An adaptive optics visual simulator (AOVS) with an extended dioptric range was developed, allowing measuring and correcting aberrations in a majority of highly ametropic eyes. In the instrument, a tunable lens is used for defocus correction, while a liquid-crystal-on-silicon spatial light modulator is used for compensating or inducing any other aberration. The instrument incorporates a digital projector, which uses a micromirror array to display the stimuli. A motorized diaphragm enables operation for any physiological pupil size. A full description of the instrument and its calibration are provided, together with the results obtained in seven highly myopic subjects with refraction of −7.2±1.8 D (mean±SD). Refraction obtained with the instrument was compared to the standard refraction prescribed by trial lenses. When using the refraction obtained by the AOVS, the visual acuity (VA) exhibited an average increase of 0.21 (decimal scale). The visual impact of correcting high-order aberrations is presented in three subjects, whose VAs slightly improved with the correction. High myopes are able to benefit from the improved refraction assessment. The new instrument creates a possibility for a wide number of new experiments, especially for eyes exhibiting large refractive errors, where previous AO instruments failed to operate.
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