Impact of positive coupling of the eye's trefoil and coma in retinal image quality and visual acuity.

When the eye's higher-order aberrations are measured and reported, as important as the magnitude of each individual term are the possible combinations between them, which may change the overall retinal image quality and therefore visual performance. We have evaluated the relationships among different aberration terms in the human eye-coma, trefoil, and spherical aberration-and their effects on both retinal image quality and visual acuity (VA). In a group of normal young subjects with normal to excellent vision, we measured the eye's aberrations and high contrast VA under natural conditions after carefully correcting defocus and astigmatism. Among the different combinations of aberration terms, we only found a significant negative correlation (r2=0.30) between the vertical coefficients of trefoil C(3,-3) and coma C(3,-1). This is a positive coupling that produces a better retinal image quality than any of the other possible combinations of these terms. However, this improvement in image quality is limited by the presence of other aberrations. Only in a few eyes that presented the larger values of coupled vertical trefoil and coma appeared a significant improvement of image quality. Although we did not find a clear correction between the coma-trefoil vertical coupling and VA, most eyes with large amounts of aberrations (RMS>0.4 μm) have these terms coupled, keeping decimal acuity around 1.2 or higher.