit circle. The Zemike polynomials can be conveniently written in polar coordinates (p,e), where p is the radial coordinate ranging from 0 to I and 0 is the azimuthal component ranging from 0 to 211. They are defined as: r \/i) Rm (p) cos mO for m > 0 zm = \JjjTJ) Rm (p) sin mO for m <0 L \/iiT) Rm (p) for Each of the Zernike consists of three components: a normalization factor \1i5, a radial dependent component (Ram), and an azimuthal component. The radial component is a polynomial function, whereas the azimuthal component is a sinusoidal function.

The wavefront can be written as follow: W (p,O) = Zn * Zn (p,0) where Zn is the Zernike coefficient and Zn (p,O) the Zernike polynomial which depends on the pupil coordinates.

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Whilst the RMS gives information about the amplitude of aberrations present, it does not give any information about the effect provided by the different components of the RMS. Thus when a clinician evaluates a RMS chart, the same importance is given to the RMS of each individual Zemike coefficient, regardless of the type of aberration present.

In conventional approaches the overall aberrations of the eye are measured, for example by videoaberroscopy, in some circumstances this is combined with a measurement of cornea! front surface aberrations which may be measured by videokeratoscopy. From this measurement calculations can be made to correct all of the detected aberrations up to a certain order.

Maximum orders are often identified as fourth, sixth and tenth. It is believed that the correction of these higher order aberrations provides a higher visual performance than can be achieved by conventional corrections.

However, one problem with this approach is that it does not consider whether the higher order aberrations present are high enough to produce a significant loss of visual performance such that their correction will not achieve a noticeable improvement in vision. A further problem is that it is assumed that optical effects and visual effects are synonymous such that the visual effect of the higher order aberrations is measured by the optical effect of these aberrations. It is now believed that these conventional viewpoints may be incorrect.

Another aspect overlooked by current technology is that the process of accurately correcting the higher order aberrations is complex involving firstly an accurate measurement of the aberrations and secondly an accurate correction. Both the measurement techniques and the correction techniques are not perfectly accurate or repeatable and thus it is now believed that it may not be appropriate to correct all aberrations measured regardless of their visual effects, due to the limited reliability of their determination. In particular it is noted that the measurement of individual corneal aberrations is not totally repeatable, the measurement of individual overall aberrations is not totally repeatable, that there is no standardised methodology to measure higher order aberrations of contact lenses as per the International Standard Organisation and that the resurfacing of the cornea by either surgical methods such as PRK or LASIK is not fully predictable. PRK produces an inflammatory cornea! response that is variable amongst individual

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patients and leads to a final correction at times which is grossly different to the intended correction. LASIK produces the correction deep within the corneal tissues but its effect takes place at the corneal front surface and the molding of the surface where the treatment is applied by the overlying corneal flap is not fully understood.

It has now been discovered that the effects of higher order aberrations should be evaluated in terms of their effects on vision and their correction and the order of corrections should be decided based upon these criteria. In particular, it has now been discovered that the blur created by the same level of Zemike coefficient of each specific aberration will have a different optical effect and will not affect the visual performance in the same way. Similar conclusions can be drawn where alternative methods of considering higher order aberrations are used such as Point Spread Function are used. The present invention takes note of this and provides methods that enable a different importance to be attributed to each individual Zernike coefficient and in particular the visual effect of different higher order aberrations to be normalised in relation to the visual effect produced by defocus, the effects of which are well understood.

Thus according to a first aspect of the present invention there is provided a process in which the visual effect of different higher order aberrations are normalised in relation to the visual effect produced by defocus.

According to the second aspect of the present invention there is provided a correcting factor that will normalise the RMS with regard to the effect on visual performance in order to obtain a Visual Performance Detrimental Factor (VPDF) rather than relying on the total RMS. To establish the relative visual effect of the different aberrations, vision test charts were distorted by different higher order aberrations, all distortion having an equal optical value defined by an equal RMS.

One method to normalise the visual effects of higher order aberrations is to deform images, for example test charts, with higher order aberrations of fixed optical effects, for example, the same level of wavefront error RMS. The effects can then be compared to the visual effects of such distortions with those produced with different levels of defocus. One alternative means of 4 4 achieving the distorted images is to use a deformable mirror.

Thus according to a third aspect of the present invention there is provided a test chart suitable for measuring the effects of higher order aberrations wherein the images are deformed with higher order aberrations of fixed optical effects, defined by equal Zernike or other optical means.

Test charts distorted by defocus of several RMS values as well as test charts distorted with higher order aberrations were produced. The relative readability of the charts was then measured by a test panel of subjects who read all the charts. The relative readability was quantified in terms of relative visual loss compared to an undistorted vision test chart viewed under the same conditions.

According to a fourth aspect of the present invention there is provided a method of testing for the effects of higher order aberrations comprising the steps of: (a) showing at least one test chart of the above-mentioned third aspect of the present invention to a test subject; (b) noting the visual effects of the distortions; and (c) comparing the relative readability of such distorted charts by a test panel of subjects who read or who have read all the charts.

