Effect of pupillary dilation on corneal optical aberrations after photorefractive keratectomy

Background: Complaints of glare, halos, and disturbances of night vision after photorefractive keratectomy (PRK) probably result from changes in the corneal aberration structure induced by the laser ablation procedure. The purpose of this article is to characterize changes in the corneal aberration structure after PRK and to demonstrate the effect of pupil dilation on these changes. Methods: Videokeratographs obtained preoperatively (n = 112) and at 1 (n = 94), 3 (n = 103), 6 (n = 91), 12 (n = 60), 18 (n = 53), and 24 (n = 44) months postoperatively from 112 eyes of 89 patients who had undergone PRK for myopia were analyzed. The data were used to calculate the wavefront variance of the cornea for both small (3-mm) and large (7-mm) pupils. Results: For both the 3- and 7-mm pupil, coma-like aberrations increased significantly from preoperative values to 1-month postoperative values (P<.05 and P<.001, respectively); for 7-mm pupils, the postoperative values never returned to preoperative values (P<.001, 24 months). For the 3-mm pupil, spherical-like aberrations decreased significantly 1 month after surgery (P<.001), and never returned to preoperative values. For the 7-mm pupil, spherical-like aberrations increased significantly 1 month after surgery (P<.001) and did not return to preoperative values. Opening the pupil from 3 to 7 mm increased spherical-like aberrations only 7-fold before PRK. After PRK, however, pupillary dilation caused a 300-fold increase in this type of aberration. For both pupil sizes at all times after PRK, the magnitude of the surgically induced aberration correlated with the amount of the attempted correction (P<.001, r(2) = 0.6 at 1 month for a 7-mm pupil). Conclusions: Photorefractive keratectomy increases the wavefront variance of the cornea; PRK changes the relative contribution of coma-like and spherical-like aberrations; after PRK, the diameter of the entrance pupil greatly affects the amount and character of the aberrations; and the magnitude of the aberration increases with the attempted correction. Clinical Relevance: Quantitative characterization of irregular astigmatism with the measurement of aberration structures following corneal surgery and the correlation of these data with visual performance in clinical trials provide the basis for understanding patient complaints and for improving surgical approaches. Our analysis shows that, whereas induced aberrations are minimal for simulated day time vision (3-mm pupil), the increase in aberrations measured for simulated night vision (7-mm pupil) supports the use of large treatment zones to reduce visual disturbances such as glare and halos.