Purpose: The purpose of this study was to characterize aberrations in 2 populations of eyes, namely those with keratoconus (KC) and those having undergone penetrating keratoplasty (PK), using a large-dynamic range Shack-Hartmann wavefront sensor. Design: Prospective comparative case series. Participants: Twenty-one people with ocular pathologic features (either KC or PK) were recruited for this study. A previously compiled population of 190 people with no pathologic features other than refractive error was used as a means for comparison. Methods: Thirty-three abnormal eyes (19 with KC and 14 PK) were measured using a high-dynamic range wavefront sensor, and Zernike coefficients were computed over a 6-mm pupil. The data then were used to characterize the populations by themselves, as well as to compare them with the population of normal eyes. Main Outcome Measures: Root mean square (RMS) higher-order aberration (HOA), percent of higher-order or total aberration variance, and magnitude of individual Zernike modes (in micrometers). Visual benefit of correcting higher-order aberrations was used when comparing pathologic and normal populations. Results: The keratoconic eyes exhibited 2.24 μm of HOA RMS on average. Vertical coma accounted for 53±32% (mean±standard deviation [SD]) of the HOA variance and was the most dominant higher-order aberration. The PK subjects had an average higher-order RMS of 2.25 μm, and trefoil dominated in this population with an average HOA variance contribution of 38±23% (mean±SD). The KC and PK higher-order aberrations represented 16±20% and 16±13% (mean±SD) of the total aberration variance, whereas the ratio was only 1±1% in the normal population. A visual benefit calculation on 15 KC eyes and 14 PK eyes yielded a result of 4.4±2.0 and 6.0±1.5 (mean±SD), respectively, whereas the normal population had a visual benefit of only 2.1±0.4. Conclusions: Eyes with KC and PK have higher-order aberrations that are approximately 5.5 times more than what is typical in normal eyes. Vertical coma is the dominant higher-order aberration in people with KC, whereas PK eyes are dominated by trefoil, spherical aberration, and coma. Correcting these aberrations may provide substantial improvements in vision beyond what is possible with conventional correction methods.
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