Chapter 6 Aberrometric Correction of Astigmatism Alejandro De la Torre M Ximena Nunez Claudia Blancoiister ev Step Asnamane Agtaion INTRODUCTION Wavelront-sensing techniques pravide an understanding of the optical quality of the eye before and after laser refractive surgery and assist in further refinements of ablation algorithms to enhance the predictability of surgical outcomes.' These techniques also make it possible to correct higher-order aberrations (HOAs) using advanced methods such as adaptive optics, customized laser refractive surgery and customized optics.’ Even though conventional and customized laser refractive surgery techniques have proved to be effective in improving the patient's visual performance, a better understanding of the wave aberration induced by a laser ablation procedure is required to achieve a significant greater improvement in vision.** Geometry and changes in the refractive index deter- mine the optical aberrations contributed by each aspheric surface. The quality of retinal images depends on the combined optical effects of all these elements.* Refractive standard surgery changes the optical power of the eye by modifying the corneal surface. The cornea is made steeper for hyperopic astigmatic corrections and flatter for myopic astigmatic corrections, altering the curvature of the corneal surface and hence its asphericity.* THE PROBLEM Although most patients are satisfied with their vision after standard astigmatic LASIK, some patients experience glare,halos and ghost images, particularly at night or in dim conditions. Visual aberrations change after standard astigmatic LASIK, and surgery has received increased attention in the scientific literature, because patients have experienced poor visual outcomes after surgery.’ Commonly Cited Limitations in Customized Corneal Ablation = Variability in wound healing and biomechanical responses to surgery, = Changes in aberrations generated by flap formation— LASIK. «Changes in aberrations with age. = Changes in aberrations with variations in pupil size. = Changes in aberrations with variations in accommodative state * Limitations in wavefront analysis for highly irregular corneas * Limitations in Zernike polynomial-based analysis. Limitations due to Central Nervous System Processing A. Wavefront analysers only provide information regarding the optical system from the tear film to the retinal surface. B. No information is provided about processing from the retina to the visual cortex: *