Editorial

Time to replace the spherical equivalent with the average paraxial lens power

A scalar measure of refractive power is frequently used to evaluated refractive outcomes. Such scalar measures are based on the average power of a lens or lens system, for example, spherocylinder.

A commonly used measure has been the mean spherical equivalent usually referred to as the spherical equivalent (SE). Harris recognised, however, that there may be other scalar terms for the SE.1 As such, it has recently been shown that the  Inline Formula  which in addition to orthogonal rays, includes the average or mean of oblique paraxial rays. It is also associated with better visual acuity than the SE and therefore may be of more clinical use.2 The relationship between the  Inline Formula  and SE, however, needs clarification.

There are currently two methods used to calculate the average paraxial power of a lens:

  • SE, which is derived from the average orthogonal paraxial power3  Inline Formula .

  • Average paraxial power  Inline Formula , which is derived from the average orthogonal and oblique paraxial powers2  Inline Formula 

Consider the following lens system F written as an optical cross where C1 and C2 are two orthogonal lens cylinders at axes a and a±90:

inline graphic

This can be separated into the sum of two paraxial lens systems:

inline graphic

often then written in sphere/cylinder x-axis ( Inline Formula ) form as  Inline Formula , based on the assumption that two equal orthogonal cylinders equal a spherical lens, that is,  Inline Formula 

The average power  Inline Formula  of the system is the sum of the average power of each component, that is,  Inline Formula 

where  Inline Formula ,  Inline Formula  and  Inline Formula  are the average paraxial powers of each of the three lenses.

For the SE, the average is the average of orthogonal paraxial rays, that is,

SE=average orthogonal paraxial power  Inline Formula 

Display Formula

So that

Display Formula

While for the  Inline Formula , the average is the average of orthogonal and oblique paraxial rays, that is,

 Inline Formula =average orthogonal and oblique paraxial power  Inline Formula 

Display Formula

Display Formula

Therefore, the  Inline Formula  is equal to half the SE if calculated in cross cylinder form, that is,  Inline Formula 

Transposition and ApP

Analogous to the SE, the  Inline Formula  also holds under transposition, that is,

inline graphic

Display Formula

and after transposition

inline graphic

Display Formula

Transformation

Transforming an optical cross of cylinders into a spherocylinder  Inline Formula  often rests on the assumption that two equal orthogonal cylinders equal a spherical lens,3 that is,  Inline Formula  or  Inline Formula  . This is an approximation, as it has been shown that two equal orthogonal cylinders are not equal to a spherical lens3 and in addition, the intersection of two equal orthogonal cylinders is Steinmetz solid rather than a sphere.2 It would, therefore, be more accurate to state that within a paraxial ray system that two equal orthogonal cylinders only approximate a spherical lens.

If  Inline Formula , where  Inline Formula  represents the resultant spherical lens,  Inline Formula ; and  Inline Formula  where  Inline Formula , represents the resultant spherical lens  Inline Formula .

Then, based on this approximation, the lens system is written in  Inline Formula  notation as:

Display Formula

Display Formula

Display Formula

It is important to note, however, that the derivation of the SE is based on treating a lens cylinder as a cylinder and not on the assumption that two orthogonal cylinders equate to a spherical lens.

Although not strictly correct, the SE is often calculated as:

Display Formula

Display Formula

where  Inline Formula  and  Inline Formula 

It is also important to note that the error introduced by this approximation is not constant and the magnitude of the error depends on the power of the two lenses.3 Therefore, application of the formula for the SE based on the assumption that two orthogonal lenses equate to a spherical lens should be limited to small powers.

If a refractive error, however, does comprise a true spherical component, then the average of that component is of course the sphere.

Therefore, for a refractive power that contains a sphere, the  Inline Formula  and the Inline Formula 

and the difference between the  Inline Formula  and SE is equal to  Inline Formula  .

Conclusion

While any scalar measure of refractive error loses dimensions of sensitivity, scalar measures of power remain important in many applications. The  Inline Formula  as a scalar measure is more inclusive and appears to be associated with better visual acuity than the SE, although further clinical trials are needed particularly in different age groups and conditions. It will also be important to explore and evaluate the  Inline Formula  with higher refractive errors. If the evidence remains supportive, then useful clinical applications of the  Inline Formula  would include, for example, providing an equivalent lens for a person who is unable to tolerate the toric prescription as this is associated with less degradation of visual acuity than may occur with the SE.