Digital Pupillometry and Centroid Shift Changes in Dominant and Nondominant Eyes

Abstract

Purpose To investigate the differences between dominant and nondominant eyes in a predominantly young patient population by analyzing the angle kappa, pupil size, and center position in dominant and nondominant eyes.

Methods A total of 126 young college students (252 eyes) with myopia who underwent femtosecond laser-combined LASIK were randomly selected. Ocular dominance was determined using the hole-in-card test. The WaveLight Allegro Topolyzer (WaveLight Laser Technologies AG, Erlangen, Germany) was used to measure the pupil size and center position. The offset between the pupil center and the coaxially sighted corneal light reflex (P-Dist) of the patients was recorded by the x- and y-axis eyeball tracking adjustment program of the WaveLight Eagle Vision EX500 excimer laser system (Wavelight GmbH). The patientʼs vision (uncorrected distance visual acuity [UDVA], best-corrected visual acuity (BCVA), and refractive power (spherical equivalent, SE) were observed preoperatively, 1 week, 4 weeks, and 12 weeks postoperatively, and a quality of vision (QoV) questionnaire was completed.

Results Ocular dominance occurred predominantly in the right eye [right vs. left: (178) 70.63% vs. (74) 29.37%; p < 0.001]. The P-Dist was 0.202 ± 0.095 mm in the dominant eye and 0.215 ± 0.103 mm in the nondominant eye (p = 0.021). The horizontal pupil shift was − 0.07 ± 0.14 mm in dominant eyes and 0.01 ± 0.13 mm in nondominant eyes (p = 0.001) (the temporal displacement of the dominant eye under mesopic conditions). The SE was negatively correlated with the P-Dist (r = − 0.223, p = 0.012 for the dominant eye and r = − 0.199, p = 0.025 for the nondominant eye). At 12 weeks postoperatively, the safety index (postoperative BDVA/preoperative BDVA) of the dominant and nondominant eyes was 1.20 (1.00, 1.22) and 1.20 (1.00, 1.20), respectively, and the efficacy index (postoperative UDVA/preoperative BDVA) was 1.00 (1.00, 1.20) and 1.00 (1.00, 1.20), respectively; the proportion of residual SE within ± 0.50 D was 98 and 100%, respectively.

Conclusions This study found that ocular dominance occurred predominantly in the right eye. The pupil size change was larger in the dominant eye. The angle kappa of the dominant eye was smaller than that of the nondominant eye and the pupil center of the dominant eye was slightly shifted to the temporal side under mesopic conditions. The correction of myopia in the dominant and nondominant eyes exhibits good safety, efficacy, and predictability in the short term after surgery, and has good subjective visual quality performance after correction. We suggest adjusting the angle kappa percentage in the dominant eye to be lower than that of the nondominant eye in individualized corneal refractive surgery in order to find the ablation center closest to the visual axis.

Zusammenfassung

Ziel Untersuchung der Unterschiede zwischen dominanten und nicht dominanten Augen in einer überwiegend jungen Patientenpopulation durch Analyse des Kappa-Winkels, der Pupillengröße und der Zentrumsposition in dominanten und nicht dominanten Augen.

Methoden Insgesamt wurden 126 junge Studenten (252 Augen) mit Myopie, die sich einer Femtosekundenlaser-kombinierten LASIK-Operation unterzogen hatten, zufällig ausgewählt. Die okulare Dominanz wurde mit dem Loch-in-Karte-Test bestimmt. Der WaveLight Allegro Topolyzer (WaveLight Laser Technologies AG, Erlangen, Deutschland) wurde zur Messung der Pupillengröße und Zentrumsposition verwendet. Der Versatz zwischen dem Pupillenzentrum und dem koaxial gesichteten Hornhautlichtreflex (P-Dist) der Patienten wurde durch das x- und y-Achsen-Augapfel-Tracking-Anpassungsprogramm des WaveLight Eagle Vision EX500 Excimer-Lasersystems (Wavelight GmbH) aufgezeichnet. Die Sehkraft des Patienten (unkorrigierte Fernsehschärfe [UDVA], bestkorrigierte Sehschärfe [BCVA] und refraktive Leistung [sphärisches Äquivalent, SE]) wurden präoperativ, 1 Woche, 4 Wochen und 12 Wochen postoperativ beobachtet, und ein Fragebogen zur Sehqualität (QoV) wurde ausgefüllt.

