Skip to main content
Published Online: by:12



To introduce a new sequential wavefront device with rapid sampling that can be used as an intraoperative, real-time aberrometer/refractometer for immediate diagnosis and management of refractive outcomes during cataract surgery.


A unique wavefront device uses a rotating prismatic mirror to rapidly shift the incident wavefront emanating from the eye through an aperture for analysis of a sequentially sampled wavefront segment. The sampled segment is then focused onto a quad detector that localizes its angular displacement of the sampled segment’s wavefront gradient. Although the device’s capability is higher for other applications, the wavefront is herein rapidly sampled at 200 Hz (frames/second), with a 2-mm aperture that moves along a 5-mm outer diameter annulus to capture a real-time analysis of refractive error for intraoperative application (ie, an intraoperative wavefront movie). The prototype wavefront device has been miniaturized into a narrow profile attachment that can be fixed to an operating microscope. In pilot analysis, several eyes undergoing cataract surgery were analyzed to determine both the qualitative and quantitative change in refraction with surgical intervention in an effort to document and improve outcomes intraoperatively.


Clinical application of the device was easily implemented without changing or limiting the working distance, magnification, or illumination of the surgeon’s ergonomics intraoperatively. The real-time wavefront outcome was visualized overlaying a live eye image, presenting the refractive error both qualitatively and quantitatively. Qualitative representation of spherical refractive error was seen as a circle, cylinder as a thin ellipse, and emmetropia as a dot. Localization of lower-order aberrations with a practical sample rate of 200 frames/ second enables a real-time visualization of qualitative refractive data coaxially aligned with the eye image and quantitatively as sphere, cylinder, and axis at the bottom of the screen. Practical evaluation of residual cylinder prior to and during limbal relaxing incision placement, rotational accuracy during toric intraocular lens alignment, and refractive effect of subtle surgical maneuvers were all achieved with this device.


Real-time, intraoperative refraction and visualization is possible with a new sequential wavefront device attached to the operating microscope. The precision and accuracy of intraoperative documentation and refinement of outcomes is likely to be enhanced, making this an important future tool for optimizing cataract surgery outcomes.

[J Refract Surg. 2013;29(9):630–635.]

  • 1.Miyata K, Miyai T, Minami K, Bissen-Miyajima H, Maeda N, Amano S. Limbal relaxing incisions using a reference point and corneal topography for intraoperative identification of the steepest meridian. J Refract Surg. 2011; 27:339–344.10.3928/1081597X-20101005-02

    LinkGoogle Scholar
  • 2.Holland E, Lane S, Horn JD, Ernest P, Arleo R, Miller KM. The AcrySof Toric intraocular lens in subjects with cataracts and corneal astigmatism: a randomized, subject-masked, parallel-group, 1-year study. Ophthalmology. 2010; 117:2104–2111.10.1016/j.ophtha.2010.07.033

    Crossref MedlineGoogle Scholar
  • 3.Mrochen M, Kaemmerer M, Mierdel P, Krinke HE, Seiler T. Principles of Tscherning aberrometry. J Refract Surg. 2000; 16:S570–S571.

    LinkGoogle Scholar
  • 4.Cheng X, Himebaugh NL, Kollbaum PS, Thibos LN, Bradley A. Test-retest reliability of clinical Shack-Hartmann measurements. Invest Ophthalmol Vis Sci. 2004; 45:351–360.10.1167/iovs.03-0265

    Crossref MedlineGoogle Scholar
  • 5.Chalita MR, Xu M, Krueger RR. Correlation of aberrations with visual symptoms using wavefront analysis in eyes after laser in situ keratomileusis. J Refract Surg. 2003; 19:S682–S686.

    LinkGoogle Scholar
  • 6.Shulman M. The cataracts are gone-and so is the need for glasses. With the latest implantable lenses, you can see near and far. US News World Rep. 2007; 143:64,66.

    MedlineGoogle Scholar
  • 7.Packer M. Effect of intraoperative aberrometry on the rate of postoperative enhancement: retrospective study. J Cataract Refract Surg. 2010; 36:747–755.10.1016/j.jcrs.2009.11.029

    Crossref MedlineGoogle Scholar
  • 8.Chen M. Correlation between ORange (Gen 1, pseudophakic) intraoperative refraction and 1-week postcataract surgery autorefraction. Clin Ophthalmol. 2011; 5:197–199.10.2147/OPTH.S17489

    Crossref MedlineGoogle Scholar
  • 9.Krueger RR, Gomez P, Herekar S. Intraoperative wavefront monitoring during laser thermal keratoplasty. J Refractive Surg. 2003; 19:S602–S607.

    LinkGoogle Scholar
  • 10.Su W, Zhou Y, Zhao QC, inventors; Clarity Medical Systems, Inc., assignee. Sequential wavefront sensor. US patent 7,445,335. January20, 2006.

    Google Scholar
  • 11.Gimbel HV, Sun R. Accuracy and predictability of intraocular lens power calculation after laser in situ keratomileusis. J Cataract Refract Surg. 2001; 27:571–576.10.1016/S0886-3350(00)00795-1

    Crossref MedlineGoogle Scholar
  • 12.Hayashi K, Manabe S, Yoshida M, Hayashi H. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens. J Cataract Refract Surg. 2010; 36:1323–1329.10.1016/j.jcrs.2010.02.016

    Crossref MedlineGoogle Scholar
  • 13.Nagy Z, Takacs A, Filkorn T, Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009; 25:1053–1060.10.3928/1081597X-20091117-04

    LinkGoogle Scholar
  • 14.Palanker DV, Blumenkranz MS, Andersen D, et al.Femtosecond laser-assisted cataract surgery with integrated optical coherence tomography. Sci Transl Med. 201017; 2:58ra85.10.1126/scitranslmed.3001305

    Crossref MedlineGoogle Scholar
  • 15.Masket S, Sarayba M, Ignacio T, Fram N. Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility. J Cataract Refract Surg. 2010; 36:1048–1049.10.1016/j.jcrs.2010.03.027

    Crossref MedlineGoogle Scholar

We use cookies on this site to enhance your user experience. For a complete overview of all the cookies used, please see our privacy policy.