In an alternative arrangement, there is provided a method of testing for the effects of higher order aberrations comprising the steps of: (a) showing at least one test chart having distortion to a test subject; (b) noting the visual effects of the distortions; and (c) comparing the relative readability of such distorted charts by a test panel of subjects who read all the charts.

The distortion of the at least one test chart can be achieved by any suitable means.

A model has been validated to establish the relative visual effect of the third and fourth orders aberrations as given below. II I.

RMS = SQRT( 1.1* (Z42) 2 1.1*(Z42) 2 07* (Z3' 2 07* (Z3' ) 2 0.8* (Z40) 2 +o*5* (Z33) 2 05* (Z33) 2 0.3*(Z) 2 0.3*(Z44) 2 A further model has been validated to establish the relative visual effect of the third, fourth, fifth and sixth order aberrations as given below.

RMS = SQRT( 1.1* (Z42) 2 l.l*(Z42) 2 07* (Z3' 2 07* (Z3' 2 0.8* (Z40) 2 +0.5* (Z33) 2 05* (Z33) 2 0.3*(Z4) 2 O3*(Z44)2 + 1.2* (Z62)2+ 1.2* (Z62) 2 Li * (Z53) 2 + 1.1 * (Z53) 2 + 1.0 * (Z5 2 + 1.0 * (Z5' 2 + 0.9* (Z60) 2 + 0.9* (Z6) 2 + 0.9* (Z64) 2 5* (Z55) 2 05* (Z55) 2 03*(Z 6) 2 0.3*(Z66) 2 Models can be developed up to the tenth order. Different models may be arrived at by the same technical approach for different populations. These models fall within the scope of the present invention.

The VPDF can be calculated for a given pupil as the loss in visual acuity compared to the best corrected visual performance. The following steps are used in order to calculate the VPDF: * Calculation of visual loss compared to baseline performance, which is the best corrected visual acuity, for high contrast and low contrast letters.

Visual Acuity loss = Best corrected Visual Acuity - Visual Performance measured * Calculation of the mean Visual Acuity loss for high and low contrast charts Mean Visual Acuity loss = ((Visual Acuity loss High Contrast) + (Visual Acuity loss Low Contrast)) /2 * Calculation of the mean visual acuity loss for all the individual Zemike coefficients * Calculation of the VPDF for each individual Zernike coefficients VPDF (Zx) = (Mean Visual Acuity loss for Zx) / (Mean Visual Acuity loss for defocus) VPDF can alternatively be developed for charts with different contrasts and alternative techniques to calculate visual loss can be used. I,

The VPDF is calculated for each individual Zernike coefficients and for specific pupil sizes.

By the recognition of the different effects provided by the various aberrations the clinician can decide which require treatment and which can be left untreated as their effect on vision is minimal. In particular, the decision as to whether or not to correct and which aberrations to correct include the quantification of the effect of correcting such higher order aberrations.

According to a fifth aspect of the present invention there is provided a method for designing a custom lens having a spherical back surface which is tailored for the relative visual effect of different types of aberrations. The method comprises the steps of: (a) measuring total ocular higher order aberrations; (b) calculating the front surface correction needed in terms of Zemike coefficients; (c) converting the correction using the Visual Performance Detrimental Factor; (d) obtaining the relevant higher order aberrations for correction; and (e) obtaining the optimised design for the front surface of the lens.

* The custom lens may be a contact lens, preferably a soft or rigid contact lens, an inlay, an onlay or an intra-ocujar lens.

The total ocular higher order aberrations may be measured by any suitable method. Suitable methods include the use of a wavefront sensor but may include other techniques including phase * diversity techniques. A particularly suitable method is described in US 6305802 which is incorporated herein by reference.

The front surface correction needed in terms of Zemike coefficients can also be calculated by any suitable technique and again a suitable technique is described in US 6305802.

The VPDF, calculated according to the above first aspect can then be used to obtain the relevant higher order aberrations for which correction will be appropriate and an appropriate lens can then be prepared by known techniques.

In a sixth embodiment of the present invention the VPDF is used to optimise the design of both the front and back surface of the lens. In this arrangement the method comprises the steps of: (a) measuring total ocular higher order aberrations; (b) measuring ocular aberrations generated by irregularities of the corneal topography; (c) calculating the back surface design; (d) calculating the back surface correction needed in terms of Zernike coefficients; (e) converting the correction of (d) using the Visual Performance Detrimental Factor; (f) calculating the residual aberrations; (g) calculating the front surface correction needed in terms of Zernike coefficients; (h) converting the correction of(g) using the Visual Performance Detrimental Factor; (i) obtaining the relevant higher order aberrations for correction; and (j) obtaining an optimised design for the front and back surface of the lens.

The steps of this sixth aspect of the present invention which are the same as those of the above- mentioned second aspect may be carried out in the same or different manner.

The corneal topography which will illustrate irregularities of the front surface of the cornea can be measured using any method.

