1. RAY TRACING & WAVEFRONT ANALYSIS USING THE TRACEY SYSTEM Donald R. Sanders, M.D., Ph.D. Center For Clinical Research

2. 20/10 UNCORRECTED PATIENT

3. Retinal Spot P S F

4. 20/10 UNCORRECTED PATIENT

5. 20/10 UNCORRECTED PATIENT Ref +0.04 + 0.16 X 110 Total RMS = 0.068  m Lower Higher

6. 5 th Order 4 th Order 3 rd Order 2 nd Order Astigmatism Defocus (Refraction) Higher

7. Breakdown of Zernike Terms -0.500.511.52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Zernike term Coefficient value (microns) astig. defocus astig. trefoil coma trefoil spherical aberration 2 nd order 3 rd order 4 th order 5 th order

8. Root Mean Square astigmatism term defocus term astigmatism term trefoil term ……

9. GROSS APPROXIMATION Total RMS Vs. Visual Acuity 1.0  m = 20/20 - 20/25 0.5  m = 20/15 0.25  m = 20/10

10. COMPONENTS OF TOTAL RMS Lower Order Aberrations Defocus (Sphere) Astigmatism (Cylinder) Plus Higher Order Aberrations

11. 20/10 VISION Ref -0.14 + 0.39 X 168 Total RMS = 0.204  m P S F

12. LARGELY LOWER ORDER ABERRATIONS Retinal Spot P S F

13. 99% OF RMS VALUE IS LOWER ORDER ABERRATIONS (Refractive Error) Lower Higher

14. AFTER SUBTRACTING LOWER ORDER ABERRATIONS Retinal Spot P S F

15. REFRACTIVE ERROR “UCVA” “BCVA” All AberrationsHigher Order Only P S F

16. REFRACTIVE ERROR “UCVA” “BCVA” All AberrationsHigher Order Only

17. REFRACTIVE ERROR “UCVA” “BCVA” All AberrationsHigher Order Only Retinal Spot

18. CORNEAL BIRTH TRAUMA “UCVA” “BCVA” All AberrationsHigher Order Only P S F

19. CORNEAL BIRTH TRAUMA “UCVA” “BCVA” All AberrationsHigher Order Only Retinal Spot

20. CORNEAL BIRTH TRAUMA “UCVA” “BCVA” All AberrationsHigher Order Only

21. COMMON SIGNIFICANT HIGHER ORDER ABERRATIONS Coma Spherical Aberration Trefoil

22. (T.M.) POST LASIK Complains Of Night Glare 6mm Scan (Undilated)

23. PATIENT T.M. (OD) 6 mm Scan – P S F “UCVA” “BCVA” All AberrationsHigher Order Only

24. “UCVA” “BCVA” All AberrationsHigher Order Only PATIENT T.M. (OD) 6 mm Scan – Retinal Spot

25. “UCVA” “BCVA” All AberrationsHigher Order Only PATIENT T.M. (OD) 6 mm Scan

26. PATIENT T. M. (OD) Decentered Excimer COMA

27. PATIENT T. M. (OD) Vertical Coma

28. PATIENT T.M. (OD) EFFECT OF SCAN DIAMETER (PUPIL SIZE) ON PSF Higher Order Aberrations Only 4 mm 6 mm

29. UCVA (All Aberrations) BCVA (Higher Order Only) PATIENT T. M. (OS) 6.5mm Scan – P S F

30. COMA SPHERICAL

31. ABERRATION HORIZONTAL COMA

32. PATIENT T.M. NIGHT MYOPIA DUE TO SPHERICAL ABERRATION Pupil Size (Undilated) Amount Of Myopia (D) 0.85 2.49 1.99 1.66 OS

33. PATIENT T. M. (OS) Night Myopia Due To Spherical Aberration 4 mm 5 mm 6 mm6.5 mm

34. PATIENT T. M. (OS) – P S F Night Myopia Due To Spherical Aberration 4 mm 5 mm 6 mm6.5 mm

35. SUMMARY PATIENT T.M. Large Pupils In Dim Light OD Vertical Coma (Decentration) With Mild Spherical Aberration OS Horizontal Coma(Decentration) + Spherical Aberration

36. PATIENT S. P. Complains Of Severe Night Glare 6.5mm Scan Pupil is 7.0 –7.5mm Undilated

37. PATIENT S. P. (OD) Severe Night Glare 4 mm 4.5 mm 6.0 mm6.5 mm PUPIL SIZE RMS = 0.261RMS = 0.407 RMS = 1.83 RMS = 1.1

38. PATIENT S. P. (OD) Severe Night Glare Pupil Size RMS = 0.166RMS = 0.346 RMS = 1.83 RMS = 0.656 Higher Order Aberration Only 4mm 6.5mm6.0mm 4.5mm

39. 4 mm6.0 mm PATIENT S. P. (OD) Severe Night Glare Lower Higher

40. PATIENT S. P. (OS) Complains Of Severe Night Glare 4.5 mm 5.5 mm 6.0 mm 6.5 mm

41. 4.5 mm6.5 mm PATIENT S. P. (OS) Complains Of Severe Night Glare NOTE: Scale Doubles

42. PATIENT J. C. Most Higher Order Aberrations – Trefoil, Tetrafoil

43. J. C. D. S/P RK SURGERY