FEATURE ARTICLE

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Wavefront and Adaptive Optics

Mike Gzik, FCLSA

Light can be described in

several ways depending on
how you want to measure it,
and what you want to do with
it. The wavelength of light and
other related properties are
associated with physical optics. Geometric optics deals
with ray tracing, the math of
light, and its behavior with
lenses and mirrors. Lasers and Figure 1: Zernike Polynomials. Thibos, LN; Applegate, RA;
other devices utilizing light in
Schwiegerling, JT; Webb, R; Standards Taskforce Members,
Standards for Reporting the Optical Aberrations of Eyes, OSA,
various forms of energy fall
Trends in Optics and Photonics, 2000. Photo courtesy Ray
into quantum optics (phoApplegate.
tons). Quantum optics utilize
both wave and particle aspects to describe aberrations while the more complicated
light.By definition, if the human eye is not expressions are higher order aberrations.
To understand wavefront and adapperfect or emmetropic, then it has a retive optics, we need a short review of the
fractive error or an optical aberration.
properties of light. Ray optics and light
Wavefront technology is a more specific
way of detecting, describing, and measur- particles (corpuscles) was a theory that
Newton, Snell, Descartes, Fermat, and
ing refractive defects. These defects inothers believed in, and was initially supclude, but are not limited to, myopia,
ported by the physicist Planck. This theory
hyperopia, and astigmatism.
began in the early 1600s with Snells Law
Defining Light Through History
of Refraction. In this theory, light was
In 1857, Ludwig Von Seidel wrote a paper propagated by rays in the form of corpuscles that some thought vibrated a
describing monochromatic aberrations
substance called ether. In the early 1800s,
concerning lenses and mirrors. These
William Hamilton used work by Snell,
aberrations Seidel called third-order
Descartes, and Fermat to formulate a
optics. They are spherical aberration,
general mathematical theory of ray optics.
coma, astigmatism, curvature of field,
Christian Huygens was the first to
and distortion (pincushion and barrel).
propose
the wave theory in the 1600s.
In 1888, Seidel added chromatic aberration to his list. Astigmatism is now consid- Wave optics seemed to have more supporters in the 1800s with work done by
ered a second order aberration.
Over the next 100 years various meth- Thomas Young, Fresnel, Hooke, and Doppler. The wave theory can be described
ods for measuring and describing optical
using the analogy of waves in water. The
aberrations were used. In the 1990s, a
waves length can be determined by meatask force commissioned by the Optical
Society of America recommended the use suring the distance from crest to crest.
of Zernike Polynomials to describe optical Amplitude is the intensity, maximum value
or height of the wave. Frequency is the
aberrations of the eye (Fig. 1). Zernike
Polynomials vary from simple to complex number of wave crests that pass a fixed
point per second.
mathematical expressions. The simple
In the 1800s and early 1900s, the
expressions, which describe defocus and
current theories of light began emerging.
astigmatism, are considered lower order
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ABOUT THE AUTHOR

Mike Gzik is a New York
State licensed optician/
contact lens practitioner.
He is a Fellow member of
CLSA, JCAHPO COT, NCLE
certified. Mike works for
New York Optometric, a
private optical office in
Syracuse NY, and as a
consultant and technical
trainer for Bausch & Lomb
professional services. He is
an adjunct instructor for
contact lens technology at
SUNY Health Science
Center, Syracuse NY. He was
CLSA member of the year in
2001 and presented the
Theo E. Obrig lecture at the
2002 CLES meeting.

What is wavefront
technology?
Is this new stuff?
How is this measured?
What will influence
the measurements?
How do we interpret
the data?
How does this differ from a
conventional refraction?
What are adaptive optics?
How can we utilize
the data to improve the
quality of a patients vision?
Whats in it for me?

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FEATURE ARTICLE

Figure 2: Hartmann-Shack Wavefront Sensor.

Figure 3: Hartmann-Shack Wavefront Sensor. Liang & Williams 1997

JOSA.