The calculation of the back surface design may be carried out with an assumption that the corneal aberrations are reduced to zero. In one alternative, the calculation may assume that the back surface of the lens creates new aberrations or that there are still further aberrations from the corneal surface.

* The calculation of the residual aberrations in step (g) may be the total minus the corneal aberrations or in one alternative may be a calculation taking the back surface aberrations into account.

The methods of the second and third aspects of the present invention may be further customised to take account of the actual subject's pupil size under determined lighting condition, usually low

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luminance.

In a further modification, the methods may include fitting the subject with a trial contact lens, measuring contact lens decentration and then compensating accordingly. In particular, the aberrations produced by the absence of coaxiality between the contact lens and the pupil of the eye may be considered. The trial contact lens may be of a similar design to a contact lens which will be subsequently prescribed. The lens may include correction for defocus to match the patient's requirements or a standard lens may be used. The trial lens is preferably allowed to equilibrate before the decentration is measured. Measurement of contact lens decentration and the subsequent compensation may be carried out by any suitable method. One example of a suitable method is described in US 6499843 which is incorporated herein by reference.

According to a seventh aspect of the present invention there is provided a lens produced to correct the relative visual effect of different types of aberrations in which the visual performance detrimental factor has been considered. The lens may be a contact lens, an inlay, an onlay or an intra-ocular lens but is preferably a gas permeable contact lens. The lens may have a spherical or aspherical back surface. The lens is preferably designed using the method of the second or third aspect of the present invention. The lenses will be produced by any suitable method. Suitable * methods include laser ablation, lathing, cast-moulding or machining.

Whilst the present invention has been described above with reference to custom making a lens to a particular patient's requirements, the premise of the invention may also be applied to the design of a lens which can be more widely used. These lenses (and particularly those detailed below) * may, or may not, include the VPDF correction. According to an eighth aspect of the present invention there is provided a lens, particularly a contact lens, which can optimise the higher order aberration correction by producing the inverse aberration to the population mean aberration for rotationally symmetrical aberrations of third to tenth orders, most particularly the fourth to sixth orders. (Spherical Aberration: Z12 Z40; and Z24 Z60). The benefits of such designs include optimising the optical correction for the population average without changing the contact lens fitting technique for population using rotationally symmetrical contact lens and maintaining the comfort achieved by current "spherical" contact lenses.

The lens of this arrangement may be a rigid contact lens. Rigid lenses maintain their shape without support and either do not deform when positioned in the eye or deform by a minimum amount. Rigid contact lenses are particularly useful in the correction of myopia and hyperopia particularly where significant levels of astigmatism are present.

The ninth aspect of the present invention provides a lens, particularly a contact lens, which can optimise the higher order aberration correction by producing the inverse aberration to the population mean aberration for rotationally and non-rotationally symmetrical aberrations of third to tenth orders, most particularly the fourth to sixth orders. (Coma Z7 Z3' and Z8 Z3', Secondary astigmatism Z 11 Z42 and Z 13 Z42, Spherical Aberration: Z 12 1?; and Z23 Z2 and Z25 Z642 Z24 Z60). The benefits of such designs include optimising the optical correction for the population average for populations currently using "spherical" and "toric" contact lenses, for those using toric contact lenses the result is achieved without changing the contact lens fitting technique and the comfort achieved by current toric contact lenses is maintained.

* In a specific arrangement for "toric" contact lenses, the correction of higher order non rotationally symmetrical aberrations for the average population is particularly recommended as such rotationally symmetrical aberrations are correlated to the astigmatism present and greater than for populations with low levels of astigmatism and habitually corrected by "spherical" contact lenses.

* The back surface of the contact lens may be spherical such that it is the front surface of the lens which is designed to achieve the targeted correction. In the eight and ninth aspects of the present invention, the back surface may be toric. Toric contact lenses are usually used to correct astigmatism at least equal to 0.75 dioptre. In an alternative arrangement the back surface of the lens may be multi-spherical or multitoric to achieve the desired fitting characteristics.

In an alternative modification, the back surface of the lens may be formed to neutralise the mean cornea! rotationally symmetrical aberrations. In this arrangement the front surface is designed to achieve the desired correction. This alternative modification is particularly useful for soft contact lenses which change shape when placed on the eye. The change in shape depends upon the mechanical properties of the lens which are influenced by the rigidity of the contact lens material and the profile of the lens and the relative geometry of the contact lens back surface and cornea! front surface. Matching the mean corneal front surface rotationally symmetrical aberrations minimises the effect of the shape of the lens on the eye.

In a still further alternative modification, the back surface of the lens may be designed to optimise the mechanical fit of the lens. In this arrangement the front surface is designed to achieve the targeted correction. Spherical or non-spherical surfaces such as aspheric surfaces, rotationally symmetrical surfaces such as certain polynomial progressions or other continuous or non- continuous surfaces may be used. For the second alternative arrangement the spherical, multi- spherical and multi-non-spherical surfaces may be used alone or in combination.

