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Contrast Sensitivity Function and Ocular Higher-Order Aberrations following Overnight Orthokeratology

¹From the Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan; and ²Kakita Eye Clinic, Chiba, Japan.

PURPOSE. To evaluate relationships among contrast sensitivity function, ocular higher-order aberration, and myopic correction in eyes undergoing overnight orthokeratology for myopia.

METHODS. A prospective study was conducted in 46 eyes of 23 patients undergoing orthokeratology. Inclusion criteria were spherical equivalent refraction between –1.00 and –4.00 diopters (D), refractive astigmatism up to 1.00 D, and best-corrected visual acuity of 20/20 or better. Ocular higher-order aberrations and contrast sensitivity function were determined before and 3 months after initiation of the procedure. We measured three indices of contrast sensitivity function: contrast sensitivity, low-contrast visual acuity, and letter contrast sensitivity with the CSV-1000 charts (Vector Vision Co., Greenville, OH). Area under the log contrast sensitivity function (AULCSF) was calculated from the contrast sensitivity data.

RESULTS. Orthokeratology significantly improved logMAR uncorrected visual acuity (P < 0.0001; paired t-test) but significantly increased ocular higher-order aberrations (P < 0.0001) and decreased contrast sensitivity function, including AULCSF (P < 0.0001), low-contrast visual acuity (P = 0.0025), and letter contrast sensitivity (P < 0.0001; Wilcoxon signed-rank test). The induced changes in AULCSF, low-contrast visual acuity, and letter contrast sensitivity by orthokeratology showed significant correlation with changes in third-order (Pearson r = –0.430, P = 0.0026; r = 0.423, P = 0.0031; and Spearman r_s = –0.351, P = 0.0186, respectively), fourth-order (r = –0.418, P = 0.0035; r = 0.425, P = 0.0029; and r_s = –0.566, P = 0.0001, respectively), and total higher-order (r = –0.460, P = 0.0011; r = 0.471, P = 0.0008; and r_s = –0.434, P = 0.0036, respectively) aberrations. The induced changes in contrast sensitivity function and higher-order aberrations significantly correlated with the amount of myopic correction (P < 0.01).

CONCLUSIONS. Orthokeratology significantly increases ocular higher-order aberrations and compromises contrast sensitivity function, depending on the amount of myopic correction.