Change in shape of the aging human crystalline lens with accommodation

The objective was to measure the change in shape of the aging human crystalline eye lens in vivo during accommodation. Scheimpflug images were made of 65 subjects between 16 and 51 years of age, who were able to accommodate at least 1D. The Scheimpflug images were corrected for distortion due to the geometry of the camera and the refraction of the cornea and anterior lens surface, which is necessary to determine the real shape of the lens. To ensure accurate correction for the refraction of the anterior lens surface, the refractive index of the crystalline lens must be determined. Therefore, axial length was also measured, which made it possible to calculate the equivalent refractive index of the lens and possible changes in this index during accommodation. The results show that during accommodation there is a decrease in both the anterior and the posterior radius of the lens, although the change in mm per diopter of the latter is much smaller. The increase in lens thickness with accommodation is higher than the decrease in the anterior chamber depth, indicating that the posterior lens surface moves backwards with accommodation. During accommodation the anterior lens surface becomes more hyperbolic. Furthermore, an increase in the equivalent refractive index during accommodation was determined.     

The thickness of the aging human lens obtained from corrected Scheimpflug images.

Commonly, measurements of lens thickness are performed using A-scan ultrasonography or slitlamp Scheimpflug photography. Both techniques have their drawbacks in the study of presbyopia: ultrasonography requires the velocity of sound in the lens which may change with age, whereas Scheimpflug photography requires knowing the refractive index of the lens to enable correction of the photographs for the distortion due to the refraction of the cornea and lens. By combining Scheimpflug photography and axial optical eye-length measurements, we were able to individually correct the Scheimpflug images for distortion and calculate the refractive index and thickness of the human lens. Lens thickness of 90 subjects ranging in age between 16 and 65 years was measured, and an average increase of 24 microm/year was found. This value is consistent with ultrasonographic measurements assuming an age-independent velocity of sound in the lens of 1641 m/s. The posterior lens surface recedes from the cornea with age, and this backward movement does not differ significantly from the forward movement of the anterior lens surface.     

Crystalline lens radii of curvature from Purkinje and Scheimpflug imaging

We present a comparison between measurements of the radius of the anterior and posterior lens surface, which was performed using corrected Scheimpflug imaging and Purkinje imaging in the same group of participants (46 for the anterior lens, and 34 for the posterior lens). Comparisons were also made as a function of accommodation (0 to 7 D) in a subset of 11 eyes. Data were captured and processed using laboratory prototypes and custom processing algorithms [for optical and geometrical distortion correction in the Scheimpflug system and using either equivalent mirror (EM) or merit function (MF) methods for Purkinje]. We found statistically significant differences in 4 of 46 eyes for the anterior lens radius, and 10 of 34 eyes for the posterior radius (using the MF and individual biometric data to process the Purkinje images). For the anterior lens, the agreement increases using individual biometry as opposed to biometric data from a model eye. For the posterior lens, the agreement increases using the MF as opposed to the EM method. For the changes during accommodation, no significant difference between the two techniques was found. In conclusion, the results of the cross-validation using the Scheimpflug and Purkinje imaging technique show that both techniques provide comparable lens radii and similar changes with accommodation. Purkinje tends to overestimate posterior lens radius, whereas pupil size limits the acquisition of posterior lens data with the Scheimpflug camera. Computer simulations using the Scheimpflug data as input show that the consistent slight overestimation of the posterior lens radius using Purkinje imaging can be partly attributed to the asphericity of the lens surface.     