Ergebnisse Die okulare Dominanz trat überwiegend im rechten Auge auf [rechts vs. links: (178) 70,63% vs. (74) 29,37%; p < 0,001]. Der P-Dist betrug 0,202 ± 0,095 mm im dominanten Auge und 0,215 ± 0,103 mm im nicht dominanten Auge (p = 0,021). Die horizontale Pupillenverschiebung betrug − 0,07 ± 0,14 mm bei dominanten Augen und 0,01 ± 0,13 mm bei nicht dominanten Augen (p = 0,001) (die temporale Verschiebung des dominanten Auges unter mesopischen Bedingungen). Das SE korrelierte negativ mit dem P-Dist (r = − 0,223, p = 0,012 für das dominante Auge und r = − 0,199, p = 0,025 für das nicht dominante Auge). Nach 12 Wochen postoperativ betrug der Sicherheitsindex (postoperative BDVA/präoperative BDVA) der dominanten und nicht dominanten Augen jeweils 1,20 (1,00, 1,22) bzw. 1,20 (1,00, 1,20), und der Effektivitätsindex (postoperative UDVA/präoperative BDVA) betrug jeweils 1,00 (1,00, 1,20) bzw. 1,00 (1,00, 1,20); der Anteil des Rest-SE innerhalb von ± 0.50 dpt betrug jeweils 98% bzw.100%.

Schlussfolgerungen Diese Studie fand heraus, dass die okulare Dominanz überwiegend im rechten Auge auftrat. Die Pupillengrößenänderung war im dominanten Auge größer. Der Kappa-Winkel des dominanten Auges war kleiner als der des nicht dominanten Auges und das Pupillenzentrum des dominanten Auges war unter mesopischen Bedingungen leicht zur temporalen Seite verschoben. Die Korrektur der Myopie in den dominanten und nicht dominanten Augen zeigt nach der Operation eine gute Sicherheit, Wirksamkeit und Vorhersagbarkeit auf kurze Sicht und hat nach der Korrektur eine gute subjektive Sehqualitätsleistung. Wir schlagen vor, den Kappa-Winkel-Prozentsatz im dominanten Auge niedriger als den des nicht dominanten Auges in der individualisierten hornhautrefraktiven Chirurgie anzupassen, um das Ablationszentrum zu finden, das am nächsten zur Sehachse liegt.

Conclusion Box

Already known:

• Pupil changes in dominant eyes are slightly different from those in nondominant eyes.

• Accurate positioning of the excimer laser cutting center for dominant and nondominant eyes is crucial.

• Further research is needed to study angle kappa compensation and wavefront aberrations of dominant and nondominant eyes.

Newly described:

• Under mesopic conditions, the pupil center of the dominant eye is slightly shifted to the temporal side.

• In individualized corneal refractive surgery, adjusting the angle kappa percentage in the nondominant eye to be higher than that of the dominant eye may be beneficial for UDVA, predictability, effectiveness, safety, and quality of vision.

• Further research is needed to study angle kappa compensation and wavefront aberrations of dominant and nondominant eyes, and the digital correspondence between personalized ablation of various modes remains to be further explored.

Key words

dominant eye - pupil center - angle kappa - refractive surgery

Schlüsselwörter

dominantes Auge - Pupillenmitte - Kappa-Winkel - refraktive Chirurgie

Publication History

Received: 14 May 2023

Accepted: 19 September 2023

Accepted Manuscript online:
29 September 2023

Article published online:
27 November 2023

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