Optical, neural and perceptual basis of blur sensitivity and the effect of text detail in myopes and emmetropes

Retinal blur experienced by myopes during near work has been linked to myopia development and progression. Whether poor responses to blur signals are due to poor perceptual blur sensitivity (subjective depth of focus), poor neural accommodation responses (objective depth of focus) to blur or optical differences such as higher order aberrations making blur detection difficult is yet unclear. This study investigates whether myopes respond to blur differently compared to emmetropes and whether filtering spatial frequencies in reading text influence accommodation responses. Accommodative functions were investigated using spatial frequency filtered text targets of two different sizes (N10 and N20). Monocular objective depth of focus (DOF), accommodative microfluctuations, and dynamic accommodation were measured. Subjective DOF after cycloplegia was also recorded with the same targets. Higher order aberration measurements explored optical contributions to blur. Peripheral refraction and accommodative lag were also measured to consider how in combination they might increase peripheral retinal blur for near tasks. Results showed that myopes demonstrated larger subjective DOF. Subjective DOF was larger when viewing the peak text spatial frequency in both refractive error groups. The optimum focus was more myopic for text peak spatial frequencies. Levels of spherical aberration were correlated with the point of optimum focus. Objective DOF and accommodative microfluctuations were larger in myopes when viewing the peak text spatial frequencies. Dynamic accommodation showed that while myopes were not poorer at initiating accommodation responses they had longer positive response times. Accommodative lag, although not different in myopes, increases the peripheral hyperopic blur experienced for near tasks. Conclusion: Myopes were poorer at using retinal blur cues to refine accommodation responses especially when viewing peak text spatial frequencies. Larger positive response times, DOF and accommodative microfluctuations in myopes resulted in accommodative error and hyperopic blur for near tasks. Spherical aberration, previously thought to provide a myopigenic stimulus, was not different between refractive groups and is unlikely to be large enough to enhance DOF during naturalistic viewing. Blur adaptation studies might consider using peak text spatial frequencies as adaptation targets to reduce accommodation differences in myopes and emmetropes. Optical treatment strategies aimed at correcting peripheral refraction to control myopia should consider the combined effect of accommodative lag which increases levels of hyperopic peripheral blur experienced by myopes.