In this connection it should be noted that if a good visual performance is to be achieved, the lens should have a good mechanical fit. This is particularly important where aspheric surfaces are present. It is well known in the art that in order to achieve optimal fit it may be necessary to modify the contact lens back surface which may lead to its shape not matching the front surface of the cornea.

Whichever design is selected for this seventh to ninth aspect of the invention, the design may be custom made or may be suitable for the whole population or in one alternative, a series of designs may be provided to optimise the results for sub-populations based on the ocular, such as corneal topography, and/or refractive characteristics and/or for demographics, such as age.

In one arrangement, rotationally symmetrical contact lens design is provided which achieves improved optical results by incorporating the correction of Z 12 and Z24 aberrations and possibly all higher order rotationally symmetrical aberrations.

The rotationally symmetrical aberrations are preferably correlated to the refractive error. The mean rotationally symmetrical aberration is different for different spherical refractive error, in particular for high myopic corrections. In a second arrangement, a mean correction of rotationally symmetrical aberrations that would differ for different prescriptions may be incorporated in the design.

The non rotationally symmetrical aberrations are preferably correlated to the cylindrical refractive error. In particular, for higher cylinders (>1. 25D) the mean of these aberrations is significantly greater than for low cylinders. In a third arrangement, a mean correction of not rotationally symmetrical aberrations that would differ with different cylindrical prescriptions is incorporated in the design.

For simultaneous vision bifocal contact lenses, it is generally essential to optimise the quality of both the distance and near images. In a fourth arrangement, the correction of aberrations as suggested in second and third arrangement can be incorporated in such designs. This correction is applicable to concentric type bifocal in particular multi-ring bifocal.

Further, one of the higher order aberrations, spherical aberration Z 12, has been shown to increase with age. In a further arrangement, a different level of aberration correction can be incorporated in the designs for presbyopes compared to non-prebyopes younger population. Such consideration is particularly suitable for the design of bifocal contact lenses.

In a fifth arrangement, different levels of higher order aberrations correction can be incorporated into a bifocal contact lens (to correct presbyopia) for early to medium presbyopes which are generally of up to 55 years of age or having up to + 1. 75D addition and for established presbyopes which are generally over 55 years of age or have an addition of +2.OOD and above.

In a sixth arrangement, different levels of higher order aberrationcorrection can be incorporated in rotationally symmetrical bifocal contact lens designs (to correct presbyopia) for early to medium presbyopes which are generally of up to 55 years of age or having up to + l.75D addition and for established presbyopes which are generally over 55 years of age or have an addition of 2.OOD and above.

In a seventh arrangement, a rotationally symmetrical bifocal can be provided in which the correction of spherical aberration (e.g.Z4 (Z 12)), which is achievable without need for rotational stabilisation will be of a greater magnitude for established presbyopes (eg: over 55 years of age or +2.00 addition or above) than for early to medium presbyopes (eg: up to 55 years of age or up to +1.75D addition).

In an eighth arrangement, the determination of the level of rotationally symmetrical aberrations to correct for rotationally symmetrical single vision contact lenses for an average population needs to be measured with a population of up to 55 years old to match the usual contact lenses population demographics.

In a ninth arrangement, different levels of overall higher order aberrations correction will be incorporated in non rotationally symmetrical bifocal contact lenses designs (to correct presbyopia) for early to medium presbyopes (up to 55 years old of age or up to +1.75D addition) and for established presbyopes (over 55 years of age or addition +2.OOD and above).

In a tenth arrangement, a non rotationally symmetrical bifocal can be provided in which the correction of aberrations, in particular Z3 (Z7), will be of a greater magnitude for established presbyopes (eg: over S5years of age or +2.00 addition or above) than for early to medium presbyopes (eg: up to 55 years of age or up to +1.75D addition).

In an eleventh arrangement, the determination of the level of rotationally and non rotationally symmetrical aberrations to correct for non rotationally symmetrical single vision contact lenses for an average population is determined with a population of up to 55 years old to match the usual contact lenses population demographics.

In a twelfth arrangement, different mean level of aberration corrections is incorporated into a lens for a different range of corrections to optimize optical performance. In particular, different levels of rotationally symmetrical aberration corrections are incorporated in the design of symmetrical contact lenses.

When producing the lenses of the seventh to ninth aspect it may be desirable to take the moulding of the lens on the average front surface of the cornea into consideration. Any suitable level of moulding may be taken into consideration including: no moulding in the case of a very rigid lens;

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total moulding in the case of a very flexible lens; and partial moulding in the case of soft lenses with intermediate moulding characteristics.

In order to further optimise the design of the lens of the seventh to ninth aspect of the present invention, it may be desirable to carry out an in vitro trial. The trial will comprise the steps of: (a) constructing a lens of the fifth aspect of the invention; (b) placing the lens on a reference corneal surface; (c) measuring the front surface of the lens on the reference corneal surface; (d) calculating the true moulding for the lens; and (e) calculating the modified design from the data.

The reference corneal surface may be produced from any suitable material including plastics such as Perspex, glass, or other rigid or semi-rigid materials.

The steps of the trial can be repeated as often as is necessary until the design is optimised.