In 1818, work done by Fraunhofer on absorption lines for

elements led to James Maxwells equations of electromagnetic fields. Maxwell calculated that electromagnetic waves
traveled at the speed of light. Hertz demonstrated that
electromagnetic waves were reflected and refracted like
light. Work, theory, and analysis by Planck, Einstein, Bohr,
and others, led to Luneburgs final mathematical identification of optics with electromagnetism in 1944.

History of Wavefront Technologies

In the 1600s, a Jesuit astronomer and philosopher described an optical device currently known as Scheiners
disk in his book Optical Foundations of the Eye. This
double pinhole disk was used to measure refracting errors.
An eye with no refractive error, or corrected refractive
error, saw a single spot of light viewed at distance. An eye
with an uncorrected refractive error saw two spots of light.
This was known as Scheiners principle. The principle is
still used today in some autorefractors. An instrument using
this principle is only able to detect an error that would
require a sphere or sphero-cylinder lens correction.
Technology in optics leapt forward during the late
1600s and early 1700s. Lippershey, Galileo, Newton,
Cassegrain, Leeuenhoek, and others, invented and improved optical lenses that were used in telescopes and
microscopes. They not only discovered the properties of
spherical lenses in these instruments, but also distortions
caused by the optics of these lenses. They discovered chromatic and spherical aberration, as well as other optical
32

refractive errors that were at that time left unnamed. Discovering the problem helped to lead to solutions. For
example, the Cassegrain reflecting telescope was able to
correct spherical aberration. George Airy, a British astronomer, was the first to use cylindrical lenses to correct
astigmatism in the early 1800s.
The next phase of development came when Tscherning,
using a grid superimposed on a +4.00D lens, was able to
determine subjective deviations of a point source of light
(he used a star). His findings were published in 1894.
Today, these principles are used in some aberrometers.
A more sensitive method of determining complicated
refractive errors was made by Smirnov in 1961. Smirnov
used Scheiners disk but with a fixed light source for the
reference pinhole and a movable light for the second pinhole. Along with a series of computations, this modification
would allow for a mathematical interpretation of data that
yielded an aberration map.
Hartman used the principles of Scheiners disk and by
increasing the number of apertures in the disk presented
numerous points of reference, or a wavefront, to be measured. Shack and Platt improved on this system by replacing the apertures with small lenses. This lens array projected a specific pattern or wave of light points on the
retina, and the deviations from a perfect wavefront were
measured and mathematically converted to a wavefront
map (Fig. 2 and 3).

Wavefront and the Eyes Refraction

In wavefront technology, a laser light projects an image
onto the retina. The image must pass through the cornea,
pupil, crystalline lens, and vitreous on its way to the retina.
The instrument then assumes the reflected image originates
from a point source on the retina. The instrument subtracts
this wavefront from a perfect wavefront and the difference becomes a map of the eyes optical aberrations (Fig. 4
and 5).
With a Tscherning aberrometer, a grid is projected
onto the retina and cameras record the image distortion.
The distortion is compared to a perfect grid image and the
values are expressed in polynomial expansion form.
Hartmann-Shack aberrometers project an infrared
laser light point image on the retina. A camera captures the
emerging reflected light rays as they pass through an array
of small lenslets. If the emerging light is from an optically
perfect eye, all of the individual rays will exit the eye simultaneously and the wavefront will be straight or perfectly
curved (Fig. 3). If the eye has aberrations, the wavefront
will have irregularities since the light rays exit the eye at
different times. In an aberrated eye, this image is compared
to an image of an ideal wavefront and the deviations are
computed, and an aberration map is produced using
Zernike polynomials (Fig. 1).
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Planar wavefront

Spherical wavefront

Line through
exit pupil

Reference sphere

Figure 4: The perfect eye.

