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Objectively Determined Refraction Improves Peripheral Vision

Lewis, Peter*; Baskaran, Karthikeyan; Rosén, Robert; Lundström, Linda; Unsbo, Peter; Gustafsson, Jörgen

doi: 10.1097/OPX.0000000000000301
Original Articles

Purpose: The purpose of this study was twofold: to verify a fast, clinically applicable method for determining off-axis refraction and to assess the impact of objectively obtained off-axis refractive correction on peripheral low-contrast visual acuity.

Methods: We measured peripheral low-contrast resolution acuity with Gabor patches both with and without off-axis correction at 20 degrees in the nasal visual field of 10 emmetropic subjects; the correction was obtained using a commercial open-field Hartmann-Shack wavefront sensor, the COAS-HD VR aberrometer. Off-axis refractive errors were calculated for a 5-mm circular pupil inscribed within the elliptical wavefront by COAS using the instruments’ inbuilt “Seidel sphere” method.

Results: Most of the subjects had simple myopic astigmatism, at 20 degrees in the nasal visual field ranging from −1.00 to −2.00 DC, with axis orientations generally near 90 degrees. The mean uncorrected and corrected low-contrast resolution acuities for all subjects were 0.92 and 0.86 logMAR, respectively (an improvement of 0.06 logMAR). For subjects with a scalar power refractive error of 1.00 diopters or more, the average improvement was 0.1 logMAR. The observed changes in low-contrast resolution acuity were strongly correlated with off-axis astigmatism (Pearson r = 0.95; p < 0.0001), the J180 cross-cylinder component (Pearson r = 0.82; p = 0.0034), and power scalar (Pearson r = −0.75; p = 0.0126).

Conclusions: The results suggest that there are definite benefits in correcting even moderate amounts of off-axis refractive errors; in this study, as little as −1.50 DC of off-axis astigmatism gave improvements of up to a line in visual acuity. It may be even more pertinent for people who rely on optimal peripheral visual function, specifically those with central visual field loss; the use of open-field aberrometers could be clinically useful in rapidly determining off-axis refractive errors specifically for this patient group who are generally more challenging to refract.




Department of Medicine and Optometry, Linnæus University, Kalmar, Sweden (PL, KB, JG); and Biomedical and X-Ray Physics, KTH, Royal Institute of Technology, Stockholm, Sweden (RR, LL, PU).

Peter Lewis Department of Optometry and Medicine SE-39182 Kalmar Sweden e-mail:

© 2014 American Academy of Optometry