PubMed · 17189779
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2007. Consultation section. Refractive surgical problem.. https://doi.org/10.1016/j.jcrs.2006.10.023
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PURPOSE: The paraxial propagation of astigmatic wavefronts through astigmatic optical systems can be described by the augmented step-along method (ASAM). Its equivalence to the linear ray optics approach is considered in detail. METHODS: The ASAM is exploited to derive paraxial ray paths through a general coaxial astigmatic system. RESULTS: Starting from the information inherent in the ASAM all 2x2 submatrices rendering the general 4x4 transference of linear optics can be generated. This proves the complete equivalence of both approaches. Additionally, we show that the symplectic relations are automatically obeyed in the ASAM. CONCLUSIONS: The ASAM offers a complete alternative to describe the paraxial optics of astigmatic optical systems. According to the ASAM, an optical system is fully characterized by the back vertex vergence and the angular magnification matrix. Hence, a complete description of the paraxial optics of an eye should not only report the state of refraction but the angular magnification matrix as well, although it is not yet very common. The magnification matrix might be important in cases of anisometropia or the design of progressive addition lenses. Yet, a simple clinical procedure to determine the angular magnification matrix is missing.
PURPOSE OF REVIEW: To provide an update on the status of toric intraocular lenses. These lenses can be used as an alternative or adjunct to corneal astigmatic incisions for correcting preexisting astigmatism in patients with cataracts. They are a particularly attractive option in those cases where limbal-relaxing incisions are not powerful or predictable enough. Other toric lenses may correct astigmatism in addition to spherical refractive errors in phakic patients. RECENT FINDINGS: Toric lenses have continued to gain popularity with the US Food and Drugs Administration (FDA) approval of the Acrysof Toric intraocular lenses. This lens is designed to be implanted in patients undergoing cataract removal and who have significant preexisting corneal astigmatism. In the FDA clinical trial, study patients received one of the three cylindrical powers, and control patients received a standard monofocal intraocular lenses. The study found that the Acrysof Toric intraocular lenses provided excellent visual outcomes and exhibited excellent rotational stability. With the Acrysof Toric intraocular lenses, the average lens rotation was less than 4 degrees from the lens' initial placement at 6 months after surgery. SUMMARY: Toric intraocular lenses provide excellent vision for astigmatic cataract patients, and new designs are significantly improving visual acuity by minimizing the risk of rotation.
PURPOSE OF REVIEW: Aspheric intraocular lens technology has been implemented during the past 5 years, and more and more intraocular lenses with different amounts of asphericity are becoming available. Despite the efficacy in the correction of spherical aberration and the good results on implanted eyes, the theoretical advantages of aspheric intraocular lenses are still controversial. RECENT FINDINGS: All investigations showed the ability of the aspheric intraocular lenses to correct the positive spherical aberration of the cornea, with variable impact on the total eye wavefront but with constant advantages in the optical quality of the eyes as measured by the Modulation Transfer Function, the Point Spread Function, and the contrast sensitivity of implanted patients. Theoretical studies on model eyes underlined some possible limitations of aspheric intraocular lenses, especially sensitivity to decentration. In addition, the actual optical quality in implanted eyes is also affected by light scattering, a parameter missed by simple aberration analysis. SUMMARY: Aspheric intraocular lenses effectively reduce spherical aberration in implanted eyes, with improvement in optical quality over the parent spherical intraocular lens. The advantages for implanted eyes could be limited by decentration, by small pupil diameter, and by reduced media transparency.