Conventional adaptive optics enables correction of high-order aberrations of the eye, but only for a single retinal point. When imaging extended regions of the retina, aberrations increase away from this point and degrade image quality. The zone over which aberrations do not change significantly is called the "isoplanatic patch." Literature concerning the human isoplanatic patch is incomplete. We determine foveal isoplanatic patch characteristics by performing Hartmann-Shack aberrometry in 1 deg increments in 8 directions on 7 human eyes. Using these measurements, we establish the correction quality required to yield at least 80% of the potential patch size for a given eye. Single-point correction systems (conventional adaptive optics) and multiple-point correction systems (multiconjugate adaptive optics) are simulated. Results are compared to a model eye. Using the Marechal criterion for 555-nm light, average isoplanatic patch diameter for our subjects is 0.80+/-0.10 deg. The required order of aberration correction depends on desired image quality over the patch. For the more realistically achievable criterion of 0.1 mum root mean square (rms) wavefront error over a 6.0-mm pupil, correction to at least sixth order is recommended for all adaptive optics systems. The most important aberrations to target for a multiconjugate correction are defocus, astigmatism, and coma.

Our modeling is consistent with clinical findings that certain corneal aberrations almost balance those arising from the lens. Our calculations also support the general notion that, by optical sculpting, corneal aberrations can be adjusted to completely balance out those of the lens. This can effectively eliminate the eye's total monochromatic aberrations, but for only one retinal image point at a time. Centered on this point of minimal aberration is a region (the isoplanatic patch) within which the aberrations produce a point spread smaller than some tolerable limit. Also, using available evidence in the literature concerning changes in critical ocular parameters with age and accommodation, our modeling results parallel established clinical findings, and additionally indicate that the major source of aberration change can be attributed to the gradient index distribution in the lens.