Changes in ocular dimensions and refraction with accommodation

The purpose of this study was to measure the changes in ocular dimensions with accom-modation, with particular reference to the radius of curvature of the posterior surface of the crystalline lens. The increase in power of the eye with accommodation is considered to arise primarily from a decrease in the radius of curvature of the anterior surface of the lens, with the role of the posterior surface somewhat unclear. We measured the axial dimensions (A-Scan ultrasonography), cornea1 radius of curvature (keratometryl, refractive error (auto-refractor) and radii of curvature of the lenticular surfaces (video phakometryl for 11 subjects, mean age 21.2 + 2.6 years, for five levels of ocular accommodation up to 8.00D. At maximum accommodation the mean changes were a decrease in anterior chamber depth of 0.24 mm. an increase in lens thickness of 0.28 mm. a decrease in radius of curvature of the anterior surface of the lens of 4.95 mm and 1.34 mm for the posterior surface. The corres-pondtng increase in power of the lenticular surfaces for an equivalent refractive index of 1.422 for the lens was 5.53 D and 3.10 D for the anterior and posterior surfaces respectively. No significant changes were recorded in axial length or vitreous chamber depth. We conclude that when crystalline lens power is calculated on the basis of an equivalent refractive index, changes in the posterior surface of the lens contribute around one third of the Increase in lens power associated with 8.00 D of ocular accommodation.     

Radius and asphericity of the posterior corneal surface determined by corrected Scheimpflug photography

PURPOSE: To obtain the shape of the posterior corneal surface in a healthy population, using Scheimpflug photography corrected for distortion due to the geometry of the Scheimpflug imaging system and the refraction of the anterior corneal surface. METHODS: The posterior corneas of 83 subjects, ranging in age from 16 to 62 years, were measured in the vertical meridian using corrected Scheimpflug photography. The aspherical shape of the anterior Corneal surface was also determined in conjunction with the correction of Scheimpflug images. RESULTS: The average radius of the anterior corneal surface was 7.87 +/- 0.27 mm (SD), while the average radius of the posterior corneal surface was 6.40 +/- 0.28 mm (SD). The ratio between the posterior and the anterior radius of curvature was 0.81 +/- 0.02. The asphericity of the anterior and the posterior corneal surfaces was 0.82 +/- 0.18 and 0.62 +/- 0.27, respectively. The asphericity of the posterior corneal surface decreased significantly with age. The posterior/anterior asphericity ratio is also dependent on age and was 0.98 +/- 0.17 at 16 years of age and 0.53 +/- 0.30 at 62 years of age. CONCLUSION: Corrected Scheimpflug photography is an appropriate technique for measuring the radius and asphericity of the posterior corneal surface. The asphericity of the posterior corneal surface changes with age.     

The shape of the anterior and posterior surface of the aging human cornea

PURPOSE: To determine the shape and astigmatism of the posterior corneal surface in a healthy population with age, using Scheimpflug photography corrected for distortion due to the geometry of the Scheimpflug imaging system and the refraction of the anterior corneal surface. METHODS: Scheimpflug imaging was used to measure in six meridians the cornea of the right eye of 114 subjects, ranging in age from 18 to 65 years. RESULTS: The average radius of the anterior corneal surface was 7.79+/-0.27 (SD) mm and the average radius of the posterior corneal surface was 6.53+/-0.25 (SD) mm. Both surfaces were found to be flatter horizontally than vertically. The cylindrical component of the posterior surface of 0.33 mm is twice that of the anterior surface (0.16 mm). The asphericity of both the anterior and the posterior surface was independent of the radius of curvature at the vertex, refractive error and gender. In contrast with that of the anterior corneal surface, the asphericity of the posterior corneal surface varied significantly between meridians. With age, the asphericity of both the anterior and the posterior corneal surface changes significantly, which results in a slight peripheral thinning of the cornea. CONCLUSION: On average, the astigmatism of the posterior corneal surface (-0.305 D) compensates the astigmatism of the anterior corneal surface (0.99 D) with 31%. The results show that the effective refractive index is 1.329, which is lower than values commonly used. There is no correlation between the asphericity of the anterior and the posterior corneal surface. As a result, the shape of the anterior corneal surface provides no definitive basis for knowing the asphericity of the posterior surface.     

The change in lens curvature with age

The radii of curvature of the anterior and posterior lens surfaces have been measured in emmetropic eyes by slit-image photography. The measurements have been corrected for corneal refraction by data obtained from an artificial eye.Reduction in the radius of curvature of the unaccommodated lens with age is demonstrated. The central chord of the anterior surface changes from a mean value of 15·98 mm at the age of 8 to 8·26 mm at the age of 82, and the radius of the peripheral chord has a similar rate of decrease.The posterior lens surface also undergoes reduction in radius of curvature with age. The rate of change is less than that of the anterior surface, and differences between central and peripheral chords are not significant.The reduction in radius of curvature with age, which is now demonstrated, is in contradiction to the accepted teaching on the lens.     

