Visual performance after correcting higher order aberrations in keratoconic eyes

Keratoconic eyes are affected by an irregular optical blur induced by significant magnitude of higher order aberrations (HOAs). Although it is expected that correction of ocular aberrations leads to an improvement in visual performance, keratoconic eyes might not achieve the visual benefit predicted by optical theory because of long-term adaptation to poor retinal image quality. To investigate this, an adaptive optics (AO) system equipped with a large-stroke deformable mirror and a Shack-Hartmann wavefront sensor was used to correct the aberrations and measure high contrast tumbling E visual acuity (HCVA) in 8 keratoconic eyes. Eight normal eyes were employed as control. Aberrations were dynamically corrected with closed-loop AO during visual acuity testing, with residual root-mean-square error of around 0.1 mu m in both groups over 6-mm pupil (p = 0.11). With AO correction, the HCVA in logMAR was -0.26 +/- 0.063 in normal eyes, and in keratoconic eyes, it was -0.07 +/- 0.051 (p = 0.0001) for the same pupil size. There was no correlation in the AO-corrected HCVA for normals with the magnitudes of their native HOA. However, within keratoconic eyes, poorer AO-corrected HCVA was observed with an increase of the native magnitudes of HOA (R-2 = 0.67). This may indicate that long-term visual experience with poor retinal image quality, induced by HOA, may restrict the visual benefit achievable immediately after correction in keratoconic eyes.