Four corneal presbyopia corrections: simulations of optical consequences on retinal image quality.

PURPOSE To investigate the possibility of multifocal or aspherical treatment of the cornea with optical ray tracing. SETTING Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland. METHODS The optical consequences of 4 corneal shapes-global optimum (GO) for curvature and asphericity, central steep island (CSI), decentered steep island (DSI), and centered steep annulus (CSA)-for presbyopia correction were analyzed using a modified Liou-Brennan eye model and ray tracing with a commercial optic design software (Zemax, Zemax Development Corp.). The ocular optical configuration for far vision was a point light source at a distance of 5 m, 1 degree up, and a pupil diameter of 5.0 mm and for near vision, 0.4 m distance, 1 degree up, and a pupil diameter of 2.5 mm. The curvature radius (R) of the cornea and its asphericity (Q) were used as operands to optimize (simultaneously for near and far vision) the quality of the retinal image described by means of the minimum spot diameter or the root-mean-square (RMS) wavefront error. RESULTS Starting from an emmetropic eye optimized for R and Q, the RMS wavefront error in the retina was 0.07 microm (far) and 1.42 microm (near). The GO resulted in a wavefront error of 1.42 microm (far) and 0.52 microm (near); improvement of near vision using reading glasses is possible. The CSI yielded 0.91 microm (far) and 0.13 microm (near); spectacles did not improve far or near vision. The DSI and CSA had significantly worse results for near and far vision. CONCLUSIONS Of the options studied, GO and CSI seemed the most promising alternatives for corneal presbyopia correction. Although reading glasses can improve near vision in GO, reading glasses did not improve near vision in CSI-treated eyes. The CSI treatment is critically dependent on centration and a reverse treatment is difficult to achieve.