Low_resolution_Thesis_CDD_221009_public - Visual Optics and ...

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$XXX Congress of the European Society of Cataract and Refractive ...$

CHAPTER 1 How does it change with the lens parameters (thickness, correction) How is the structure of the retinal images through a simultaneous vision lens fitted on an eye Predictions from optical estimates: The initial fitting of contact lenses (selection of the optimal design and parameters) is in many cases, a costly process in terms of wasted contact lenses and time for the patient and the contact lens practitioner. Precise methods to simulate contact lens fitting from objective measurements, considering the combined effect of shape deformations, tear, and optical interactions, and knowledge of the correct simulation parameters to use, are now of key importance to predict the optimal parameters, and to improve the efficiency of the fitting process. 1.12. HYPOTHESIS AND GOALS OF THIS THESIS The main goal of this thesis is the detailed optical study of contact lens fitting and laser refractive surgery. Both are complex processes where the optical effects are entangled with biological effects, and subject to high variability. In this thesis we will test the following hypothesis: (1) that the development of novel rigorous experimental models based on artificial eyes will allow a better understanding of the physical basis, and therefore the subsequent improvement of the optical and visual outcomes, of corneal ablation for the correction of refractive errors and contact lenses for the correction of refractive errors and presbyopia; (2) that the optical, structural and visual quality measurements on patients will allow a deeper understanding of the mechanisms involved in refractive surgery and contact lens fitting. The present thesis aims at isolating and quantifying physical and optical effects such as: - laser ablation on materials - laser efficiency losses from the center to the periphery - the design the ablation patterns - influence of the posterior corneal surface - optical coupling of the eye optics and the optics of the contact lens - contact lens shape conformity to the cornea - the design of contact lenses from biological effects such as: - biomechanics and wound healing - corneal swelling and bulging after surgery - tear variability - movement of the contact lens - neural effects of vision. 1.13. SPECIFIC QUESTIONS The specific questions that we want to solve in this thesis are: 1. Reasons for the increase of spherical aberration in conventional refractive surgery. 2. Isolate physical from biomechanical contributions in refractive surgery. 3. Accurate measurement of the shape of corneal ablation patterns. 4. Assess and compare the optical outputs of different laser platforms. 5. Anterior and posterior corneal elevation changes in refractive surgery patients. 58
INTRODUCTION 6. Evaluation and understanding of optical performance of eyes with RGP contact lenses. 7. Reasons for the improved optics with RGP contact lenses. 8. Evaluation of optical performance with monofocal and multifocal soft contact lenses in physical and real eyes. 9. Understanding of the failure/success of multifocal contact lenses in producing effective multifocality, on an individual basis. 10. Correlations of visual and optical quality in patient eyes. 1.14. THESIS SYNOPSIS In this thesis we studied the physical implications of corneal ablation and the effect of contact lens fitting. Both are complex phenomena, entangled with biological effects, and with many mixed (and often yet unbounded) physical causes. Our approach was to study the problem starting with a high degree of control, and lowered complexity. In following steps, the degree of complexity is progressively increased. Three experimental models have been developed during this thesis, with the aim of isolating the physical process of interest from the inherent variability of human eyes and gaining control (avoiding biomechanics, theoretical assumptions, crossinteractions, tear effects, etc): 1) a model for the study of the laser ablation of the anterior cornea, 2) a model for the study of the posterior surface of the cornea which was applied to the study of posterior cornea stability after refractive surgery, and 3) an in-vitro model of contact lens fitting, oriented to multifocal lenses. These three models were used to study, with high precision, the optical changes produced by the manipulation of the refractive properties of the cornea. To support those experimental studies, we developed new measurement methods and procedures. In particular, a new generation of LRT aberrometer was implemented for this Thesis, and methodologies for the measurement of changes in optical surfaces. These were applied to the experimental models. Besides, during this thesis different clinical studies were performed on patients, of the specific questions studied in vitro: the posterior surface of the cornea, and contact lens fitting (from monofocal RGP – semirigid- contact lenses to soft multifocal contact lenses). The body of this thesis is structured as follows: Chapter 2 describes the common methods used throughout this thesis: instruments for the precise measurement of optical surfaces (and real and artificial corneas in particular), a versatile system (Laser Ray Tracing) for the measurement of optical quality of the eye, methods for the measurement of optical performance, and different techniques for computer simulation of different phenomena. Chapter 3 introduces in vitro plastic artificial eye model for the study of the physical factors involved in refractive surgery. Efficiency effects were measured by ablating flat and spherical artificial corneas of PMMA, with a conventional refractive surgery system, provided with non-optimized algorithms. In Chapter 4 a study of the ablation process vs material, number of pulses and fluence is presented, aiming at a better understanding the use of plastic models in refractive surgery, and providing valuable information of the optical and ablation properties of the materials and for the improvement ot the model. A new material, Filofocon A, is introduced, with ablation properties that make it more suitable for refractive surgery models. 59
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Doctoral thesis Corneal Ablation an
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Contents Corneal Ablation and Conta
Page 7 and 8: 2.2.1. Fitting surfaces............
Page 9 and 10: 5.3.3. Ablation efficiency factors
Page 11: 10.5. DISCUSSION...................
