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Comparison of binocular through-focus visual acuity with monovision and a small aperture inlay


Corneal small aperture inlays provide extended depth of focus as
a solution to presbyopia. As this procedure is becoming more popular, it is
interesting to compare its performance with traditional approaches, such as
monovision. Here, binocular visual acuity was measured as a function of
object vergence in three subjects by using a binocular adaptive optics
vision analyzer. Visual acuity was measured at two luminance levels
(photopic and mesopic) under several optical conditions: 1) natural vision
(4 mm pupils, best corrected distance vision), 2) pure-defocus monovision
( + 1.25 D add in the nondominant eye), 3) small aperture monovision (1.6
mm pupil in the nondominant eye), and 4) combined small aperture and
defocus monovision (1.6 mm pupil and a + 0.75 D add in the nondominant
eye). Visual simulations of a small aperture corneal inlay suggest that the
device extends DOF as effectively as traditional monovision in photopic
light, in both cases at the cost of binocular summation. However,
individual factors, such as aperture centration or sensitivity to mesopic
conditions should be considered to assure adequate visual outcomes.

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