PURPOSE.To investigate the impact on visual performance of modifying monovision with monocularly induced spherical aberration (SA) to increase depth of focus (DoF), thereby enhancing binocular through-focus visual performance. METHODS.A binocular adaptive optics (AO) vision simulator was used to correct both eyes' native aberrations and induce traditional (TMV) and modified (MMV) monovision corrections. TMV was simulated with 1.5 diopters (D) of anisometropia (dominant eye at distance, nondominant eye at near). Zernike primary SA was induced in the nondominant eye in MMV. A total of four MMV conditions were tested with various amounts of SA (60.2 and 60.4 lm) and fixed anisometropia (1.5 D). Monocular and binocular visual acuity (VA) and contrast sensitivity (CS) at 10 cyc/deg and binocular summation were measured through-focus in three cyclopledged subjects with 4-mm pupils.RESULTS. MMV with positive SA had a larger benefit for intermediate distances (1.5 lines at 1.0 D) than with negative SA, compared with TMV. Negative SA had a stronger benefit in VA at near. DoF of all MMV conditions was 3.5 6 0.5 D (mean) as compared with TMV (2.7 6 0.3 D). Through-focus CS at 10 cyc/deg was significantly reduced with MMV as compared to TMV only at intermediate object distances, however was unaffected at distance. Binocular summation was absent at all object distances except 0.5 D, where it improved in MMV by 19% over TMV. CONCLUSIONS.Modified monovision with SA improves through-focus VA and DoF as compared with traditional monovision. Binocular summation also increased as interocular similarity of image quality increased due to extended monocular DoF.Keywords: aberrations, presbyopia, monovision, binocular adaptive optics P resbyopia, the age-related loss of accommodation, mostly affects the population aged over approximately 50 years.

PURPOSE To evaluate spherical aberration and through-focus optical performances of 5 premium and 2 monofocal intraocular lenses (IOLs) in optical bench tests. SETTING Flaum Eye Institute, University of Rochester, Rochester, New York, USA. METHODS Five premium IOLs, ReSTOR +4D (SN6AD3), ReSTOR +3D (SA6AD1), ReZoom (NXG1), Tecnis multifocal (ZM900) and Crystalens HD (HD500), were tested using an optical bench system consisting of a wet cell with an artificial pupil, a custom-developed Shack-Hartmann wavefront sensor, and an image capturing device. Two monofocal IOLs, SofPort AO (LI60AOV) and AcrySof (SN60AT), were used as controls. No accommodation was simulated in the system. The spherical aberration profiles of each IOL were measured using the wavefront sensor. Through-focus images of a 1951 United States Air Force resolution target were analyzed. To evaluate image quality cross-correlation coefficients, comparing the likenesses of captured images and perfect reference image, were calculated. RESULTS For a 5 mm pupil the SN6AD3, SA6AD1, NXG1, ZM900 and HD500 premium IOLs had spherical aberrations of −0.27 μm, −0.24 μm, −0.35 μm, −0.33 μm and +0.12 μm, respectively. Image quality for distant objects was poorer with multifocal and accommodating IOLs than with monofocal IOLs. All multifocal IOLs had effective distant and near image quality, but showed loss in intermediate image quality. Due to bispheric optic design, an accommodating IOL, HD 500, showed slightly increased depth of field compared with the monofocal IOLs. CONCLUSIONS Each premium IOL has different design strategy and optical characteristics, including spherical aberration profile and through-focus image quality. Thus, the choice of premium IOLs should be based on optical characteristics.