Planar wavefront

Aberrated wavefront

Ray tracing aberrometry projects multiple rays of laser light

onto the retina. The resulting exit location is compared to the
known entry point position and the aberrations are calculated
using polynomial expressions.
Dynamic skiascopy uses a moving slit projected in to the eye
A (retinoscopy). The calculation for the refractive error is based on
the relative motion of the slit image. A wavefront aberration map is
then produced.
All of these systems have advantages and disadvantages. The
Tscherning and HartmanShack, both frequently used
aberrometers, may not accurately measure a cornea with significant amounts of irregularity. This is due to a condition known as
crossover. Reflected light from one lenslet crosses over into a
region designated for a different spot.
These misdirected images confuse the instrument and inaccurate readings may occur.
A

Line through
exit pupil

Adaptive Optics

With the launch of the Hubble space telescope, astronomers had a

clear aberration-free view of the universe for the first time. Terrestrial telescopes, despite precision optics and computer-enhanced
photography, cannot overcome inherent problems. Temperature
Reference sphere
fluctuations create small changes in the surface of the glass lenses
Figure 5: The aberrated eye.
and mirror systems due to natural expansion and contraction.
Additionally, the size and weight of the primary and secondary
Deformable
reflective surfaces also lent themselves to surface fluctuations
Mirror
Computer
caused by gravity and structural instability. Changes in the Earths
atmosphere (temperature and density) constantly change the
index of refraction of the air through which the light must travel.
Rochester
Adaptive Optics
Active optics combines actuators in the mirrors with comSystem
puter calculations to deform the primary and secondary mirrors
to correct for the surface aberrations. This is to compensate for
Wavefront
the changes caused by temperature fluctuations affecting the
Sensor
mirrors and structural changes due to the size of the mirrors. The
first fully operational telescope with active optics was put into use
in La Silla, Chile, in 1989.
SLD
Adaptive optics also uses small actuators in the reflective
Gratings or
Display
Snellen Letters
surfaces
of the primary and secondary mirrors to correct for
in White Light
atmospheric induced aberrations. Light from distant objects enFigure 6: Rochester Adaptive Optics System.
ters the atmosphere and this wavefront (from real optical infinity)
is distorted. The incoming wavefront is constantly sampled by
charged-coupled devices (CCDs), calculations are made, and the
Customized Contact Lens
corrective changes to the actuators (usually piezoelectric)* are
made. In this form of adaptive optics, the samples are taken and
thousands of adjustments are rapidly made each second. This
combination of active and adaptive optics has increased the astronomical properties of terrestrial telescopes to rival that of the
Hubbles atmosphere-free optics.
Aberrated Wavefront

Adaptive Optics for the Human Eye

Figure 7: Customized contact lenses.

* Electricity or polarity induced in certain crystals by mechanical

stress.
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Adaptive optics is the term used to describe an optical system

created to correct higher order aberrations detected by a wavefront sensor. For the human eye this optical system may be an
33

