RAY TRACING & WAVEFRONT ANALYSIS USING THE TRACEY SYSTEM

1. RAY TRACING & WAVEFRONT ANALYSIS USING THE TRACEY SYSTEM Donald R. Sanders, M.D., Ph.D. Center For Clinical Research

2. 20/10 UNCORRECTED PATIENT

3. 20/10 UNCORRECTED PATIENT P S F Retinal Spot

4. 20/10 UNCORRECTED PATIENT

5. 20/10 UNCORRECTED PATIENTRef +0.04 + 0.16 X 110 Total RMS = 0.068m Lower Higher

6. Astigmatism Defocus (Refraction) 2nd Order Higher 3rd Order 4th Order 5th Order

7. Breakdown of Zernike Terms Coefficient value (microns) -0.5 0 0.5 1 1.5 2 1 2 astig. 3 2nd order defocus 4 astig. 5 trefoil 6 3rd order coma 7 coma 8 Zernike term trefoil 9 10 11 4th order spherical aberration 12 13 14 15 16 5th order 17 18 19 20

8. Root Mean Square …… trefoil term defocus term astigmatism term astigmatism term

9. GROSS APPROXIMATIONTotal RMS Vs. Visual Acuity 1.0m = 20/20 - 20/25 0.5m = 20/15 0.25m = 20/10

10. COMPONENTS OF TOTAL RMS Lower Order Aberrations Defocus (Sphere) Astigmatism (Cylinder) Plus Higher Order Aberrations

11. 20/10 VISIONRef -0.14 + 0.39 X 168 Total RMS = 0.204mP S F

12. LARGELY LOWER ORDER ABERRATIONS P S F Retinal Spot

13. 99% OF RMS VALUE IS LOWER ORDER ABERRATIONS(Refractive Error) Lower Higher

14. AFTER SUBTRACTING LOWER ORDER ABERRATIONS P S F Retinal Spot

15. REFRACTIVE ERROR P S F “UCVA” “BCVA” All Aberrations Higher Order Only

16. REFRACTIVE ERROR “UCVA” “BCVA” All Aberrations Higher Order Only

17. REFRACTIVE ERROR Retinal Spot “UCVA” “BCVA” All Aberrations Higher Order Only

18. CORNEAL BIRTH TRAUMA P S F “UCVA” “BCVA” All Aberrations Higher Order Only

19. CORNEAL BIRTH TRAUMA Retinal Spot “UCVA” “BCVA” All Aberrations Higher Order Only

20. CORNEAL BIRTH TRAUMA “UCVA” “BCVA” All Aberrations Higher Order Only

21. COMMON SIGNIFICANT HIGHER ORDER ABERRATIONS Trefoil Coma Spherical Aberration

22. (T.M.) POST LASIK Complains Of Night Glare6mm Scan (Undilated)

23. PATIENT T.M. (OD)6 mm Scan – P S F “UCVA” “BCVA” All Aberrations Higher Order Only

24. PATIENT T.M. (OD)6 mm Scan – Retinal Spot “UCVA” “BCVA” All Aberrations Higher Order Only

25. PATIENT T.M. (OD)6 mm Scan “UCVA” “BCVA” All Aberrations Higher Order Only

26. PATIENT T. M. (OD)Decentered Excimer COMA

27. PATIENT T. M. (OD) Vertical Coma

28. PATIENT T.M. (OD)EFFECT OF SCAN DIAMETER (PUPIL SIZE) ON PSFHigher Order Aberrations Only 6 mm 4 mm

29. PATIENT T. M. (OS)6.5mm Scan – P S F UCVA (All Aberrations) BCVA (Higher Order Only)

30. COMA SPHERICAL

31. HORIZONTAL COMA SPHERICAL ABERRATION

32. PATIENT T.M.NIGHT MYOPIA DUE TO SPHERICAL ABERRATION 2.49 OS Amount Of Myopia (D) 1.99 1.66 0.85 Pupil Size (Undilated)

33. PATIENT T. M. (OS)Night Myopia Due To Spherical Aberration 4 mm 5 mm 6 mm 6.5 mm

34. PATIENT T. M. (OS) – P S FNight Myopia Due To Spherical Aberration 4 mm 5 mm 6 mm 6.5 mm

35. SUMMARY PATIENT T.M.Large Pupils In Dim Light OD Vertical Coma (Decentration) With Mild Spherical Aberration OS Horizontal Coma(Decentration) + Spherical Aberration

36. PATIENT S. P. Complains Of Severe Night Glare6.5mm Scan Pupil is 7.0 –7.5mm Undilated

37. PATIENT S. P. (OD)Severe Night Glare PUPIL SIZE 4 mm 4.5 mm RMS = 0.261 RMS = 0.407 6.0 mm 6.5 mm RMS = 1.1 RMS = 1.83

38. PATIENT S. P. (OD)Severe Night Glare Pupil Size Higher Order Aberration Only 4mm 4.5mm RMS = 0.166 RMS = 0.346 6.0mm 6.5mm RMS = 0.656 RMS = 1.83

39. PATIENT S. P. (OD)Severe Night Glare 4 mm 6.0 mm Lower Higher

40. PATIENT S. P. (OS)Complains Of Severe Night Glare 4.5 mm 5.5 mm 6.5 mm 6.0 mm

41. PATIENT S. P. (OS)Complains Of Severe Night Glare 4.5 mm 6.5 mm NOTE: Scale Doubles

42. PATIENT J. C.Most Higher Order Aberrations – Trefoil, Tetrafoil

43. S/P RK SURGERY J. C. D. D.