Background: Photorefractive keratectomy (PRK) using a dilating diaphragm mask engraves a delicate three-dimensional staircase pattern into a formerly smooth corneal surface. The created steps are later smoothed by tear film and wound healing processes. The present study investigates, in a mathematical simulation, the effects that such staircase patterns and their smoothing may have on retinal image contrast.
Methods: All simulations are based on the Gullstrand eye model and calculate retinal image contrast from point spread function (PSF) analysis of Gullstrand eyes treated by simulated PRK under various conditions.
Results: The simulations indicate that PRK can reduce retinal contrast markedly. The most critical factor for such a reduction is the step height of the ablation pattern. With step heights below 0.4 microns, loss of contrast due to the created staircase pattern is always moderate and should be restored during early wound healing. Complete wound healing may smooth out larger step heights. Micromovements during PRK also can lead to partial loss of retinal image contrast.
Conclusions: Simulation of retinal contrast after PRK shows that step heights below 0.4 microns seem to be acceptable. A minimization of the micromovements during PRK can offset some of the reduction of retinal contrast.