title: Image quality analysis of pseudophakic eyes with uncorrected astigmatism.
abstract: OBJECTIVE
  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.
authors: *BS †MS ‡BS, PhD Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, Hyderabad, Andhra Pradesh, India (VP, SRB); Cornea and Anterior Segment Services, Hyderabad Andhra Pradesh, India (PG); and Bausch and Lomb School of Optometry, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India (SRB).
authors: Veerendranath
authors: V
authors: Pesala
authors: Prashant
authors: P
authors: Garg
authors: Shrikant R
authors: SR
authors: Bharadwaj
mesh_terms: D057128:Aberrometry; D000328:Adult; D001251:Astigmatism / Q000503:physiopathology*; D057108:Corneal Wavefront Aberration / Q000503:physiopathology; D003867:Depth Perception / Q000502:physiology*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D019591:Pseudophakia / Q000503:physiopathology*; D011680:Pupil / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology*