Ординатура / Офтальмология / Английские материалы / Age-Related Changes of the Human Eye_Cavallotti, Cerulli_2008

Fig. 2.21 Transversal section of the interstitial connective tissue of orbicular muscle stained with blue toluidine and seen by polarization microscopy. With aging, an evident increase of collagen density can be seen when comparing specimen A (61 yrs) and B (80 yrs) (x200)

the age-related decline of muscle function and is essentially similar to those seen in various forms of congenital or acquired myopathies. Second, changes in the interstitial connective tissue also influence metabolic exchange between capillaries and muscle cells, as well as modulate neurotransmission. These changes, may also be indirectly responsible for impaired function of aged muscle.

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that the mean ocular modulation transfer function (MTF)—the ratio of contrast between object and image for a given spatial frequency—in a group of older subjects was lower than the average MTF for a group of younger subjects. This result, although it was obtained in a rather small population, suggested that the ocular aberrations—in addition to intraocular scattering—increase with age. Burton et al.5 compared CSFs obtained both with laser interferometry and conventional gratings also supporting the idea of a decreasing optical image quality with age. Measurements in a larger population showed a nearly linear decline of retinal image quality with age 6. This suggested a significant increase in the optical aberrations of the eye with age, in agreement with other studies in which aberrations were measured directly.7,8,9 In addition, intraocular scatter also increases noticeably in older eyes10 All this research indicates that the degradation in the quality of the retinal image in older eyes may play an important role in limiting spatial vision.

Different factors contribute to this increase in optical aberrations with age: possible modifications in the aberrations of the cornea, the lens, or even their relative contributions. The aberrations associated with the anterior surface of the cornea slightly change with age in a normal population,11 but the aberrations of the crystalline lens change due to the continuous modification of the lens shape with age. As the lens grows, its dimensions, curvatures, and refractive index change, altering the lens aberrations. Glasser and Campbell found a large change in the spherical aberration of excised older lenses measured in vitro.12,13,14 Another important factor to be considered is the nature of aberration coupling within the eye. It was shown that, in young subjects, the lens tends to compensate part of the corneal aberrations to produce an improved retinal image.13,14 As the aberrations of the lens change with age, it is quite plausible that this compensation is partially or completely lost. This explains the overall increase in aberration and the reduction of retinal image quality throughout the life span.15

In this chapter, I will review the current ideas on the change of ocular aberrations with age and the possible impact this will have on the design of some ophthalmic devices, such as intraocular lenses.

The optical performance of the eye can be measured by different, and in most cases complementary, procedures. By direct recording of the double-pass retinal image, 16,17,18 an overall estimate of the eye optics is obtained, usually expressed through the point-spread function (PSF) or the modulation transfer function (MTF). By using wave-front sensors,19,20,21,22, the optical aberrations of the whole eye are obtained and the retinal image or the MTF are calculated afterwards. Furthermore, by using computer ray-tracing techniques, the aberrations produced by the anterior surface of the cornea alone can be determined from the corneal shape.23 Finally, by comparing the corneal aberrations and the overall retinal image quality, it is possible to establish the relative contributions to aberrations of the different ocular elements. By combining these results with customized modeling of the eye, it is possible to predict the retinal images under many different conditions.24

Retinal Image Quality as a Function of Age

Figure 3.1 shows the average double-pass images for three age groups obtained for a 4 mm pupil diameter.

Fig. 3.3 Strehl ratio as a function of every subject’s age for 4 mm pupil diameter. The line is the best linear fitting

Fig. 3.4 Average Strehl ratio for the three age groups, with 4 mm pupil diameter at best focus and at 0.5 D defocus. Error bars indicate the standard deviation

tolerant to small amounts of defocusing. This is quite consistent with the accepted idea of a smaller reduction in image quality with defocusing in systems with reduced overall performance. That is, possible small refractive errors should reduce the MTF relatively more in a younger subject (with good image quality at best focus) than in an older subject (with poorer image quality at best focus).

In addition, due to the effect of senile miosis—a smaller pupil size for similar luminance levels in older subjects—the average MTF is approximately constant over time at low luminance levels with natural pupils.

These two factors—senile miosis and a better tolerance of defocusing in the older subjects—indicate that the differences in image quality among young and

Fig. 3.6 RMS of the aberrations of the eye expressed in microns as a function of age (5.9 mm pupil diameter; defocus and astigmatism not included)

Fig. 3.7 RMS of the aberrations of the cornea expressed in microns as a function of age. Larger symbols with error bars indicate mean values and standard deviations for each age group

generally larger, they are still much smaller than the differences found when comparing the old with the young subjects. On average, we can expect an increase of 0.01 microns of aberration per year.

Aberrations of Cornea as a Function of Age

The shape and aberrations of the cornea change with age. It is well known that the radius of curvature slightly decreases with age, and the asphericity also changes. On average, the cornea becomes more spherical with age and, as a consequence, spherical aberrations tend to increase. Fig. 3.7 shows the RMS of the wave aberration of the