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Effect of cylinder power and axis changes on vision in astigmatic participants

Authors Sha J, Fedtke C, Tilia D, Yeotikar N, Jong M, Diec J, Thomas V, Bakaraju RC

Received 8 October 2018

Accepted for publication 1 February 2019

Published 19 March 2019 Volume 2019:11 Pages 27—38


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Mr Simon Berry

J Sha,1 C Fedtke,1,2 D Tilia,1,2 N Yeotikar,1 M Jong,1,2 J Diec,1 V Thomas,1 RC Bakaraju1,2

1Brien Holden Vision Institute, Sydney, NSW, Australia; 2School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia

Purpose: To ascertain the impact of altering cylinder (cyl) power and axis on vision in astigmatism.
Methods: In a prospective, randomized, participant-masked, crossover clinical trial, 28 astigmatic participants were tested for the following conditions on different days: full sphero-cyl correction and undercorrection by 0.25, 0.50, and 0.75 DC while maintaining spherical equivalence. Axis was also misaligned between –30° and +30°, in 10° steps. For each configuration, monocular high- and low-contrast visual acuities (HCVA, LCVA) were measured at 6 m, and participants rated vision clarity (1–10), vision satisfaction (1–10), and vision acceptability (yes/no). Linear mixed models were used to compare visual performance in the overall group and in low, medium, and high cyl subgroups.
Results: Undercorrecting cyl power affected all groups equally (P≥0.073). Undercorrection by 0.75 DC was significantly different to full cyl power for all variables (P≤0.007), while 0.25 DC undercorrection did not cause any significant decreases (P>0.05). Undercorrection by 0.50 DC was significantly different to full cyl power for HCVA (P=0.006, however not clinically significant) and vision acceptability (P=0.034). Axis misalignment affected the cyl groups differently (P<0.001), with the greatest impact in the high cyl group, followed by the medium then the low-cyl group. Misalignment by ±30° caused significant decreases in almost all cases (P≤0.003), while misalignments by ±10° or ±20° caused significant decreases for some cyl groups and test variables.
Conclusion: Undercorrection of cyl by ≤0.50 DC while maintaining spherical equivalence has no significant effect on HCVA, LCVA, vision clarity, and vision satisfaction, while the amount of axis misalignment that can be tolerated is dependent on the cyl power. These results may have practical ophthalmic applications, such as reducing the total number of stock keeping units of toric contact lenses.

Keywords: astigmatism, toric, sensitivity, misalignment, visual performance

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