Contribution of the gradient refractive index and shape to the crystalline lens spherical aberration and astigmatism

The optical properties of the crystalline lens are determined by its shape and refractive index distribution. However, to date, those properties have not been measured together in the same lens, and therefore their relative contributions to optical aberrations are not fully understood. The shape, the optical path difference, and the focal length of ten porcine lenses (age around 6 months) were measured in vitro using Optical Coherence Tomography and laser ray tracing. The 3D Gradient Refractive Index distribution (GRIN) was reconstructed by means of an optimization method based on genetic algorithms. The optimization method searched for the parameters of a 4-variable GRIN model that best fits the distorted posterior surface of the lens in 18 different meridians. Spherical aberration and astigmatism of the lenses were estimated using computational ray tracing, with the reconstructed GRIN lens and an equivalent homogeneous refractive index. For all lenses the posterior radius of curvature was systematically steeper than the anterior one, and the conic constant of both the anterior and posterior positive surfaces was positive. In average, the measured focal length increased with increasing pupil diameter, consistent with a crystalline lens negative spherical aberration. The refractive index of nucleus and surface was reconstructed to an average value of 1.427 and 1.364, respectively, for 633 nm. The results of the GRIN reconstruction showed a wide distribution of the index in all lens samples. The GRIN shifted spherical aberration towards negative values when compared to a homogeneous index. A negative spherical aberration with GRIN was found in 8 of the 10 lenses. The presence of GRIN also produced a decrease in the total amount of lens astigmatism in most lenses, while the axis of astigmatism was only little influenced by the presence of GRIN. To our knowledge, this study is the first systematic experimental study of the relative contribution of geometry and GRIN to the aberrations in a mammal lens.     

Refractive properties of the healthy human eye during acute hyperglycemia

PURPOSE: To measure the refractive properties of the healthy human eye during acute hyperglycemia by means of Scheimpflug imaging and Hartmann-Shack aberrometry. METHODS: Acute hyperglycemia was induced in five healthy subjects (two males, three females, mean age +/-SD 24.8 years +/- 4.6) by means of an oral glucose tolerance test (OGTT) after subcutaneous somatostatin injection. Before and every 30 minutes after the OGTT, measurements with Scheimpflug imaging and Hartmann-Shack aberrometry were performed. The main outcome measures were the thickness and shape of the lens, and the ocular refractive error and higher order aberrations. The equivalent refractive index of the lens was calculated from these parameters. Measurements at baseline and during hyperglycemia were analyzed by means of Wilcoxon signed rank sum tests. RESULTS: During hyperglycemia (mean blood glucose level at baseline: 4.0 mmol/l; mean maximal blood glucose level: 18.4 mmol/l) no changes could be found in the refractive properties within the group. In one subject, a hyperopic shift (0.4 D) was observed, together with a more convex shape of the anterior lens surface and a decrease in the equivalent refractive index of the lens. CONCLUSIONS: This study shows that hyperglycemia generally does not cause changes in the refractive properties of the healthy eye. Nevertheless, in one subject a hyperopic shift accompanied by a change in shape and refractive index of the lens was measured. This finding could provide an explanation for the mechanism underlying the refractive changes that are often observed during hyperglycemia.     

