Adaptive Optics in

Vision and Ophthalmology

Josef F Bille

Kirchhoff-Institute of Physics
University of Heidelberg
 Contents
•The History of Wavefront-Based Adaptive Optics
•Wavefront-Description by Zernike-Polynomials
•Optical Quality of the Human Eye
•Components of Adaptive Optics Systems
•Wavefront-Based Vision Testing
•Aberration-Free Retinal Imaging
•Custom Excimer Laser Surgery
 Technology Background

• Wavefront technology originally began with

astronomical applications
• Used to measure wavefront distortions that
occurred when light traveling through the
atmosphere entered a telescopic mirror
• Developed in association with anti-missile
defense systems (Star Wars)
 Technology Background

• 1978: Astronomical wavefront principle

adapted at the University of Heidelberg for
ophthalmic applications
• Hartmann-Shack wavefront sensor tracks and
measures the optical path of light rays through
the eye to detect all aberrations at all points in
the optical system
• Adaptive optics measures and compensates
wave aberrations of the human eye with closed
loop control
 Hartmann-Shack Sensor

Incident plane wave resulting Distorted wavefront causes

in a square grid of spots lateral displacement of spots
Setup of a Wavefront Device
The History of Wavefront-Based
Adaptive Optics
 History of Adaptive Optics Closed-Loop Control

• 1976 Adaptive optics in astronomy

• 1982 JF Bille, et al: Image restoration by adaptive-
optical
phase compensation, 6th ICPR
• 1986 JF Bille: U.S. Patent, 4, 579, 430—Method
and apparatus for forming an image of the ocular fundus
• 1986 ES Claflin, et al: JOSA 3(11)—Configuring
an electrostatic membrane mirror by least-squares fitting
with analytically derived influence functions
 Principle of adaptive optics

Deformable mirror

Propagation

Wavefront
regulation
Object Picture

Optical
aberrations
Wavefront
Feedback control
Regulation measurement

Hartmann-Shack unit
 Adaptive Optics in astronomy

M. Kasper, Looze D., Hippler S., Herbst T., Glindemann A., Ott T., Wirth A., “ALFA:
Adaptive Optics Calar Alto Observatory-Optics, Control System and Performance“,
Experimental Astronomie 10, 1, 49, 2000
ALFA-Demo
 Adaptive Optics
Surface of the Sun

Uncorrected Compensated
Adaptive Optics: Key Elements
 Real-Time AO-Systems

sensor processor actuator

kHz Vision Chips

electrostatic
frame rate

CMOS analogue/digital ASIC micro mirrors

FPGA's
liquid crystal
Hz adaptive lenses
CCD frame grabber software
 Correction of refractive errors of the human eye

According to current definition 50% of the population is affected ...

Current
correction methods
offer only
suboptimal
Visual acuity
„commodity style“
 Optical Quality of the Human Eye

Hermann von Helmholtz, 1821-1894

Professor für Physiologie in Heidelberg (1858-1870)

„“Wollte mir jemand ein optisches Gerät mit all diesen

Defekten verkaufen, würde ich es in aller Deutlichkeit
zurückweisen.“ (1859)
“Das Auge zeigt jeden Defekt, der in einem optischen
Instrument gefunden werden kann und zudem noch einige
dem Auge eigentümliche. Aber diese wirken einander so
entgegen, dass die Ungenauigkeiten des Bildes, die sie
verursachen, unter normalen Beleuchtungsbedingungen
kaum die Grenzen erreichen, die dem Sinneseindruck des
Sehens durch die Dimensionen der retinalen Rezeptoren
gesetzt sind.“ (1862)
Photopic Vision vs. Mesopic Vision

Small
Large pupil
pupil

Blurred image
Sharp image
 Definition of the Wavefront
Wellenfronten

geom. Lichtstrahlen

• The Wavefront is perpendicular to ray direction

• Wavefronts are planes of equal phase
• All points of a wavefront have the same optical pathlength
to starting point
 Methods for Wavefront Measurement

• Hartmann-Shack Method
Alcon, Bausch & Lomb, VISX,
Wavefront Sciences (Zeiss Meditec, Schwind)
• Tscherning Method
Wavelight
• Sequential Ray-Traycing
Tracey Technologies
• Spatially resolved Skiaskopy
Nidek
Principle of Hartmann-Shack-Method

• A micro-lenses array
spatially resolves wavefront
distortion
• From the shift of the focal
spots the wavefront can be
reconstructed
 Hartmann-Shack Spot pattern for
Cataracts

