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.