Abstract
This study examines the extent to which a Zernike-based optical correction can restore acuity in keratoconus as a function of disease severity and contrast level. Increasingly complete Zernike corrections in the presence of Zernike-fit error were simulated. Acuity for keratoconic eyes with <60 D maximum corneal power reached 20/13 with a fifth-order Zernike correction under high-contrast conditions and exhibited a loss of 0.1 logMAR (minimum angle of resolution) (from 20/32 to 20/40) for low-contrast conditions. Acuity for keratoconic eyes with >60 D maximum corneal power approached 20/13 with sixth-tenth-order corrections under high-contrast conditions but did not return to similar levels with a tenth-order correction for low-contrast conditions. The results suggest that fit error affects visual performance for more difficult tasks and that restoring high-contrast acuity (20/16 or better) using a fifth-order Zernike correction is not limited by Zernike=fit error for over 88% of keratoconus cases.