Spot pattern of cortical Spot pattern of

cataract cloudiness of posterior
capsule
 Tscherning Method

Ab e rro sko p Linse

Bild a n
d e r Re tina

Ap e rturm a ske
Op hth a lm o skop Linse

CC D
Fina le s Bild
 Ray-Tracing Verfahren

Sc a nn ing

La te ra le Ve rsc hie b ung d es

re tina le n Punkte s wird mit
e ine r PSD g e m e sse n.
Po sitioning
Se nsing
De te c to r
PSD

n= 1
n= 2 y
n= 3
n= 4
n= ... x
n= 64
 Presentation of wavefront-aberrations

Hyperopie

Hyperopia and
Myopia are
presented in 2-
Myopie
dimensional
Wellenfront-maps
as concentric
circles
Perfect Wavefront
Distorted Wavefront
WaveScan - Wavefront Analysis
Wavefront-Description by
Zernike-Polynomials
 Fritz Zernike

• 1953 Nobel Laureate in

Physics

• Dutch Physicist

• Developed mathematical
model of optical aberrations

1888-1966
PPoint Spread Function (PSF)
Zernike-Tree
 Zernike Polynomials

• Mathematical description of optical

aberration

• Breaks down components of “blur”

• The new language of optics

 Zernike-Expansion

The definition of the Zernike polynomials Znm(r,q)

The radial function Rn|m|(r) is a polynomial in r

The normalization factor Nnm

 Zernike Polynomials

The orthonormality properties of the Zernike polynomials

in polar

and Cartesian coordinates

where the integration is over the unit circle x2+y2≤1

δij is the Kronecker symbol

the asterisk denotes the complex conjugate

The single index scheme is possible: Zi(r,q) with

The Zernike polynomials up to fifth degree
The Zernike polynomials up to fifth degree
The Zernike polynomials
Wave fronts are measured relative to the
entrance pupil
3-D View of Wavefront
m -5 -4 -3 -2 -1 0 1 2 3 4
5
n

0 j=0
Zj j = [n(n+2)+m]/2
n = round up [(-3+sqrt(9+8j))/2]
1 m= 2j-n(n+2)
j=1 j=2

2 j=3 j=4 j=5

3 j=6 j=7 j=8 j=9

4 j=10 j=11 j=12 j=13 j=14

5 j=15 j=16 j=17 j=18 j=19 j=20

 Zernike Mode

Z
-1
Coma
3
High Order
 Wavefront looks like a hill next to a
valley

Point spread function Wavefront

 -1
Vertical coma Z 3

6mm 0.2um
rms
 -1
Horizontal coma Z 3

6mm 0.2um
rms
 180 0
0 .0 0 0 .0 0
- 0 .2 5 - 0 .5 0
Typical Coma wavefront pattern
- 0 .5 0
- 0 .7 5
- 1.0 0
- 1.5 0
- 1.0 0 - 2 .0 0
- 1.2 5 - 2 .5 0
- 1.5 0 - 3 .0 0
- 1.7 5 - 3 .5 0

Bille Aberration Map OAI: 0.29 Bille Aberra

90
m ic ro n s m ic ro n s
120 60
1.7 5 1.7 5
1.5 0 1.5 0
1.2 5 150 30
1.2 5
1.0 0 1.0 0
0 .7 5 0 .7 5
0 .5 0 0 .5 0
0 .2 5 180 0 0 .2 5
0 .0 0 0 .0 0
- 0 .2 5 - 0 .2 5
- 0 .5 0 - 0 .5 0
- 0 .7 5 - 0 .7 5
- 1.0 0 - 1.0 0
- 1.2 5 - 1.2 5
- 1.5 0 - 1.5 0
- 1.7 5 - 1.7 5
Adaptive Optical Components
 wavefront sensors
interferometric:
•e.g. Twyman-Green
irradiance:
•curvature sensor
geometrical:
•Foucault knife-edge test
•Hartmann-Shack sensor
•Laser ray tracing
•Pyramidal sensor
 CMOS-based HS wavefront sensors
• integrated image-capture and spot tracking
• high-bandwidth (4 kHz frame-rate)
• miniaturize an AO system
drawbacks: fixed geometry, limited
resolution or sensitivity
 Closed-loop AO systems

Consist of:
•Wavefront sensor
•Processing unit
•actuator
actuators
 micro-electro-mechanical mirrors
advantage
fast (kHz) and small
high spatial frequency
(1000x1000 pixels)
low voltage (~40 V)Fraunhofer
CMOS compatible

disadvantage
not yet commercially available
limited fill-factor
Boston
Wavefront-Based Vision Testing
 Aberrations in dependence of frequency
1
Artificial Eye (2 deg. scan angle)
Average of 4 eyes: defocus only
Average of 4 eyes in mydriasis: defocus only
Average of 4 eyes: higher orders
Average of 4 eyes in mydriasis: higher orders