Additionally or alternatively the design of the lens of the seventh to ninth aspect of the present invention may be optimised using an in vivo clinical trial. The clinical trial will comprise the steps of: (a) constructing a lens of the fifth aspect of the invention; (b) selecting a test population representative of the mean of the target or targets populations; (c) measuring the front surface of the lens fitted on the test population; (f) calculating the true moulding for the lens; and (d) calculating the modified design from the data.

Whether the in vivo or in vitro optimisation trials are used, or both, the front surface of the lens may be measured by any suitable techniques. Suitable techniques include videokeratoscopy and interferometry. II I.

The lens of the above-mentioned seventh to ninth aspect of the present invention may include any * of the conventional lens design features such as those used to achieve lens stabilisation on the eye. Such lens design features include, but are not limited to, prism ballast, truncation, peripheral thinning, slab off, double slab off. One or more of these features may be present.

According to a tenth aspect of the present invention there is provided a method for designing a * surgical procedure which is tailored for the relative visual effect of different types of aberrations.

The method comprises the steps of: (a) measuring total ocular higher order aberrations; (b) calculating the correction needed in terms of Zernike coefficients; (c) converting the correction using the Visual Performance Detrimental Factor; (d) obtaining the relevant higher order aberrations for correction; and (e) obtaining the optimised design for the lens.

According to a eleventh aspect of the present invention there is provided a method of ocular surgery comprising the steps of: (a) measuring total ocular higher order aberrations; (b) calculating the correction needed in terms of Zernike coefficients; (c) converting the correction using the Visual Performance Detrimental Factor; (d) obtaining the relevant higher order aberrations for correction; (e) obtaining the optimised design for the front surface of the lens; and.

(f) carrying our corresponding surgery.

Any suitable method of surgery may be used. The surgery may be refractive surgery or may be moulding. Particularly suitable methods include PRK, LASIK and LASEK.

The present invention will now be described for exemplification purposes only with reference to the following examples and figures in which: Figure 1 is a graphic representation of the Mean ± 2SE for RMSHO, *1 RMS3, RMS4, RMS5, RMS 6 and RM124 of Table 1; Figure 2 is a graphic representation of the Mean ± 2SE for Z12, Z24, Z7, Z8, Zi I and Z13 of Table 1; Figure 3 is a graphic representation of the Mean ± 2SE for RMSHO, RMS3, RMS4, RMS5, RMS 6 and RM124 of Table 2; Figure 4 is a graphic representation of the Mean ± 2SE for Z12, Z24, Z7, Z8, Zi I and Z13 of Table 2; Figure 5 is a graphic representation of the Mean ± 2SE for RMSHO, RMS3, RMS4, RMS5, RMS 6 and RM124 of Table 3; and Figure 6 is a graphic representation of the Mean ± 2SE for Z12, Z24, Z7, Z8,Zl1 andZl3ofTable3.

Example 1

The objective of the example was to assess the effects of specific higher order aberrations on visual performance and compare it to the effects of spherical defocus. In the example, distorted visual acuity charts were generated for each specific aberration corresponding to a specific Zernike coefficient. The visual performance measured with those charts was compared to that of spherical defocus as it is the defect commonly corrected by spectacles or contact lenses. All charts were blurred by the same total amount of aberrations.

The baseline visual performance was determined with best corrected spherocylindrical refraction and was used as a reference to assess the visual loss due to defocus and higher order aberrations.

Calculations of VPDF are shown for a 6 mm pupil.

Visual Visual Loss - Visual Visual Loss - Performance - High Contrast Performance - Low Contrast High Contrast Low Contrast Optimal +1.0 -1.0 Defocus 0.25D -1.6 -2.6 -2.7 -1.7 Defocus 0. 50D -4.2 -5.2 -5.2 -4.2 * Defocus 0.75D -5.4 -6.4 -6.8 -5.8 Data given in VA unit = -10 LogMAR (0=20/20, positive values >20/20; negative values <20/20) 1 VA unit = 1 VAline * The mean visual loss for a 6 mm pupil for high and low contrast letters for a defocus of 0.5 diopters was -4.7 VA lines as calculated by (-5.2 for high contrast + -4.2 for low contrast)/2.