Analysis of crystalline lens position

PURPOSE: To study normal crystalline lens position to provide a comparative baseline for future studies of crystalline lens or intraocular lens shift. SETTING: Taipei Municipal Yang-Ming Hospital, Taipei, Taiwan. METHODS: A Scheimpflug anterior segment analyzer (EAS-1000, Nidek) was prospectively applied to measure the cycloplegic crystalline lens position in subjects who had not had previous ocular surgeries or who had been diagnosed previously with major ocular diseases such as glaucoma, retinal detachment, or cataract. Measurements included anterior chamber depth (ACD), magnitudes, direction of lens decentration, and lens tilt. Refractive error was measured with an autorefractometer, and multiple linear regression was used to verify revealed relationships. The aging effect was determined with the Pearson correlation test. RESULTS: Thirty-nine eyes of 30 subjects (15 men, median age 13 years, range 4 to 53 years) were included. The center of the anterior lens surface was decentered 0.25 mm superotemporally. The lens tilted 2.85 degrees with the anterior lens surface facing the inferotemporal quadrant. The mean ACD was 3.26 mm; it tended to increase before subjects reached 20 years of age and to decrease thereafter. With age, the lens tended to exhibit less tilt. Lens position did not affect the spherical equivalent or the magnitude of astigmatism. CONCLUSION: The crystalline lens was not aligned perfectly along the visual axis, but its effect on refraction was limited.     

Estimation of the thickness of the crystalline lens from on-axis and off-axis Scheimpflug photographs

Measurement of human lens biometry directly from Scheimpflug images of the anterior ocular segment may be impossible when pupil size precludes an adequate Scheimpflug view of the posterior lens surface. The authors describe a simple and accurate geometric method of overcoming this problem by estimating the true lens thickness from pairs of on-axis and off-axis Scheimpflug images. The method is validated and the variability of the estimate is quantified. This new method has utility in the study of lens biometry in subjects with large lenses whose pupils cannot be adequately dilated.     

Crystalline lens parameters in infancy

Despite the importance of lens power to ocular development, few data are available regarding infant crystalline lens parameters. Lens and corneal radii of curvature were measured in the horizontal meridian using a video-based keratophakometer, and refractive error was measured by cycloplegic retinoscopy in 19 out of 27 infants ranging in age from 3 to 18 months. The median refractive error was + 1.50 D, and the median corneal power was 43.5 D. Using previously reported values for axial ocular dimensions, the median anterior and posterior lens radii of curvature were 8.7 and 5.6 mm, respectively, both substantially flatter than infant schematic eye values. The median equivalent refractive index of the lens was 1.49, considerably higher than previous reported schematic values for infants or children. There was a significant reduction in hyperopia with age ( r = −0.47, P = 0.043), but no age-related trends in lens or corneal radii of curvature, suggesting that calculated values for lens power and equivalent index may undergo substantial decline with age during early childhood development as axial length increases. Most of the decrease in lens power (75%) may be due to decreases in equivalent index rather than to flattening of the surface radii of curvature. Videophakometry appears to be a feasible and useful technique for documenting the role of the crystalline lens in infant ocular development.     

The shape of the human lens nucleus with accommodation

Knowledge about geometric properties such as shape and volume and Poisson's ratio of the nucleus can be used in the mechanical and optical modeling of the accommodation process. Therefore, Scheimpflug imaging was used to determine the shape of the human lens nucleus during accommodation in five subjects. To describe the shape of the nucleus, we fitted a parametric model of the cross-sectional geometry to the gradient of the Scheimpflug images using the Hough transform. The geometric model made it possible to estimate the anterior and the posterior central radius, central thickness, equatorial diameter, and cross-sectional area of the nucleus. Assuming that the nucleus is rotationally symmetric, the volume of the nucleus can be estimated by integrating around the circumference. For all five subjects, the results show that during accommodation the nucleus became more convex and that the central thickness increased whereas the equatorial diameter decreased. This decrease in equatorial diameter of the nucleus with accommodation is in accordance with the Helmholtz accommodation theory. Finally, the volume of the nucleus (on average 35 mm(3)) showed no significant change during accommodation in any of the subjects, presumably due to the fact that the human nucleus consists of incompressible material with a Poisson's ratio that is near .5.     

