Purpose: To determine the combined impact of uncorrected astigmatism, pupil diameter, and wavefront aberrations on the distance and near visual performance of pseudophakic eyes with monofocal intraocular lens (IOL) implants using objective image quality (IQ) metrics.
Methods: Monocular distance (4 m) and near (40 cm) logMAR acuities of 15 emmetropic pseudophakic eyes were obtained without astigmatism and with 2.5 diopters myopic to 2.5 diopters hyperopic astigmatism induced along a 90-degree axis. The IQ metrics were calculated from the participant’s wavefront aberrations and habitual pupil diameter for all values of astigmatism and correlated with logMAR acuity. The analysis was repeated without higher-order aberrations (HOAs) and with the entire wavefront data for 6-, 3-, and 1.5-mm pupil diameters.
Results: Distance acuity deteriorated with uncorrected astigmatism (p < 0.01), whereas near acuity improved with uncorrected myopic astigmatism and deteriorated with uncorrected hyperopic astigmatism (both p < 0.01). The logEW IQ metric showed the best correlation with logMAR acuity (r = 0.86). Distance logEW values deteriorated whereas near logEW values improved in the presence of HOAs for all values of uncorrected astigmatism (p < 0.01). Distance logEW values for 6- and 3-mm pupil diameters were worse than that of the 1.5-mm pupil diameter for all values of uncorrected astigmatism and for both viewing distances (p < 0.01).
Conclusions: Image quality metrics analysis can be used successfully to determine the impact of uncorrected astigmatism, pupil diameter, and HOAs on the distance and near logMAR acuities of pseudophakic eyes with monofocal IOL implants. The improvement in near IQ with uncorrected myopic astigmatism and HOAs suggests that these two factors supplement each other to improve near visual performance of pseudophakic eyes. Such an improvement in near vision is however associated with a loss of distance vision in these eyes.