Page 14 and 15: We thank José Antonio Sánchez-Gil
Page 16 and 17: BOZR Back Optic Zone Radius BCVA Be
Page 19 and 20: INTRODUCTION 1.1. MOTIVATION The fr
Page 21 and 22: INTRODUCTION 1.2. THE OPTICAL SYSTE
Page 23 and 24: INTRODUCTION Myopia is a very commo
Page 25 and 26: INTRODUCTION a point focus: the dif
Page 27 and 28: INTRODUCTION system, and tilt repre
Page 29 and 30: INTRODUCTION term Z 0 2 stands for
Page 31 and 32: INTRODUCTION which image was shadow
Page 33 and 34: INTRODUCTION The defocus Zernike te
Page 35 and 36: INTRODUCTION 1.4.6.3. Internal Aber
Page 37 and 38: INTRODUCTION 1.5.2.3. Alternating v
Page 39 and 40: INTRODUCTION and further-more, at l
Page 41 and 42: INTRODUCTION alcohol is used to loo
Page 43 and 44: INTRODUCTION changes in reflectivit
Page 45 and 46: INTRODUCTION Marcos et al. (Marcos
Page 47 and 48: INTRODUCTION 1.7.3. Ablation effici
Page 49 and 50: INTRODUCTION corneal surface may be
Page 51 and 52: INTRODUCTION Algorithm design: The
Page 53 and 54: INTRODUCTION contact lenses the fie
Page 55 and 56: INTRODUCTION 1.10.1. Tear studies A
Page 57: INTRODUCTION there are still many u
Page 61 and 62: METHODS 2Chapter Chapter 2 - Method
Page 63 and 64: METHODS 2.1. MEASUREMENT OF OPTICAL
Page 65 and 66: METHODS In both profilometers, cust
Page 67 and 68: METHODS The measurement method that
Page 69 and 70: METHODS Fig. 2. 9. Set of points in
Page 71 and 72: METHODS Slit lamp Scheimpflug Camer
Page 73 and 74: METHODS representing the deviation
Page 75 and 76: METHODS 2.2.2.2. Ablation pattern f
Page 77 and 78: METHODS direction. These calculatio
Page 79 and 80: METHODS eye through the whole pupil
Page 81 and 82: METHODS (1993) power thresholds for
Page 83 and 84: METHODS alignment (frontal-illumina
Page 85 and 86: METHODS Fig. 2. 24. Example frame f
Page 87 and 88: METHODS 4) New image processing too
Page 89 and 90: METHODS Fig. 2. 28. Corrected entra
Page 91 and 92: METHODS Badal lens, corresponds to
Page 93: METHODS Each VA measurement consist
Page 99: REFRACTIVE SURGERY PMMA MODEL 3.1.
Page 102 and 103: CHAPTER 3 optimization of refractiv
Page 104 and 105: CHAPTER 3 These data demonstrate th
Page 106 and 107: CHAPTER 3 regression line, since it
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CHAPTER 3 Figure 3.3 shows one of t
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CHAPTER 3 Ablation efficiency facto
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CHAPTER 3 considering the same set
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CHAPTER 3 3.5.3 Impact of correctio
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ABLATION PROPERTIES OF FILOFOCON A
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OPTIMIZED LASER PLATFORMS 5.1 ABSTR
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CHAPTER 5 pulses. Fluence, repetiti
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CHAPTER 5 ablations. The slit-confo
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CHAPTER 5 (Anera et al., 2003): d S
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CHAPTER 5 asymmetries also appeared
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CHAPTER 5 5.3.4. Ablation patterns
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CHAPTER 5 a) b) : 6.5 mm c) Fig. 5.
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CHAPTER 5 achieve proper reflection
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CHAPTER 5 Both the ablation algorit
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HYBRID PORCINE/PLASTIC MODEL 6.1. A
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CHAPTER 6 6.3.1. Hybrid porcine-pla
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CHAPTER 6 is detected. Therefore, i
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CHAPTER 6 no preferential orientati
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ANTERIOR AND POSTERIOR CORNEAL ELEV
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183
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SOFT CONTACT LENS FITTING USING MOD
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SOFT CONTACT LENS FITTING USING MOD
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ON-EYE OPTICAL PERFORMANCE OF RIGID
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SOFT MONOFOCAL AND MULTIFOCAL CONTA
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SOFT MONOFOCAL AND MULTIFOCAL CONTA
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CORRELATION BETWEEN RADIUS AND ASPH
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CONCLUSIONS Conclusions This thesis
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CONCLUSIONS 5We have developed a pr
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CONCLUSIONS LIST OF METHODOLOGICAL
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CONCLUSIONS FUTURE RESEARCH LINES T
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CONCLUSIONS LIST OF PUBLICATIONS AN
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REFERENCES References AIZAWA, D., S
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REFERENCES PHOTODECOMPOSITION (APD)
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REFERENCES DORRONSORO, C., CANO, D.
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REFERENCES GISPETS, J., ARJONA, M.
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REFERENCES KOPF, M., YI, F., ISKAND
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REFERENCES MARCOS, S., DORRONSORO,
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REFERENCES NOVO, A., PAVLOPOULOS, G
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REFERENCES SAKIMOTO, T., ROSENBLATT
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REFERENCES WANG, L., DAI, E., KOCH,
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RESÚMENES pacientes reales fue com
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RESÚMENES experimentales de cirug
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RESÚMENES cada punto de las cornea
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RESÚMENES plástico medidas anteri
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RESÚMENES 8 Evaluación óptica de
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RESÚMENES 9 Prestaciones ópticas
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RESÚMENES 10 Calidad óptica y cal
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RESÚMENES A Correlación entre rad
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CONCLUSIONES clínicos. La descripc
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CONCLUSIONES 12 Las superficies ocu
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CONCLUSIONES IMPLICACIONES DE ESTA
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CONCLUSIONES contribuyen a la compr
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(y muchísimo más difícil). Me da
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