Accommodation and presbyopia in the human eye--aging of the anterior segment

Ocular biometric parameters and accommodative amplitude were measured by various techniques in 100 normal emmetropic human subjects age 18-70 yr. Anterior chamber depth decreased and lens thickness increased linearly over the entire age group. Accommodative amplitude declined linearly until a stable nadir was reached at about age 50 yr. The respective slopes and intercepts of the age-dependent decline in anterior chamber depth were essentially the same for measurements made independently by optical pachmetry, A-scan ultrasonography, and slit-lamp Scheimpflug photography. The age-dependent increase in lens thickness differed in slope and intercept for measurements made by photography and ultrasonography if the generally accepted lenticular sound velocity was assumed for all subjects. However, if putative lenticular sound velocity was adjusted for age, the relationships given by the two techniques were essentially identical. Total anterior segment length (defined as the distance between the anterior corneal and posterior lens surfaces), vitreous cavity length (distance between the posterior lens and anterior retinal surfaces), and total globe length were all independent of age. This constellation of findings indicates that the human lens grows throughout adult life while the globe does not, that thickening of the lens completely accounts for shallowing of the anterior chamber with age, but that the posterior surface of the lens remains fixed in position relative to the cornea and retina.     

The contribution of the posterior surface to the coma aberration of the human cornea

Scheimpflug imaging was used to measure in six meridians the shape of the anterior and posterior cornea of the right eye of 114 subjects, ranging in age from 18 to 65 years. Subsequently, a three-dimensional model of the shape of the whole cornea was reconstructed, from which the coma aberration of the anterior and whole cornea could be calculated. This made it possible to investigate the compensatory role of the posterior surface to the coma aberration of the anterior corneal surface with age. Results show that, on average, the posterior surface compensates approximately 3.5% of the coma of the anterior surface. The compensation tends to be larger for young subjects (6%) than for older subjects (0%). This small effect of the posterior cornea on the coma aberration makes it clear that for the coma aberration of the whole eye, only the anterior corneal surface and the crystalline lens play a role. Consequently, for the design of an intraocular lens that is able to correct for coma aberration, it would be sufficient to only take the anterior corneal surface into account.     

Optical power of the isolated human crystalline lens

PURPOSE: To characterize the age dependence of isolated human crystalline lens power and quantify the contributions of the lens surfaces and refractive index gradient. METHODS: Experiments were performed on 100 eyes of 73 donors (average 2.8 +/- 1.6 days postmortem) with an age range of 6 to 94 years. Lens power was measured with a modified commercial lensmeter or with an optical system based on the Scheiner principle. The radius of curvature and asphericity of the isolated lens surfaces were measured by shadow photography. For each lens, the contributions of the surfaces and the refractive index gradient to the measured lens power were calculated by using optical ray-tracing software. The age dependency of these refractive powers was assessed. RESULTS: The total refractive power and surface refractive power both showed a biphasic age dependency. The total power decreased at a rate of -0.41 D/y between ages 6 and 58.1, and increased at a rate of 0.33D/y between ages 58.1 and 82. The surface contribution decreased at a rate of -0.13 D/y between ages 6 and 55.2 and increased at a rate of 0.04 D/y between ages 55.2 and 94. The relative contribution of the surfaces increased by 0.17% per year. The equivalent refractive index also showed a biphasic age dependency with a decrease at a rate of -3.9 x 10(-4) per year from ages 6 to 60.4 followed by a plateau. CONCLUSIONS: The lens power decreases with age, due mainly to a decrease in the contribution of the gradient. The use of a constant equivalent refractive index value to calculate lens power with the lens maker formula will underestimate the power of young lenses and overestimate the power of older lenses.     

Biometry of the crystalline lens in early-onset diabetes.

Lenticular biometry on non-cataractous lenses has been studied by means of Scheimpflug photography and digital image analysis in 153 patients with early-onset insulin-dependent diabetes and 153 non-diabetic controls. Anteroposterior axial lens thickness, cortical thickness, nuclear thickness, anterior and posterior lenticular curvatures, and anterior chamber depth were assessed. Highly significant differences between the lenses of the diabetic subjects and non-diabetic controls were found. After the effect of age had been accounted for within the diabetic subgroup, diabetic duration was found to be a highly significant determinant of lens dimensions, such that age-related dimensional changes for various biometric parameters were accelerated by between 52% and 121% after the onset of diabetes. Because the diabetic duration of the early-onset diabetic subjects studied in this work was accurately known, this report is the first in which a precise assessment of the effect of 'true' diabetic duration on lens biometry has been possible.     

