Souvent les termes “astigmatisme fort” ou “astigmatisme irrégulier” sont employés abusivement pour décrire les aberrations d’ ordre supérieur à 2 qui est l’ “astigmatisme régulier” ou “astigmatisme simple”.
Le patients voit un effet de flou, des fantômes, des halos lumineux , des images dédoublées ou souffre d’ une perte de contraste , de vision spatiale ( binoculaire ) et d’ une vision nocturne pauvre alors qu’ aucune correction par lunettes ne peut diminuer ses troubles de la vision.
Quelque chose de très important à comprendre est que toutes les aberrations ne pas sont réduites avec Lasik, PRK, LASEK, Epi-Lasik ( ablation personnalisée par front d' onde ) . Au contraire, dans toutes les procédures de chirurgie réfractive, ( front d' onde ou conventionnelles) les aberrations d' ordre élevé ont tendance à augmenter.
C 'est une des raisons pour lesquelles la Food and Drug Administration (FDA) a approuvé l' utilisation de la chirurgie réfractive par laser , mais ne l' a pas expressément approuvé pour traiter et réduire les aberrations d' ordre élevé .
La Council for Refractive Surgery Quality Assurance a distribué un mémorandum consultatif spécial sur cette question.
usaeyes.org HOA_Advisory_Memo.pdf
Les aberrations peuvent aussi être d' origine cristallienne.
Les aberrations et leur incidence sur la vision
| ordre | type | après chirurgie , incidence sur les défauts de vision | |
| 1 | tilt | ||
| 2 | defocus astigmatisme | amétropies sphéro-cylindriques | augmentation notable |
| 3 | coma trefoil | défaut d' alignement | augmentation considérable si resurfaçage suboptimal |
| 4 | sphéricité | faible incidence sauf si cicatrisation cornéenne irrégulière , incision |
Des études ont montré que
- les aberrations optiques de haut degré augmenteraient avec l’âge et
- parmi les aberrations de haut degré à symétrie de révolution, seules les aberrations sphériques de 4e ordre varient significativement en fonction de l’amétropie associée et sont retrouvées plus élevées chez les patients hypermétropes.
Les distorsions asymétriques ou périphériques (ex. : coma, aberration sphérique) peuvent être corrigées uniquement par des lentilles cornéennes ( lentilles de contact fabriquées sur mesure ).
La seule solution acceptable est l' usage de lentilles cornéennes .
Exavue Opticien Optometriste à Paris peut mesurer ces distorsions grâce à son videokeratometre.
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