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Both the anterior surface of the cornea and the internal optics (the posterior cornea, crystalline lens) contribute to the aberration of a wavefront passing through the eye. Artal, Guirao, Berrio, and Williams (2001) reported that the wavefront aberrations produced by the internal optics offset, or compensate for, the aberrations produced by the cornea to reduce ocular wavefront aberrations. We have investigated the wavefront aberrations of the cornea, internal optics, and complete eye on both the population and individual level to determine which aberrations are compensated and probable paths leading to that compensation. The corneal and ocular aberrations of 30 young subjects at relaxed accommodation were measured with the Topcon Wavefront Analyzer, which simultaneously measures refraction, corneal topography (videokeratoscope), and wavefront aberrations (Hartmann-Shack sensor). We found strong evidence for compensation of horizontal/vertical (H/V) astigmatism (Zernike term Z5) lateral coma (Z8) and spherical aberration (Z12). H/V astigmatism compensation is scaled for each individual, suggesting that it is actively determined by a fine-tuning process. Spherical aberration shows no individual compensation, suggesting that is a passive result of genetically determined physiology. Lateral coma shows individually scaled compensation, some of which may be attributable to eccentricity of the fovea.

Conventional LASIK significantly increases ocular higher-order aberrations, which compromise the postoperative contrast sensitivity function.

In addition to the larger amount of trefoil, coma, tetrafoil, and secondary astigmatism, keratoconic eyes tend to have a reverse coma pattern and reverse trefoil aberrations compared with normal eyes. Although RGP lenses correct the irregular astigmatism, smaller comet-like retinal images in the opposite direction remain due to residual vertical coma.

Increased HOAs in dry eye at least partially result from SPK above the optical zone. The low tear volume in dry eye may not cause sequential increases in HOAs after blinking. Sequential measurement of HOAs may be useful for evaluating the sequential changes in optical quality in patients with dry eye.

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Dynamic changes in HOAs after blinking showed variations even in clinically normal subjects. Serial measurements of HOAs may be useful in evaluating the dynamic changes in tear film and the effects on the quality of vision after blinking.