Comparison of spherical aberration and small-pupil profiles in improving depth of focus for presbyopic corrections.

PURPOSE To compare the validity and effectiveness of 2 methods for expanding depth of focus to correct for presbyopia; that is, induction of spherical aberration and small-pupil apertures. SETTING University of California, Berkeley, California, USA. DESIGN Comparative case series. METHODS A random 4-alternative forced-choice acuity task was performed on 13 subjects. Visual performance and depth of focus were compared using adaptive optics-corrected distance visual acuity (CDVA) values and mean visual acuity over a 3.0 diopter (D) range of defocus using the following 3 adaptive optics-corrected profiles: 2.0 mm pupil, 5.0 mm pupil, and 5.0 mm pupil with -0.274 μm of spherical aberration. RESULTS The 5.0 mm pupil profile had a CDVA of -0.218 logMAR and a mean visual acuity through focus of 0.156 logMAR. The 2.0 mm pupil profile had a worse CDVA (0.012 logMAR) but an improved mean visual acuity (0.061 logMAR). The 5.0 mm pupil profile with -0.274 μm of spherical aberration measured a CDVA of -0.082 logMAR and a mean visual acuity of 0.103 logMAR. CONCLUSIONS The spherical aberration and small-pupil profiles improved the mean visual acuity across a 3.0 D range of defocus but resulted in decreased CDVA at the plane of best focus in comparison to an adaptive optics-corrected 5.0 mm pupil. Small-pupil profiles are a better choice than spherical aberration profiles for presbyopic corrections due to expected accuracy, predictability, and patient satisfaction. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.