Visual Performance with Wave Aberration Correction after Penetrating, Deep Anterior Lamellar, or Endothelial Keratoplasty

Abstract

PK eyes had better logMAR VA than that of DSAEK eyes with LOA correction, whereas DALK eyes performed intermediate between the two. When full correction was applied, the same trend persisted. The findings suggest that factors other than aberration contribute to decrements in VA with DSAEK compared with PK.

Determinants of visual quality after endothelial keratoplasty

“…Therefore, comparisons between the study groups cannot be accurately made, although the authors suggested that the discrepancy in visual outcomes could be partially attributed to light scatter caused by corneal haze. 91 This hypothesis was supported by Maier et al, who compared 10 patients who had received DMEK in one eye and DSAEK in the other. 75 Both BCVA and contrast sensitivity were significantly better in the DMEK eyes, but this was not explained by any significant difference in LOAs or HOAs between the two techniques, thus implicating other factors.…”

“…These include abnormal diffraction in the posterior graft, anterior host cornea, and the interface; high order aberrations (HOAs) related to surface and interface irregularity; and light scatter from corneal haze. 84,91,137 Patients with high contrast visual acuity of 20/20 or better may complain of poor visual quality secondary to phenomena such as glare and poor contrast sensitivity that do not always correlate with visual acuity. A full assessment of visual quality therefore requires testing of these visual functions, not just high contrast acuity.…”

“…77 Pantanelli et al demonstrated significantly improved visual acuity and contrast sensitivity after DSAEK using wave aberration correction with adaptive optics (AO) technology to eliminate the majority of ocular aberrations. 91 91 The PKP and DALK groups, however, were comprised of predominantly younger phakic patients with keratoconus, compared to an older pseudophakic group undergoing DSAEK for FED. Therefore, comparisons between the study groups cannot be accurately made, although the authors suggested that the discrepancy in visual outcomes could be partially attributed to light scatter caused by corneal haze.…”

“…91 An interesting confounding factor in Pantanelli et al's study (see section 1.2), which used adaptive optics correction to investigate the impact of HOAs on visual acuity, was that the PKP group were tested a significantly longer period after surgery than the DSAEK group. 91 The authors hypothesised that the better visual performance in the PKP group could support the role of neural adaptation in compensating for postoperative HOAs. 91 Importantly though, the underlying diagnosis in the PKP group was predominantly keratoconus (4 of 5 cases) and all patients were phakic.…”

“…91 The authors hypothesised that the better visual performance in the PKP group could support the role of neural adaptation in compensating for postoperative HOAs. 91 Importantly though, the underlying diagnosis in the PKP group was predominantly keratoconus (4 of 5 cases) and all patients were phakic. Conversely, the DSAEK group (n=5) were exclusively pseudophakes affected by FED and of a mean older age -factors that could affect the contribution of neural adaptation.…”