Population-based visual acuity in the presence of defocus well predicted by classical theory

According to classical theory, visual acuity (VA) can be modeled using the intersection of the eye's modulation transfer function with a retinal threshold function. To date, there have been limited attempts to validate this methodology by comparing theory with actual measured data. We use the methodology to predict the visual acuity in the presence of defocus of a population of cataract patients implanted with diffractive multifocal intraocular lenses. For the prediction, we used a set of physiological eye models that include chromatic and higher order aberrations. We found that the simulations correlated strongly to the clinical outcomes (R =0.93). While the simulated VA of the eye models was systematically 0.05 logMAR units lower (better acuity) than the clinical results, this difference was independent of defocus (p=0.98). These results show that when the simple and straightforward classical theory is applied using physiological eye models, accurate predictions of the VA, and through-focus VA of a population can be made. This method may be suited for predicting visual performance of new cataract and refractive treatments.