FEATURE ARTICLE
adaptive optic array, conventional or
CASE HISTORY
custom soft contact lenses, adaptive
This case is a 58-year-old female contact lens patient with map dot
optic guides, custom ablation, custom
corneal dystrophy and an incipient cataract in her right eye. She is
intraocular lenses, spectacles or a comaphakic in her left eye with an IOL, corneal graft and a PTK
bination of these. Utilizing the
(phototherapeutic keratectomy). She has dry eyes OU.
astronomers technology of wavefront
Rx:
OD +3.75 -1.50 x 155 20/30-2 BCVA
analysis and adaptive optics, industry,
OS +1.25 -2.00 x 52 20/ 40+2 BCVA
academia, and government agencies, are
currently conducting research in this
Ks
OD 43.25 @ 175 / 44.37 @ 85 2+ distortion
new and exciting field.
OS 41.87 @ 20 / 43.25 @ 110 2+distortion
At the University of Rochester, Center
Contact Lens Parameters:
for Visual Science, Institute of Optics, an
OD
7.86 mm (43.00 D), +4.50 D, 10.0 mm, 7.8 mm OZ,
array utilizing a wavefront aberrometer
11 2 D prism, 20/30-1
and adaptive optics was constructed. In
OS
7.86 mm (43.00 D), Plano, 10.0 mm, 7.8 mm OZ,
this array, the eye focuses on a display of
11 2 D prism, 20/30-2
Snellen letters in white light and the
Prism was added to the lens design because of excessive superior
retinal image is analyzed for aberrations
decentration. Wavefront aberrometry was performed on both eyes with
by a wavefront sensor. The information is
and without lenses in place using a B&L ZYWAVE II aberrometer**.
then sent to a computer that controls a
Wavefront aberrometry was performed on both eyes without condeformable mirror. This adaptive optic
tact lenses in place (Fig. 8). Unfortusystem corrects the eyes aberranately, with the addition of the contact
tions and projects the corrected
lens on the patients left eye, we were
image back to the eye (Fig. 6).
unable to obtain a wavefront reading
Researchers are currently
for that eye. This may have been due to
working to use the wealth of
the additional optical surface, creating
information gathered by
crossover with the instrument and or
wavefront technology to correct
pupil size at the time of the measurethe human eye in a more practiment. We did obtain a wavefront readcal application. Ian Cox, Ph.D., a
ing on the right eye with the contact
researcher at Bausch & Lomb,
lens in place. This is displayed in Figure
has been involved in studies with Figure 8: Pre-contact lens fitting.
9 and demonstrates a change in the
the University of Rochester on
aberration map. The patient reports an
the feasibility of correcting
improvement in vision when wearing
higher order aberrations with
the contact lenses. There is also a slight
custom soft contact lenses.
improvement in the Snellen visual
Bausch & Lomb has developed a
acuity OU and subjectively she reports
process that transmits the inforeverything is more sharp and distinct.
mation gathered by a wavefront
The wavefront analysis supports this for
sensor to a computer controlled
the right eye.
2-axis CNC lathe. The end result
Interpreting a wavefront map is
is a customized soft contact lens
Figure 9: Post-contact lens fitting.
difficult at first and an easier way to
whose toric-like design is
visualize the data supplied by the
used to minimize rotation that
ZYWAVE II is to look the point spread
would otherwise displace the
function. On readouts (Fig. 8, 9, 10),
corrected optics (Fig. 7).
look at the lower right display. This
Customized contact lenses
visualization is called a point spread
are technically feasible; however,
function (PSF). A PSF is what a patient
practical application on a larger
may see through their aberration if
scale for the general population
looking at a point of light. The more
is not yet available. Some of the
streamers or deviations from a point of
feasibility challenges of custom
light, the higher order the aberration.
contact lenses are the current
Figure 10: With gas permeable lenses in place.
cost and availability of wavefront
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aberrometers, and computer guided lathes, as well as stable and