0,1
Fourier Amplitude

0,01

0,001

0,0001
0 1 2 3 4 5 6 7 8 9 10 11
Frequency [Hz]
 Strehl in dependence of bandwidth
1

0,9

0,8

0,7

0,6

0,5
Strehl

0,4

0,3
FM OS
FM OD
0,2 JC OS
JC OD

0,1

0
0 1 2 3 4 5 6 7 8 9 10 11
Bandwidth [Hz]
 RMS Variation with Pupil Size
1,200

1,000
Entrance pupil
diameter [mm]
0,800
JC 1,5
JC 8,0
RMS

0,600
FM 1,5
FM 8,0
0,400

0,200

0,000
2,50 3,50 4,50 5,50 6,50

Exit Pupil Diameter [mm]

 Strehl after static compensation

Proband Eye Strehl Strehl after ideal Strehl after

uncorrected spherocylindrical static correction of all
(5.5 mm pupil) correction aberrations

FM OS < 0.05 0.21 0.38

OD < 0.05 0.10 0.63

JC OS < 0.05 0.27 0.66

OD < 0.05 0.32 0.91

Bille J, Büchler-Costa J, Müller F, Aberration-free Refractive Surgery

Springer, 2001
 Status of Wavefront Methods in
Ophthalmology

• Practice
– Wavefront measurements of the Human Eye.
– Customized Ablation
– VISX PreVueTM-Lens
• Subjective Acceptance Test of Wavefront Results
• Static Correction

• Research
– Large Laboratory Setups for Adaptive Optics
Systems
 Goals

• Test the calculated results in an objective as well

as subjective way.
• Show the patient how he will see and test if he
accept the correction
• Provide a small integrated system, which is:
– Inexpensive
– Stable
– Easy to use
The 20/10 Perfect Vision/VISX WaveScan ®
WaveScan - Wavefront Analysis
 Test Setup

Modified WaveScan:
- continuously variable precompensation
- different types of target (VA chart)
- active mirror

La se r t o e ye
Ta rg e t b e a m
 Movie of microchip mirror

Video will start automatically

Restart with mouse click on video

 Active Micro Mirror Array

2 0 0 x2 4 0 p x 3 6 µm
4 0 µm
m irro r d e fle c tio n th ic kn e ss o f m irro r

Ux,y U x+ 1 ,y
 Correcting aberrations by “phase-wrapping”

o u tg o in g b e a m

m a xim a l sh ift= /2

m ic ro m irro rs
/2 p h a se sh ift
Deformable Mirror Correction of Aberrations

• Negligible defocus
• Higher aberrations
only at the edge
• Improvement of
wavefront RMS
25 generations with from 1.35  m to
0.17  m (6-mm
40 descendants each pupil diameter)

• 0,3 diopter
astigmatism left
• Improvement of
wavefront RMS
from 0.90 m to
50 generations with 0.41  m (6-mm
60 descendants each pupil diameter)
 Visual Acuity Chart
Internal Visual Acuity Chart
•6 rows of 5 Snellen E‘s (20/32 - 20/10) for Visual Acuity test.
•Siemens Star for subjective measurement and accommodation
control.
•Monochromatic (550 nm)
 Questions

• How good can the system correct

wavefront errors ?
• Is a static correction sufficient or do we
need a closed loop correction?
• Can the subject use the gain in information
for an improvement in Visual Acuity ?
 Artificial Test Eye

p h a se p la te b e a m sp litte r d iffu se r

WaveScan

le n s

c a m e ra
 Correction of phaseplates:
Trefoil
uncorrected - corrected

Wavefront-map

PSF

Image
 Correction of phaseplates:
4th order spherical aberration
uncorrected - corrected

Wavefront-map

PSF

Real
Image
Measurement over 10 Seconds
 Higher Order Aberration Reduction in Human
Eyes with the Microchip Mirror

0,35

0,3

0,25 2nd order

3rd order
RMS [µm]

0,2 4th order

5th order
0,15 6th order
RMS (total)
0,1
RMS (without sphere)

0,05

0
-5 -4 -3 -2 -1 0 1 2 3 4 5
time [sec]

Mean data of 60 eyes

 Change in Visual Acuity Using the Micro
Mirror Array

Change in VA by Using the Micromirror Array

6
no. of e ye s

gain (1line) no difference lost (1 line)

