The art of nomograms

Background:To retrospectively analyse strategies for adjusting refractive surgery plans with reference to the preoperative manifest refraction.Methods:We constructed seven nomograms based on the refractive outcomes(sphere,cylinder,axis[SCA])of 150 consecutive eyes treated with laser in situ keratomileusis for myopic astigmatism.We limited the initial data to the SCA of the manifest refraction.All nomograms were based on the strategy:if for x diopters(D)of attempted metric,y D is achieved;we can reverse this sentence and state for achieving y D of change in the metric,x D will be planned.The effects of the use of plus or minus astigmatism notation,spherical equivalent,sphere,principal meridians notation,cardinal and oblique astigmatism,and astigmatic axis were incorporated.Results:All nomograms detected subtle differences in the spherical component(p<0.0001).Nomograms 5 and 7(using power vectors)and 6(considering axis shifts)detected significant astigmatic differences(nomogram 5,p<0.001;nomogram 6,p<0.05;nomogram 7,p<0.005 for cardinal astigmatism,p=0.1 for oblique astigmatism).We observed mild clinically relevant differences(~0.5 D)in sphere or astigmatism among the nomograms;differences of~0.25 D in the proposals for sphere or cylinder were not uncommon.All nomograms suggested minor improvements versus actual observed outcomes,with no clinically relevant differences among them.Conclusions:All nomograms anticipated minor improvements versus actual observed outcomes without clinically relevant differences among them.The minimal uncertainties in determining the manifest refraction(~0.6 D)are the major limitation to improving the accuracy of refractive surgery nomograms.

Corneal functional optical zone under monocular and binocular assessment

Background:In this retrospective randomized case series,we compared bilateral symmetry between OD and OS eyes,intercorneal differences and Functional Optical Zone(FOZ)of the corneal aberrations.Methods:Sixty-seven normal subjects(with no ocular pathology)who never had any ocular surgery were bilaterally evaluated at Augenzentrum Recklinghausen(Germany).In all cases,standard examinations and corneal wavefront topography(OPTIKON Scout)were performed.The OD/OS bilateral symmetry was evaluated for corneal wavefront aberrations,and FOZ-values were evaluated from the Root-Mean-Square(RMS)of High-Order Wavefront-Aberration(HOWAb).Moreover,correlations of FOZ,spherical equivalent(SE),astigmatism power,and cardinal and oblique astigmatism for binocular vs.monocular,and binocular vs.intercorneal differences were analyzed.Results:Mean FOZ was 6.56±1.13 mm monocularly,6.97±1.34 mm binocularly,and 7.64±1.30 mm intercorneal difference,with all strongly positively correlated,showing that the diameter of glare-free vision is larger in binocular than monocular conditions.Mean SE was 0.78±1.30 D,and the mean astigmatism power(magnitude)was 0.46±0.52 D binocularly.The corresponding monocular values for these metrics were 0.78±1.30 D and 0.53±0.53 D respectively.SE,astigmatism magnitude,cardinal astigmatism component,and FOZ showed a strong correlation and even symmetry;and oblique astigmatism component showed odd symmetry indicating Enantiomorphism between the left and right eye.Conclusions:These results confirm OD-vs.-OS bilateral symmetry(which influences binocular summation)of HOWAb,FOZ,defocus,astigmatism power,and cardinal and oblique astigmatism.Binocular Functional Optical Zone calculated from corneal wavefront aberrations can be used to optimize refractive surgery design.