Statistical variation of aberration structure and image quality in a normal population of healthy eyes

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Abstract
A Shack–Hartmann aberrometer was used to measure the monochromatic aberration structure along the primary line of sight of 200 cyclopleged, normal, healthy eyes from 100 individuals. Sphero-cylindrical refractive errors were corrected with ophthalmic spectacle lenses based on the results of a subjective refraction performed immediately prior to experimentation. Zernike expansions of the experimental wave-front aberration functions were used to determine aberration coefficients for a series of pupil diameters. The residual Zernike coefficients for defocus were not zero but varied systematically with pupil diameter and with the Zernike coefficient for spherical aberration in a way that maximizes visual acuity. We infer from these results that subjective best focus occurs when the area of the central, aberration-free region of the pupil is maximized. We found that the population averages of Zernike coefficients were nearly zero for all of the higher-order modes except spherical aberration. This result indicates that a hypothetical average eye representing the central tendency of the population is nearly free of aberrations, suggesting the possible influence of an emmetropization process or evolutionary pressure. However, for any individual eye the aberration coefficients were rarely zero for any Zernike mode. To first approximation, wave-front error fell exponentially with Zernike order and increased linearly with pupil area. On average, the total wave-front variance produced by higher-order aberrations was less than the wave-front variance of residual defocus and astigmatism. For example, the average amount of higher-order aberrations present for a 7.5-mm pupil was equivalent to the wave-front error produced by less than 1/4 diopter (D) of defocus. The largest pupil for which an eye may be considered diffraction-limited was 1.22 mm on average. Correlation of aberrations from the left and right eyes indicated the presence of significant bilateral symmetry. No evidence was found of a universal anatomical feature responsible for third-order optical aberrations. Using the Marechal criterion, we conclude that correction of the 12 largest principal components, or 14 largest Zernike modes, would be required to achieve diffraction-limited performance on average for a 6-mm pupil. Different methods of computing population averages provided upper and lower limits to the mean optical transfer function and mean point-spread function for our population of eyes.