non-rotating lens designs.
Another application of adaptive optics is in refractive surgery. Spherical aberration is seen in many post-LASIK and PRK
patients. Wavefront assessment can help the surgeon minimize,
and potentially eliminate, this induced aberration. Many laser
companies are combining wavefront technology and topographical instrumentation to help program refractive lasers for custom ablation. Some early studies have indicated that customized
ablations may decrease the amount of higher order spherical
aberration seen post-surgically.
There are also challenges to wavefront customized ablation.
In the December 2001 editorial of the American Journal of
Ophthalmology, MacRae and Williams cite nine limitations of
higher order correction or measurement. In a pupil 3 mm or
smaller, the higher order aberrations are more difficult to measure, making dilation necessary. In larger pupil sizes, the higher
order aberrations are not only easier to detect they are more
necessary to correct. This is why keratoconus, graft, and other
irregular astigmatism patients report degradation in vision at
night. Chromatic aberration is currently unable to be measured
with a wavefront sensor or corrected with customized ablations.
Measurement and customization of optical corrections are
done only for distance correction and not in an accommodated
eye. Changes in the wavefront aberrations over time, due to the
aging of an individual with a static correction, may induce different aberrations later. The depth of field may again be affected
because the aberrations are corrected for the best focus, and
viewing outside the best focus range may be adversely affected.
Biomechanical effects of laser ablation on corneal tissue with
regard to wound healing and shape changes may render preoperative calculations inaccurate. As in customized contact
lenses, centration is critical in correcting aberrations.
Decentered adaptive optics can induce different aberrations than
those which they were originally intended to correct.
Regarding the potential to creating super vision with
adaptive optics, the retina may not have the capability to process
improved images projected onto it. An analogy would be a high
definition TV signal broadcast to a low definition TV.
Wavefront technology can help explain some patient complaints in a more scientific way. Starbursts at night are caused by
spherical aberration and comet tails from lighted objects are
caused by coma. Other peculiar visual complaints can be addressed more accurately and specifically than simply using the
term irregular astigmatism. Those of us in the contact lens field
know that gas permeable contact lenses usually correct the
irregular cornea more efficiently than spectacles or soft contact
lenses. Increasing knowledge of wavefront technology will ultimately enable contact lens professionals to understand and
improve fitting techniques in all lens materials.

Definitions
Aberration: A deviation from the normal,
proper, or expected course (American Heritage
Dictionary).
Astigmatism: The refractive cylindrical aspect of
the aberration.
CCD (chargedcoupled device): A solid-state
electronic device used to gather light. CCDs are
composed of a grid of photon-absorbing material
and electronics that collect and measure the
electrons released by the material when light hits
it. They are also used in spectroscopy.
Coma: When rays at one edge of the system are
focused before the center and the center is
focused before the opposite edge. The optical
effect of a point source of light similar in
appearance to a comets tail. Clinically seen in
decentered corneal graft patients.
Defocus: The spherical aspect of the aberration.
Refractive myopia is positive defocus. Refractive
hyperopia is negative defocus.
Higher Order Aberrations: Zernike expansion
modes in the third order and higher are
collectively called higher order aberrations. These
include, but are not limited to, spherical
aberration, coma, and trefoil.
Optical Aberration: Blurred or distorted image
quality that results from inherent physical
properties (shape, curvature, density) of an optical
device (lens or prism).Dictionary of Eye
Terminology
Lower Order Aberrations: The second radial
order in the Zernike expansion, which includes
defocus and astigmatism.
Piston: A constant used in fitting Zernike
polynomials to the wavefront. Piston doesnt
affect the optical properties of the wavefront.
Point Spread Function (PSF): PSF is the
distribution of light in the image plane for a point
object.
Secondary Coma: A more complex higher order
coma.
Secondary Spherical Aberration: A more
complex higher order spherical aberration.
Spherical Aberration: When peripheral light
rays focus in front of more central rays. Clinically,
it is seen in post-LASIK and PRK patients and is
the cause of night myopia.
Tilt: Can be thought of as prism, shifting the
wavefront position horizontally, vertically, or a
combination of both but does not change the
focus of the wavefront.
Trefoil: Often called triangular astigmatism,
similar to astigmatism but contains three axes
instead of two.

References available upon request.

** My thanks to Michelle Lagana, O.D., Research Optometrist at B&L; Ian Cox, O.D., Ph.D., Researcher at B&L; Paul China, O.D., Research
Optometrist at B&L, and; Michael D. Pier, O.D., Director of Professional Relations, Education and Development at B&L for their assistance.
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FEATURE ARTICLE

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Successfully Complete These Questions to the Article on Pages 3135 to Receive NCLE/JCAHPO Credit.
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1. Zernike Polynomials are?

a. Linguistic terms for aberrations
b. Mathematical expressions
c. Shapes of aberrations
d. Wavefront instruments

