Interaction between aberrations to improve or reduce visual performance.

PURPOSE To investigate how pairs of Zernike modes interact to increase or decrease visual acuity. SETTING Visual Optics Institute, College of Optometry, University of Houston, Houston, Texas, USA. METHODS Subjects read aberrated and unaberrated visual acuity charts 3 times. Each aberrated chart was produced by convolving an aberrated point-spread function with an unaberrated acuity chart. Point-spread functions were defined by 4 pairs of Zernike modes. For each pair, 9 combinations were used, ranging from all aberration being loaded into the first mode to all aberration being loaded into the second mode. The root mean square (RMS) wavefront error always totaled 0.25 microm (6.0 mm pupil), a level similar to the aberration induced by traditional flying small-spot laser refractive surgeries. RESULTS For all conditions (except the unaberrated charts), visual acuity decreased. Acuity varied significantly depending on which modes were mixed and the relative contribution of each mode. Modes 2 radial orders apart and having the same sign and angular frequency tended to combine to increase visual acuity. Modes within the same radial order tended to combine to decrease acuity. CONCLUSIONS For low levels of aberration, the RMS wavefront error is not a good predictor of visual acuity. Clinically, it is important to define how aberrations interact to optimize visual performance. New metrics of optical/neural performance that correlate better with clinical measures of visual performance need to be adopted or developed, as well as new clinically viable measures of visual performance that are sensitive to subtle changes in optical performance.