Wavefront sensing and the dynamics of tear film

Purpose: To summarize our previous studies regarding the influence of tear-film dynamics on optical quality after blinking. Methods: Sequential higher-order aberration (HOA) measurements were performed by using a wavefront sensor. During the measurements, subjects were asked to blink every 10 seconds. The obtained aberration data were analyzed in the central 4-mm diameter for coma-like, spherical-like, and total HOAs up to the sixth-order Zemike polynomials. Results: Serial measurements of HOAs in healthy eyes. showed variations even in clinically normal subjects and were classified into 4 groups by pattern: stable, small-fluctuation, sawtooth, and others. The sequential postblink change in HOAs after punctal plug insertion was quantitatively evaluated in a patient with dry eye who complained of paradoxical visual impairment with epiphora despite improvement of dry eye. Conclusions: Wavefront sensing is a useful objective method to evaluate sequential changes of visual performance related to tear-film dynamics. Serial measurement of HOAs might show a relationship between tear dynamics and quality of vision clinically.