Biometric, optical and physical changes in the isolated human crystalline lens with age in relation to presbyopia.

The biometric, optical and physical properties of 19 pairs of isolated human eye-bank lenses ranging in age from 5 to 96 years were compared. Lens focal length and spherical aberration were measured using a scanning laser apparatus, lens thickness and the lens surface curvatures were measured by digitizing the lens profiles and equivalent refractive indices were calculated for each lens using this data. The second lens from each donor was used to measure resistance to physical deformation by providing a compressive force to the lens. The lens capsule was then removed from each lens and each measurement was repeated to ascertain what role the capsule plays in determining these optical and physical characteristics. Age dependent changes in lens focal length, lens surface curvatures and lens resistance to physical deformation are described. Isolated lens focal length was found to be significantly linearly correlated with both the anterior and posterior surface curvatures. No age dependent change in equivalent refractive index of the isolated lens was found. Although decapsulating human lenses causes similar changes in focal length to that which we have shown to occur when human lenses are mechanically stretched into an unaccommodated state, the effects are due to nonsystematic changes in lens curvatures. These studies reinforce the conclusion that lens hardening must be considered as an important factor in the development of presbyopia, that age changes in the human lens are not limited to the loss of accommodation that characterizes presbyopia but that the lens optical and physical properties change substantially with age in a complex manner.     

Slit-lamp studies of the rhesus monkey eye: II. Changes in crystalline lens shape, thickness and position during accommodation and aging

Changes in crystalline lens shape and axial thickness, anterior chamber depth and anterior cornea-posterior lens distance during accommodation induced by corneal iontophoresis of carbachol or electrical stimulation of the Edinger-Westphal nucleus were studied in 25 living, surgically aniridic rhesus monkey eyes, aged 1-25 years. Intraocular distances and anterior and posterior lens surface curvatures were evaluated from slit-lamp Scheimpflug photographs; distances were also determined by A-scan ultrasonography. With increasing accommodation, both lens surfaces become more sharply curved, the lens thickens and the anterior chamber shallows, while the posterior lens surface remains fixed relative to the cornea. Within statistical limits, the respective curvature and distance changes are the same for a given dioptric accommodation induced by either stimulation technique. The respective intraocular distance-accommodation relationships are identical whether derived from photographic or ultrasonographic measurements. Temporal and contralateral reproducibility of all measurements is excellent. Each parameter-accommodation relationship is strikingly linear in all eyes, although above 20 D the slopes of the lens surface curvature-accommodation relationships may have decreased. The curvature change per D of accommodation averages approximately 20% more for the posterior than for the anterior lens surface. There is relatively little interindividual variation in the slope of each relationship despite the significant interindividual differences in age and accommodative amplitude, indicating that the relationships are independent of age. However, when extrapolated back to the non-accommodated resting state, the data indicate that the lens thickens, both its surfaces become more sharply curved, and the anterior chamber shallows with age in adult greater than 5 years, while opposite trends are seen in younger animals.     

Changes in the internal structure of the human crystalline lens with age and accommodation

Scheimpflug images were made of the unaccommodated and accommodated right eye of 102 subjects ranging in age between 16 and 65 years. In contrast with earlier Scheimpflug studies, the images were corrected for distortion due to the geometry of the Scheimpflug camera and the refraction of the cornea and the lens itself. The different nuclear and cortical layers of the human crystalline lens were determined using densitometry and it was investigated how the thickness of these layers change with age and accommodation. The results show that, with age, the increase in thickness of the cortex is approximately 7 times greater than that of the nucleus. The increase in thickness of the anterior cortex was found to be 1.5 times greater than that of the posterior cortex. It was also found that specific parts of the cortex, known as C1 and C3, showed no significant change in thickness with age, and that the thickening of the cortex is entirely due to the increase in thickness of the C2 zone. With age, the distance between the sulcus (centre of the nucleus) and the cornea does not change. With accommodation, the nucleus becomes thicker, but the thickness of the cortex remains constant.