Purpose. To investigate analytically whether higher-order wavefront errors comprising combinations of trefoil along 30° (trefoil30), vertical coma, and spherical aberration could provide cues to sphero-cylindrical refractive error development.
Methods. A total of 25 test wavefronts, subdivided into five different types and five levels of higher-order root mean square errors (HO-RMS), were created for the study. One type contained spherical aberration only, producing HO-RMS levels between 0.1 and 0.5 μm. Four wavefront types contained coma, trefoil, and spherical aberration of various sign combinations also producing HO-RMS levels between 0.1 and 0.5 μm. From the 25 wavefronts, refractive power maps were created and 2025 different sphero-cylindrical combinations were added to each refractive power map. For each sphero-cylinder combination, the visual Strehl ratio based on the modulation transfer function (VSMTF) was calculated. Retinal images and refractive power histograms were calculated for the refractive power maps corresponding to the peak of the VSMTF.
Results. Spherical aberration affected the best focal plane thereby inducing spherical or defocus cues. The VSMTF produced by vertical coma and trefoil30, in combination with spherical aberration, could be improved with sphero-cylinders of various magnitudes and directions (i.e., with-the-rule, against-the rule, myopic astigmatism, or hyperopic astigmatism). Clinical significance of sphero-cylinders (i.e., ≥0.25 D) was reached at HO-RMS levels between 0.2 and 0.3 μm for a 5-mm pupil zone.
Conclusions. In the context of compensatory blur driven eye growth, commonly occurring combinations of the three considered higher-order aberrations have the potential to produce cues to eye growth resulting in myopia and with-the-rule astigmatism.