Visual Visual Loss Visual Visual Loss Mean Visual Correcting Performance High Performance Low Loss Factor High Contrast Low Contrast Contrast Contrast DefocusZ2 -4.62 -5.62 -5.54 -4.54 -5.08 1.1 Secondary -4.56 -5. 56 -5.44 -4.44 -5.00 1.1 Astigmatism 7 - Secondary -4.18 -5.18 -5.17 -4.17 -4.67 1 Astigmatism L4 ComaZ3' -2.42 -3. 42 -4.34 -3.34 -3.38 0.7 Coma Z3' -2.36 -3.36 -4.38 -3.38 -3.37 0.7 Spherical -2.12 -3.12 -5.33 -4.33 -3.72 0.8 Aberration L..4 TrefoilZ33 -0. 63 -1.63 -3.66 -2.66 -2.14 0.5 Trefoil Z33 -0.50 -1.50 -3.83 -2.83 -2.16 0.5 Tetrafoil Z4' -0.16 -1.16 -2.79 -1.79 -1.47 0.3 TetrafoilZ44 -0.06 -1. 06 -2.72 -1.72 -1.39 0.3 The RMS value for higher order aberrations is normally calculated as follows: RIvIS = sq root ((Z42)2 + (Z42)2 + (Z31)2 + (Z3')2 + (Z40)2 + (Z33)2 + (Z33)2 + (Z4')2 + (Z44)2) The RMS corrected for visual factor will vary depending on the pupil size. For the example of a 6 mm pupil size, the RMS will be calculated as follows: RMS = sq root (l. 1*(Z42)2 + 1.1*(Z42)2 + O.7*(Z3I)2 + O.7(Z3')2 + O.8*(Z40)2 + O.5*(Z33)2 + + O.3(Z4)2 + O.3*(Z44)2) For different pupil size, the correcting factor will be different and therefore the RMS calculation will differ.

By comparing the effect of specific higher order aberrations on visual performance, it was found that different types of higher order aberrations affected visual performance differently.

It was noted that each individual Zemike term produced a different effect on visual performance.

The relative effect of each individual Zernike term did not vary with pupil size or the contrast of letters such that coefficients affecting visual performance the most or the least remained the same independently of the test conditions. At all pupil sizes and for high and low contrast letters, fourth order secondary astigmatism terms affected visual performance the least and less than spherical defocus.

In general, Zernike terms on the centre of the Zemike pyramid tended to affect visual performance more than terms on the edge of the pyramid. For third order terms, coma had a more important detrimental effect than trefoil terms and for fourth order terms spherical aberration and secondary astigmatism degraded visual performance more than trefoil terms.

Spherical aberration tended to have a more important detrimental effect on low contrast letters.

As the pupil enlarged, the specific effect of each aberration on visual performance became more obvious, especially for high contrast letters. The differences between high order effects of specific types of aberrations on visual performance were the highest (approximately 5VA lines on high contrast charts and approximately 3 VA lines on low contrast letters) for low luminance i.e. for larger pupils and thus for significantly higher amounts of higher order aberrations.

Example 2

Details of the experimental data to support the premises of the present invention are set out below.

OVERALL POPULATION Data

Three sets of data are given: i for the overall population; ii for the population with astigmatism 0.00 to 0.75D, conventionally corrected with a rotationally symmetrical soft contact lens (e.g. spherical contact lens); and iii for the population astigmatism greater than 0.75D corrected with a non rotationally symmetrical soft contact lens (e.g. toric soft contact lens).

For each variable the mean value and standard error of the mean are given in a tabular form. The 95% confidence interval is also given, in a graphical form for the same variables.

Descriptives - Overall population (All cylinder powers) see Table I and Figures 1 and 2. I,

Table I

N Mean LUM ________________ Statistic Statistic Std. Error 3.00 RMS HO (higher 424 469 018 order) RMS 3 424.338.013 RMS4 424.220.008 RMS5 424.149.009 RMS6 424.117.006 zl2o 424.096.006 z24o 424 -.009.003 z7o 424 -.110.010 Z80 424.006.009 ZilO 424 -.016.004 zl3o 424 -.029.005 _____ RMS 12&24 424.143.005 Descriptives - Cylinder up to 0.75 D - see Table 2 and Figures 3 and 4

Table 2

N Mean ________ ________________ Statistic Statistic Std. Error RMSHO 372.464. 018 RMS3 372.333.014 RMS4 372.218.009 RMS5 372.147.010 RMS6 372.117.007 z12 372.098.007 z24 372 -.010.003 z7 372 -.113.011 Z8 372.004.009 Zil 372 -.015.005 z13 372 -.030.005 RM124 372.145.005 ________ Valid N (listwise) 372 __________ __________ Descriptives - Cylinder >O.75D - see Table 3 and Figures 5 and 6

Table 3

N Mean ________ _______________ Statistic Statistic Std. Error RMSHO 52.504.055 RMS3 52.373.042 RMS4 52.234.025 RMS5 52.163.026 RMS6 52.118.017 z12 52. 087.018 z24 52 -.002.007 z7 52 -.088.034 Z8 52.020.029 Zil 52 -.016.016 z13 52 -.023.014 RM124 52.133.014 ________ Valid N (listwise) 52 __________ _________

AGE GROUP EFFECT Data

The data is given for three different age groups: i) non presbyopes (<45 years); ii) early to medium presbyopes (45 to 55 years); iii) established presbyopes (>55 years).

Three sets of data are given: 1) for the overall population; ii) for the population with astigmatism from 0.00 to 0.75D, conventionally corrected with a rotationally symmetrical soft contact lens (eg: Spherical contact lens); iii) for the population corrected with a non symmetrical rotational soft contact lens (eg: Tone contact lens).