 Case Study: Patient RB (OD)

BSCVA, Mirror OFF Mirror ON

VA: 20/20  20/16

 Case Study: Patient JS (OD)

BSCVA, Mirror OFF Mirror ON

VA: 20/16  20/12.5

 Case Study: Patient TK (OS)

BSCVA, Mirror OFF Mirror ON

VA: 20/20  20/16

 MTF Improvement
1

diffraction limited, 6mm pupil

0,9
diffraction limited, 3mm pupil
0,8
uncorrected (TK), 6mm pupil
0,7
uncorrected (WE),6mm pupil
0,6
corrected (TK), 6mm pupil
MTF

0,5
corrected (WE), 6mm pupil
0,4
neural threshold (Campbell, Green
1965)
0,3

0,2

0,1

0
0 30 60 90 120 150 180
20/20 20/10 Spatial Frequency [cycles/ degree]
 Correction of Higher Order RMS

Chang e o f HOA (mean o f 5 s ec)

0,8

0,7

0,6

0,5
RMS [µm]

0,4

0,3

0,2

0,1

0
0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8
RMS [µm]

corrected uncorrected
 Conclusion
• Wavefront driven micromirror array can
significantly reduce wavefront aberrations
• Static correction can correct more than 50% of higher
order aberrations
• Visual acuity of patients can be improved by this
adaptive microchip mirror
• The improvement in Visual Performance will mostly
effect contrast sensitivity. Most subjects with a 5.5mm or
larger pupil and a RMS higher than 0.3µm had a gain of
one line in VA
Aberration-Free Retinal Imaging
 WE (OD): Wavefront Correction

uncorrected corrected
 WE (OD): Point Spread Function

uncorrected corrected

Side is 25 µm Side is 25 µm
 An image of a human retina*...

...through an aberration-free
1mm pupil
3mm
6mm

*BILLE, J.F., DREHER, A.W., ZINSER, G.

Scanning laser tomography of the living
human eye. In: Noninvasive Diagnostic
Techniques in Ophthalmology, Masters B.R.,
...as...as
seenseen
at the
at 20/10
the 20/10
patient
Springer Verlag (publ), p. 537, 1990. corrected
patient
with(5mm
the 40m
pupil)mirror
 retinal imaging setup
●
usage of a super luminescent diode to avoid speckle,
●
low coherence (720 nm, 20 nm width)
●
15 Hz frame rate
●
Xinetics mirror
Rochester setup
improved retinal imaging

cone class identification, Williams et al.

 confocal retinal imaging
•replace 2D-detector
(camera) with 1D-detector
(photodiode)
•add a scanning unit and a
pinhole
•achieve axial resolution

•AO:
2.5 um lat., 100 um axial
 AO confocal retinal imaging
•rms reduction from
0.55 um to 0.10 um
•axial scan: surface,
blood vessel,
photoreceptor
(Roorda.mov)
•application: glaucoma
detection Austin Roorda, Fernando Romero-Borja, William J. Donnelly III, Hope Queener, Optics Express
 outlook

current problems with vision AO

•variety of experimental systems,
but no agreement on best system
•few commercially available components
•sensors expensive or slow

next steps in vision AO

•move to 'custom of the shelve systems'
•plug & play low cost systems
•user interface
Custom Excimer Laser Ablation
 WaveScan™ Data = Basis for
Custom Ablation
Objective, spatially and temporally resolved
measurement of the eye using wavefront
sampling with many hundred data points
individual map of all refractive
errors
= data for personalized treatment &
preview system
Individualized Treatment Plan
Personalized Ablation Profile

Ablation profile
Excimer Laser
VISX S4
 Variable Spot Scanning™* Video
8mm x 6mm Ellipse

Click on the video to start the demo

 Designed Treatment from WavePrint™ Data

Ablation model with laser placement and lens creation

Designed Treatment from WavePrint™ Data

Ablation model illustrating lens creation

Iris-Recognition
Cyclotorsional Eye-Tracking
Improving Vision with Custom Refractive
Procedures

WaveScan

Excimer Laser
 Summary
•Wavefront-guided MEMS-multi-micromirror- sys-
tems can essentially compensate for higher order
optical aberrations of the human eye
•Wavefront-guided excimer-laser refractive surgery
allows for improved visual acuity in comparison to
sphero-cylindrical corrections
•Adaptive-optical closed loop systems considerably
improve the resolution of retinal imaging
•Intrastromal refractive surgery with femtosecond
lasers allows for minimal-invasive corrections of
higher order optical aberrations
Thank you
for your
attention !