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.