2. Which of the following is a lower order aberration?

a. Defocus
c. Coma

b. Spherical aberration
d. Chromatic aberration

3. A double pinhole disk first used in the 1600s to

detect aberrations of the eye is known as a:
a. Hooken Ladder
c. Scheiners Disk

b. Doppler Ganger
d. Fresnel Prism

4. Myopia and hyperopia fall in which category of

aberrations?
a. Coma
c. Chromatic aberration

b. Spherical aberration
d. Defocus

5. Spherical aberrations can be seen clinically in which

of the following patients?
a. Post PRK and LASIK
c. Keratoconus

b. Macular degeneration
d. Map dot dystrophy

6. In wavefront aberrometry, the wavefront exiting

the eye is measured against the:
a. Refractive error of the eye
b. Corneal topography
c. Simulated perfect wavefront
d. Aspheric projector shape
b. Adaptive optic system
d. Aberration

8. If a patient reports an image that looks like a

comets tail, the aberration is called:
a. Defocus
c. Coma

b. Astigmatism
d. Spherical

9. A more specific way of detecting, describing, and

measuring optical defects is called:
a. Wavefront technology
c. Refraction

b. Aberration control
d. Quantum optics

10. With a pupil that is larger than 5 mm, it is easier to

detect:
a. Myopic shift
c. Adaptive optics

Please select CEC credit:

b. Higher order aberrations

d. Field defects

NCLE JCAHPO

This course has been designated Level III.

Series 58

Please Record
Answers Below
by filling in
appropriate circle

11. What is the optical surface in a telescope that

corrects for aberration?
a. Deformable mirrors
c. Aberrometers

b. CCD
d. Scheiners disk

12. A prototype custom soft contact lens made to

correct for higher order aberrations resembles the
design of which type of soft contact lens?
a. Spheric
c. Multifocal

b. Toric
d. Aphakic

13. The first use of a cylindrical lens to correct astigmatism was by:
a. Leonardo DiCaprio
c. George Airy

b. Hans Lippershey
d. James Maxwell

a. Geometric optics
c. Physical optics

b. Quantum optics
d. Reflecting optics
b. Amplitude
d. Distortion

b. Einstein
d. Bohr

b. Adaptive optics
d. Aspheric optics

18. The aberration that occurs when peripheral light

rays focus in front of more central rays is called:
b. Spherical
d. Astigmatism

b. Ion force fields

d. Wind direction

b. Particle
d. Aberrations

10. A B C D
11. A B C D
12. A B C D

14. A B C D
15. A B C D

20. Quantum optics can be described through all of the

following aspects of light except:
a. Wave
c. Photon

7. A B C D

13. A B C D

19. Adaptive optics for telescopes are designed to

correct for aberrations caused by fluctuations in the
atmospheres:
a. Index of refraction
c. Ozone layer

4. A B C D

9. A B C D

17. What is the term used to describe an optical system

used to correct the aberrations detected by a
wavefront measuring device?

a. Chromatic
c. Coma

3. A B C D

8. A B C D

16. Who mathematically identified optics with

electromagnetism?

a. Retroactive optics
c. Aberration optics

2. A B C D

6. A B C D

15. In the wave theory, light is measured in all except:

a. Wavelength
c. Frequency

1. A B C D

5. A B C D

14. Ray tracing, the math of light, and the behavior

with lenses and mirrors, is usually described as:

a. Planck
c. Luneburg

7. HartmannShack is a name for a type of:

a. Aberrometer
c. Active optic system

RECEIVE CECThe technical article on pages 3135 has been

submitted for approval for one continuing education credit unit
with the National Contact Lens Examiners (NCLE) and the Joint
Commission on Allied Health Personnel in Ophthalmology
(JCAHPO). To obtain your CEC, submit your completed quiz, along
with an $18 processing fee to: CLSA, 441 Carlisle Drive, Herndon, VA
20170, Fax (703) 437-0727. Fees are waived for current CLSA
members. If youre not a member of CLSA, call (800) 296-9776.

16. A B C D
17. A B C D
18. A B C D
19. A B C D
20. A B C D

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