Lower- and higher-order aberrations predicted by an optomechanical model of arcuate keratotomy for astigmatism.

PURPOSE: To develop a realistic model of the optomechanical behavior of the cornea after curved relaxing incisions to simulate the induced astigmatic change and predict the optical aberrations produced by the incisions.

SETTING: ICMA Consejo Superior de Investigaciones Científicas and Universidad de Zaragoza, Zaragoza, Spain.

METHODS: A 3-dimensional finite element model of the anterior hemisphere of the ocular surface was used. The corneal tissue was modeled as a quasi-incompressible, anisotropic hyperelastic constitutive behavior strongly dependent on the physiological collagen fibril distribution. Similar behaviors were assigned to the limbus and sclera. With this model, some corneal incisions were computer simulated after the Lindstrom nomogram. The resulting geometry of the biomechanical simulation was analyzed in the optical zone, and finite ray tracing was performed to compute refractive power and higher-order aberrations (HOAs).

RESULTS: The finite-element simulation provided new geometry of the corneal surfaces, from which elevation topographies were obtained. The surgically induced astigmatism (SIA) of the simulated incisions according to the Lindstrom nomogram was computed by finite ray tracing. However, paraxial computations would yield slightly different results (undercorrection of astigmatism). In addition, arcuate incisions would induce significant amounts of HOAs.

CONCLUSIONS: Finite-element models, together with finite ray-tracing computations, yielded realistic simulations of the biomechanical and optical changes induced by relaxing incisions. The model reproduced the SIA indicated by the Lindstrom nomogram for the simulated incisions and predicted a significant increase in optical aberrations induced by arcuate keratotomy.