Clinical applications of wavefront refraction.

Area of Science:

• Ophthalmology
• Optometry
• Vision Science

Background:

• Higher-order wavefront error (HO-WFE) describes complex aberrations in the eye's optical system beyond standard refractive errors.
• Understanding normative HO-WFE ranges is crucial for diagnosing and managing visual dysfunction.
• Existing studies often use artificial pupil sizes, potentially limiting applicability to natural viewing conditions.

Purpose of the Study:

• To establish normative reference ranges for higher-order wavefront error (HO-WFE).
• To compare HO-WFE values in healthy eyes versus those with common ocular pathologies.
• To evaluate the efficacy of treatments for reducing HO-WFE.

Main Methods:

• A comprehensive review of 17 studies encompassing 31,605 subjects was conducted.
• Normative HO-WFE upper limits (95% CI) were calculated for healthy individuals aged 20-80 years.
• HO-WFE was analyzed for pupil diameters ranging from 3 to 7 mm, and effects of pathologies like keratoconus, pterygium, cataract, and dry eye were reviewed.

Main Results:

• The upper limit of normal HO-WFE (95% CI) for a 35-year-old with a 6 mm pupil is estimated at 0.471 μm.
• HO-WFE generally increases with age, though the impact of age-related pupil miosis requires further investigation.
• Pathologies significantly elevate HO-WFE: keratoconus can exceed 3.0 μm (coma-dominant), while cataracts and pterygia induce coma and trefoil, or negative spherical HO-WFE.

Conclusions:

• Normal physiological HO-WFE is approximately 0.5 μm at physiological pupil sizes.
• Ocular pathologies can increase HO-WFE beyond 1.0 μm, but various treatments demonstrate high effectiveness.
• Future research should utilize natural pupil sizes to refine normative HO-WFE reference ranges.