AGE - Overall Population (All cylinder powers) - see Table 4

Table 4

Z1 2 <45 Yrs >55 Yrs 45-55 Yrs p1O.038 Mean 0.084 0.112 0.120 SNK (5%) _______________________________ ; Z8 >55 Yrs 45-55 Yrs <45 Yrs p=O.002 * Mean -0.052 -0.013 0.029 SNK(5%) AGE - Cylinder up to 0.75D - see Table 5

Table 5

* Z12 <45 Yrs 45-55 Yrs >55 Yrs p0.028 ___________________________________________ Mean 0.085 0.118 0.126 SNK(5%) ____________________________ Z8 >55 Yrs 45-55 Yrs <45 Years p0.005 ___________________________________________ Mean -0.060 -0.011 +0.024 SNK(5%) __________________ AGE - Cylinder >0.75D - see Table 6

Table 6

Z7 >55 Yrs 45-55 Yrs <45 Yrs p=O.028 Mean -0.207 -0.050 -0.008 SNK (5%) ____________________

REFRACTIVE ERROR Data

The data is given for five different refractive groups: i. Myopes -6.0 and above; ii. Myopes -3.0 to -6.00; iii. Myopes -0.50 to -3.00; iv. Emmetrope -0.25 to <0.75; v. Hyperopes +0.75 and above.

Three sets of data are given: i) for the overall population; ii) for the population with astigmatism from 0.00 to 0.75D, conventionally corrected with a rotationally symmetrical contact lens (eg: Spherical contact lens); iii) for the population corrected with a non symmetrical rotational contact lens (eg: Toric contact lens).

Refraction Groups - Overall population (All cylinder powers) - see Table 7

Table 7

RMS TOTAL HYP -3.0-.-6.O -O.50- -3.0O EMM <-6.0 p0.014 Mean 0.376 0.426 0. 516 0.530 0.586 SNK(5%) ____________________________________ RMS 3 HYP -3. 0--3-6.0 -0.50--3.00 EMM <.6.0 p=0.045 Mean 0.277 0.312 0.359 0.396 0.411 SNK (5%) RMS 5.6 HYP -3.0-. -6.0 EMM -0.50 - -3.0 <-6.0 p0.002 Mean 0.120 0.166 0.225 0.238 0.250 SNK (5%) _______________________________________________ Z12 -0.50 - -3.0 -3.0--, 6.0 <-6.0 EMM HYP p0.006 Mean 0.080 0.081 0.112 0.115 0.144 SNK (5%) Z8 HYP -0.50 - -3.0 -3.0-, -6.0 EMM -6.0< p0.019 Mean -0.062 0.001 0.018 0. 024 0.055 SNK (5%) ____________________________________________ Z24 -0.50 - -3.0 EMM HYP -3.0--. -6.0 -6.0< P=0.003 Mean -0.025 -0.018 -0.003 0.003 0.006 SNK (5%) Refraction groups- Cylinder up to O.75D - see Table 8

Table 8

RMS TOTAL HYP -3.0--, -6.0 -0.50 -, -3.0 EMM <-6.0 p=0.013 Mean 0.386 0. 407 0.522 0.524 0.597 SNK (5%) RMS 3 HYP.3.0-, -6.0 -0.50 -, -3.0 EMM <-6. 0 p0.042 Mean 0.28 1 0.296 0.364 0.394 0.403 SNK(5%) bl RMS 5-6 HYP -3.0-+ -6.0 EMM -0.5---3.0 <-6.0 p=0.003 Mean 0.124 0.159 0.212 0.241 0.267 SNK(5%) ________________________________________ Z12 -0.50 -. -3.0 -3.0- 6.0 EMM HYP <-6.0 p<0.001 Mean 0.076 0.081 0.117 0.153 0.159 SNK(5%) ___________________________ Z24 -0.50 - -3.0 EMM HYP -6.0< -3.0-±6.0 p0. 010 Mean -0.026 -0.016 -0.006 0.002 0.003 SNK(5%) Z7 -6.0< EMM -0.50 -. 3.0 -3.0 -* -6.0 HYP p0.027 Mean -0.219 -0.147 -0.135 -0.083 -0.080 SNK (5%) Z13 EMM -6.0< -0.50 - -3.0 -3.0 -+ -6.0 HYP p=0.002 Mean -0.084 -0. 043 -0.025 -0.021 -0.015 SNK (5%) Refraction groups - Cylinder> O.75D - No significant differences were observed.

For all cylinders for the overall population, none of the RMS of the higher order aberrations 95% confidence intervals included zero, demonstrating that for the average of the population these aberrations are significant. Thus correction of the higher aberrations quantified here will produce an improved optical characteristic for the overall population.

For the cylinder up to O.75D, none of the RMS of the higher order aberrations 95% confidence intervals included zero, demonstrating that for the average of the population these aberrations are significant. Thus it can be seen that rotationally symmetrical contact lens designs will achieve improved optical results by incorporating the correction of Z 12 and Z24 aberrations and possibly all higher order rotationally symmetrical aberrations.

