Impact of higher-order aberrations on accommodation in phakic presbyopic patients

To assess the relationship and respective contribution of ocular higher-order aberrations (HOAs) on residual accommodative performance in presbyopic patients. We enrolled 20 patients (40 eyes) without ophthalmological pathology, between 48 and 58 years old, with a best-corrected visual acuity more than 10/10. Total aberrations were computed using the Wavescan Aberrometer (AMO, USA). The defocus curve and near visual acuity (30 and 50 cm) were measured. The relationship between accommodation ability and HOAs was evaluated aiming at a linear relationship with a simple regression analysis and with a multiple linear regression analysis (including manifest refraction, ocular aberrations, and age). Even if age and manifest refraction were correlated with accommodative ability, ocular coma seemed to be correlated with near visual acuity without addition and with minimal addition for reading P1.5 at 30 cm (respectively, r(2)=0.117 with P=0.035 and r(2)=0.163 with P=0.012). Total spherical aberration appeared to be correlated with minimal addition (r(2)=0.12 with P=0.032). Ocular aberrations (coma and spherical aberration) are correlated with accommodative performance in presbyopic patients, independently of age and manifest refraction. Ocular aberrations appeared to be a stimulus for accommodation but may also influence quality of accommodative reply.