A Limitation of Hartmann-Shack System in Measuring Wavefront Aberrations for Patients Received Laser Refractive Surgery

PURPOSE: To explore the relationship between ablation parameters of myopic laser surgery and measurement area of wavefront aberration (WA) with Hartmann-Shack wavefront sensor. METHODS: 58 subjects undergone myopic laser surgeries and 74 uncorrected myopic subjects were enrolled in this experiment. The laser ablation parameters were obtained from surgical records, which included spherical error (Rx), depth, and optical zone (OZ) of ablation. The measured area of WA was tested by the WASCA, and the real pupil size was tested by Pentacam. The corneal eccentricity (E value) and curvature was also measured with the Pentacam. All the measurements were performed under mydriatic condition. RESULTS: For uncorrected myopic eyes, the measured area of WA was similar with the real pupil size. But for the corrected eyes, the measured area of WA was smaller than the real pupil size with a mean difference of 0.66 ± 0.54 mm for moderate myopia (t = 6.45, p < 0.0001) and 1.76 ± 0.55 mm for high myopia (t = 18.92, p < 0.0001), but not for mild myopia. The Rx (t = -3.20, p = 0.0017), OZ (t = 64.4, p < 0.0001) and postoperative corneal E value (t = 2.52, p = 0.017) were the independent factors of measured area of WA. Measured area of WA = -0.81*Rx + 1.13*OZ + 0.49*postoperative corneal E value (r(2) = 0.997). CONCLUSIONS: The WASCA has a limitation in measuring wavefront aberration over the whole pupil area when it’s used for patients received myopic laser surgery. The measured area is smaller than the real pupil size and depends linearly on ablation depth, optical zone and corneal eccentricity.