Relation between Uncorrected Astigmatism and Visual Acuity in Pseudophakia

PURPOSE.: The end point of astigmatic correction after cataract surgery will depend on how uncorrected astigmatism impacts distance and near vision of pseudophakic eyes. This study determined the impact of induced astigmatism and pupil size on the distance and near acuity of otherwise emmetropic pseudophakic eyes implanted with monofocal intraocular lenses. METHODS.: Monocular high-contrast distance (4 m) and near (40 cm) logMAR acuity was determined in 15 subjects (mean ± 1 SD, 57.9 ± 9.0 years) without astigmatism and with 2.5 diopters (D) myopic to 2.0 D hyperopic astigmatic lenses induced in 0.5-D steps at 0-, 45-, 90-, and 135-degree axes. This experiment was repeated for the same range of induced astigmatism with 1.5-, 3-, and 6-mm artificial pupil diameters placed before one eye of 10 subjects dilated with 10% phenylephrine HCl. RESULTS.: Distance acuity deteriorated with astigmatism for all axes tested (p < 0.01). Near acuity deteriorated with hyperopic astigmatism (p < 0.1), whereas it improved with up to 1 D of myopic astigmatism before saturating for all axes tested (p < 0.01). Distance and near acuity improved with a reduction in pupil diameter (p < 0.01). The change in distance and near acuity with induced astigmatism was smaller for 1.5-mm than for 3-mm and 6-mm pupil diameters (p < 0.01). CONCLUSIONS.: Partial restoration of near acuity with uncorrected myopic astigmatism comes with a proportional loss of distance acuity in pseudophakic eyes. Uncorrected myopic astigmatism more than 1 D results in a large loss of distance acuity at no additional benefit to near acuity. Both distance and near acuities with and without astigmatism are benefited with a reduction in pupil diameter. Uncorrected hyperopic astigmatism results in deterioration of both distance and near acuities of pseudophakic eyes.