The authors have no financial interest in the subject matter of this poster Yinfei Xu, Peter S. Hersh, MD, David S. Chu, MD Institutional Affiliations University of Medicine and Dentistry of New Jersey Cornea and Laser Eye Institute

INTRODUCTIONINTRODUCTION  Wavefront analysis Aberrations can result from both lenticular and corneal abnormalities Wavefront-sensing devices measure high- and low-order total-eye aberrations Wavefront maps display deviations of an aberrated wavefront from that of an emmetropic, or theoretically perfect, eye Previously identified aberrant shapes can provide clues to diagnosis  Scheimpflug imagery Provides complete picture of the anterior segment Rotating imaging technology captures image slices over 360° to detail lenticular and corneal contours

 To demonstrate wavefront analysis and Scheimpflug imagery as effective tools in the diagnosis of anterior lenticonus as well as in other optical disorders  We present the case of a 44-year-old Alport syndrome patient Complaint of progressive reduction of vision Anterior lenticonus first detected by wavefront analysis and confirmed by Scheimpflug imagery Successful surgical treatment of left eye restored BCVA from 20/40 -2 to 20/25 PURPOSE & CASE REPORT

 Slit-lamp biomicroscopy for anatomical diagnosis  Corneal topography with Pentacam (Oculus)  Wavefront analysis using LADARwave (Alcon, Inc.) to determine total-eye aberrations (both corneal and lenticular)  Scheimpflug imagery with Pentacam (Oculus) Patient’s anterior lens contour was measured and compared to the average of fifteen normal lenses METHODSMETHODS

 Slit-lamp biomicroscopy revealed no significant cataract or other obvious lens anomalies  Normal sagittal curvature and elevation maps of cornea RESULTSRESULTS

 Predominant spherical aberrations represented by a highly negative center with positive ring (top)  RMS values correspond to decreases in optical quality, represented by deviations from the emmetropic plane as cooler or warmer colors  Post-surgical maps (bottom) show reduced total and high- order aberrations, including spherical Pre-surgical (top), Post-surgical (bottom) RESULTS: Wavefront Analysis

 Zernike modes, including coma and spherical, with patient’s total-eye aberration values RESULTS: Wavefront Analysis

 Pre- and post- operative O.S. aberrations High-order reductions: coma, spherical Low-order reductions: defocus No marked improvements for astigmatism or other aberrations RESULTS: Wavefront Analysis

 Showed central bulging of anterior lens surface RESULTS: Scheimpflug Imagery

 To compare protrusion to normal population, measurements were taken from apex to a 4 mm chord for fifteen refractive surgery candidates with normal lenses  Patient’s protrusion measured 400 μm, more than three standard deviations from μm, mean of the normal lenses Patient Normal RESULTS: Scheimpflug Imagery

 Given normal corneal topography, abnormal total- eye aberrations from wavefront maps pointed to internal optics as the source of visual deficit  More specifically, predominant spherical aberration on wavefront maps suggested that reflection patterns were produced by an anterior lens surface bulge  With patient’s medical history of Alport syndrome and wavefront analysis results, Scheimpflug imaging was sufficient to confirm the diagnosis of anterior lenticonus ANALYSISANALYSIS

 This case highlights the role of advanced imaging technologies in detecting lenticular abnormalities that initially went undetected by other ophthalmic examinations  Wavefront analysis produces characteristic patterns that can help identify subtle abnormalities  Scheimpflug imagery can further provide visual confirmation of treatable pathology as well as quantifiable results  When correlated with medical history, these imaging technologies can assist in the diagnosis of a variety of optical disorders, including anterior lenticonus CONCLUSIONCONCLUSION