Optical modeling of a corneal inlay in real eyes to increase depth of focus: Optimum centration and residual defocus

Purpose

To determine the optimum position to center a small-aperture corneal inlay and the effect of residual defocus in the surgical eye to maximize depth of focus.

Setting

Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain.

Design

Cohort study.

Methods

Personalized eye models were built using actual data (corneal topography, eye length, ocular aberrations, and eye alignment). A small aperture 1.6 mm in diameter was placed at the corneal plane in each model. The monochromatic and polychromatic Strehl ratios were calculated as a function of the pinhole position. Different residual defocus values were also incorporated into the models, and the through-focus Strehl ratios were calculated.

Results

Sixteen eye models were built. For most subjects, the optimum location of the aperture for distance vision was close to the corneal reflex position. For a given optimized centration of the aperture, the best compromise of depth of focus was obtained when the eyes had some residual myopic defocus (range −0.75 to −1.00 diopter [D]). Strehl ratio values were over 0.1 for far distance, which led to visual acuities better than 20/20. The depth of focus was 2.50 D with a mean near visual acuity of Jaeger 1 or better.

Conclusions

In eyes with little astigmatism and aberrations, the optimum centration of the small aperture was near the corneal reflex position. To improve optical outcomes with the inlay, some small residual myopia and correction of corneal astigmatism might be required.

Financial Disclosure

Dr. Artal is a consultant to Acufocus, manufacturer of the Acufocus Kamra corneal inlay. Dr. Tabernero has no financial or proprietary interest in any material or method mentioned.