For cylinder> O.75D, none of the RMS of the higher order 95% confidence intervals included zero, demonstrating that for the average of the population these aberrations are significant. Thus %l rotationally stabilised contact lens designs will achieve improved optical results for the population by incorporating the correction of the higher order aberrations quantified here.

The age group effect was then considered.

For all cylinders: Different levels of overall higher order aberrations correction will be incorporated in bifocal contact lens designs (to correct presbyopia) for early to medium presbyopes (up to 55 years old of age or up to +1.75D addition) and for established presbyopes (over 55 years of age or addition +2.OOD and above).

The overall comparisons of the individual Zemike coefficients were significant for Z34' (Z8) at low luminance (J)=O.002) and Z4 (Z12) (p=O. 038).

The individual comparisons for the two Zemike coefficients Z3 and Z4 revealed higher magnitude for the older age groups.

For the cylinder = 075D Different levels of overall higher order aberrations correction can be incorporated in rotationally symmetrical bifocal contact lens designs (to correct presbyopia) for early to medium presbyopes ( up to 55 years old of age or up to + 1.75D addition) and for established presbyopes (over 55 years of age or addition +2.OOD and above) .

The overall comparisons of the individual Zerrnke coefficients were significant for Z3 (Z8) at low luminance (p=O.005) and Z4 ( Z12) (p0. 028).

The individual comparisons for both Zernike coefficient revealed higher magnitude for the two presbyopic groups compared to the non presbyope group for Z' (Z7) and Z4 ( Z12) at low luminance.

Thus in rotationally symmetrical bifocal, the correction of Z4 (Z12) which is achievable without need for rotational stabilisation will be of a greater magnitude for established presbyopes (eg: over 55 years of age or +2.00 addition or above) than for early to medium presbyopes (eg: up to years of age orup to +l.75D addition).

Further the determination of the level of rotationally symmetrical aberrations to correct for rotationally symmetrical single vision contact lenses for an average population needs to be measured with a population of up to 55 years old to match the usual contact lenses population demographics.

For cylinder> 0.75D Different levels of overall higher order aberrations correction will be incorporated in non rotationally symmetrical bifocal contact lenses designs (to correct presbyopia) for early to medium presbyopes (up to 55 years old of age or up to +1.75D addition) and for established presbyopes (over 55 years of age or addition +2.OOD and above) .

The overall comparisons of the individual Zemike coefficients were significant for Z3 (Z7) at low luminance (p=0.028).

The individual comparisons for Zernike Z3' (Z7) coefficient revealed statistically significant higher coefficient for the older age group than for the younger groups for Z3 (Z7) at low luminance.

Thus in non rotationally symmetrical bifocal, the correction of aberrations, in particular Z3' (Z7) will be of a greater magnitude for established presbyopes (e.g.: over S5years of age or +2.00 addition or above) than for early to medium presbyopes (e.g.: up to 55 years of age or up to l.75D addition).

Further the determination of the level of rotationally and non rotationally symmetrical aberrations to correct for non rotationally symmetrical single vision contact lenses for an average population needs to be determined with a population of up to 55 years old to match the usual contact lenses population demographics. j,

Refractive error was then considered.

For all cylinders: i. The overall comparison revealed significant differences between corrections for the overall higher aberrations (p=O. 0l4), the third (p=O.045) and combined fifth and sixth (p0.002) order aberrations.

Individual comparisons between the different groups showed that the overall higher order; third and fifth and sixth order aberrations were lower for the hyperopic group than for the high myopes.

Thus different mean level of aberration corrections can be incorporated for different ranges of corrections to optimise optical performance.

ii. The Zemike coefficient Z8(p=O.O 19), Z 12 (p=O.006) & Z24(p=O.003) were overall significant * for the refractive group.

The cylinder up to O.75D: i. The overall comparison revealed significant differences between corrections for the overall higher aberrations (p=O.O 13), the third (p=O.O42) and combined fifth and sixth (p0.003) order * aberrations.

ii. The Zernike coefficient Z7 (p=O.019), Z12 (p<O.OO1), Zl3 (p=O.002), Z24 (pO.O1O) and Z7 (p=O.027) were overall significant for the refractive group.

Thus different level of rotationally symmetrical will be incorporated in the design of rotationally symmetrical contact lenses.

Claims

1. A test chart suitable for measuring the effects of higher order aberrations wherein the images are deformed with higher order aberrations of fixed optical effects.

2. A test chart according to Claim 2 distorted by defocus of different values defined optically by other coefficients than RMS.

3. A test chart according to Claim 2 distorted by defocus of several RMS values including the RMS value used to distort the charts with higher order aberrations.

4. A method of testing for the effects of higher order aberrations comprising the steps of: (a) showing at least one test chart having distortion to a test subject; (b) noting the visual effects of the distortions; and (c) comparing the relative readability of such distorted charts by a test panel of subjects who read or have read all the charts.

5. The method according to Claim 4 wherein the test chart is the test chart of any one of Claims 1 to 3.

6. A method of determining the effect of higher order aberrations on a patient's vision by normalizing the visual effect of different higher order aberrations in relation to the visual effect produced by defocus.