Corneal aberrations increase with the magnitude of radial keratotomy refractive correction

Background. Refractive surgery induces optically abrupt changes in shape in the midperiphery of the cornea. The abruptness of this change is in part dependent on the magnitude of the surgically induced refractive change. Therefore, the optical aberrations of the cornea, as quantified by wavefront variance (WFV), may be expected to increase as the surgically induced change in the refraction increases. Purpose. It is the purpose of this study to test the hypothesis that as the surgery-induced change in refraction increases, so does the WFV of the cornea. Methods. Fourteen radial keratotomy IRK) patients and seven normal patients served as subjects. Measurements were made before and 2 years after RK surgery. To quantify the WFV of the cornea, we used corneal topography measurements to calculate the surgically induced change in corneal WFV with respect to two different reference surfaces, a sphere and the presurgical cornea. To quantify the surgically induced change in the equivalent spherical correction (ESC), cycloplegic refractions were performed. The measurements were summarized by regressing the surgically induced change in the WFV against the surgically induced change in the ESC. Results. For large pupils (7 mm diameter), the correlation between the change in the WFV referenced to a sphere and the change in the ESC was significant (p < 0.0001, r(2) = 0.745) and dominated by fourth order aberrations. Similar results were found for the surgical lens. for small pupils (3 mm diameter), the effects were markedly reduced. Conclusions. (1) As the magnitude of the surgically induced refractive change increases so does the WFV of the cornea, particularly for large pupils. (2) The increase in corneal WFV for large pupils is dominated by fourth order aberrations. (3) The increase in corneal WFV is consistent with reported decreases in visual function (contrast sensitivity and low contrast visual acuity), particularly for large pupil diameters in combination with large surgically induced changes in refractive error.