Abstract
PURPOSE: This study aimed to quantify the impact of blur, contrast, and ghosting on perceived overall image quality (IQ) as well as resultant predicted visual acuity, utilizing simulated acuity charts from objective refraction among eyes of individuals with Down syndrome (DS). METHODS: Acuity charts were produced, simulating the retinal image when applying 16 different metric-derived sphero-cylindrical refractions for each eye of 30 adult patients with DS. Fourteen dilated adult observers (normal vision) viewed subsets of logMAR acuity charts displayed on an LCD monitor monocularly through a unit magnification 3-mm aperture telescope. Observers rated features blur, ghosting, and contrast on 10-point scales (10 = poorest) and overall IQ on a 0- to 100-point scale (100 = best) and read each chart until five total letters were missed (logMAR technique). Mixed modeling was used to estimate feature influence on overall perceived IQ and relative acuity (compared with an unaberrated chart), separately. RESULTS: Perceived IQ spanned the entire scale (mean = 59 ± 22) and average reduction in relative acuity was two lines (0.2 ± 0.14 logMAR). Perceived blur, ghosting, and contrast were individually correlated with overall IQ and relative acuity. Blur, contrast, and ghosting exert unique effects on overall perceived IQ (P < 0.05). Blur (b = -.009, P < 0.001) and ghosting (b = -.003, P < 0.001) influence relative acuity over and beyond their effects on overall IQ (b = .001, P < 0.0001) and contrast. CONCLUSIONS: Objectively identified refractions would ideally provide high contrast, low blur, and low ghosting. These data suggest that blur and ghosting may be given priority over contrast when improving acuity is the goal. TRANSLATIONAL RELEVANCE: Findings may guide objective refraction in clinical care.