In Experiment 3, the visual acuity of participants was measured for each illuminant at each distance, which allowed us to assess the effect that the median accommodation response of participants while they performed the staircase procedure had on their visual acuity. In
Figure 13 we present the visual acuity thresholds obtained for all participants as a function of the median accommodative error (
Figure 13A) and as a function of the median pupil diameter (
Figure 13B). Individual figures for each participant are presented in
Supplementary Figure S5.
First, we analyzed the results for stimuli that were within the subject's accommodative range, defined above as being the linear portion of the accommodation response curve (see
Figure 7). These are shown with filled markers in
Figure 13A. As observed, over this portion, participants had visual acuity thresholds that were mostly concentrated between –0.2 and 0.2 logMAR, which corresponds with better than normal to near normal vision. Median accommodative errors were mostly between –2 D and 1 D, with errors of larger magnitude mostly present where the accommodative demand was out of the subject's accommodative range (empty symbols) or when the pupil was small (small dots). The largest positive errors were of course obtained when demand was negative; that is, the participant was viewing the screen at 1 meter through a +2-D lens. When looking at the individual results of each participant (
Supplementary Figure S5), we see that most of the data points with large negative errors of up to –2 D and low visual acuity thresholds belong to subjects 16 and 19, which were the two participants who presented the typical lags in their accommodation response curves. Thus, it seems that, in these two subjects, such lags did not correlate with a worsening of visual acuity.
Another relevant feature of the data is the small cluster of trials in which participants obtained low visual acuity thresholds between –0.2 and 0.2 logMAR, despite presenting positive accommodative errors of up to 4.5 D of magnitude. As illustrated in
Figure 13B, one common feature of these trials is that the median pupil diameter of participants was mostly between 3 and 4 mm. Smaller pupil sizes improve depth of focus, which can decrease the effect that accommodative errors have on visual acuity. Additionally, the infrared photorefractor used relies on measuring the variation in reflected light intensity across the pupil to estimate the refractive state of the eye. This means that smaller pupils offer less information, which could lead to less accuracy in the measurements taken. For these reasons, and because at these small pupil sizes the measured accommodative error does not seem to correlate with visual acuity thresholds, data points where the median pupil diameter was below 4 mm were excluded from all analyses.
To further explore the relationship between accommodative error and visual acuity over the linear portion of the accommodation response curve, we fitted a linear mixed model with predictors of accommodative error magnitude, error sign, and their interaction, as well as illuminant and random intercepts and slopes of participants. The data used were the accommodative errors and visual acuity thresholds obtained within the accommodative range of participants (see filled markers in
Figure 13A); trials were excluded where the median pupil diameter was smaller than 4 mm. The estimated coefficients are shown in
Supplementary Table S6. We found that accommodative error magnitude was estimated to have a worsening effect on visual acuity, albeit the confidence intervals were wide, and the effect was not found to be significantly different from zero. The wide CIs likely reflect the fact that the errors over the linear portion of the accommodation response curve were very small in magnitude for most subjects. In other words, subjects were accommodating successfully to the stimuli over a range of distances, resulting in small values of defocus and greater uncertainty in estimating its effect on visual acuity. However, the parameter estimates still indicate that the overall effect on visual acuity was detrimental, with thresholds worsening by 0.10 logMAR for each diopter of increase in negative accommodative error [95% CI, –0.05 to 0.24;
t(8.37) = 1.51;
p = 0.168], and by 0.12 logMAR for each diopter of increase in positive accommodative error [95% CI, 0.00–0.23;
t(6.44) = 2.36;
p = 0.053].
A significant effect of illuminant on visual acuity was found. When accommodative error is zero, visual acuity for the 459-nm illuminant was estimated to be 0.04 logMAR (95% CI, –0.06 to 0.15). In comparison with this illuminant, visual acuity thresholds were lower for the 528-nm illuminant by 0.11 logMAR [95% CI, 0.06–0.17; t(8.7) = 3.95; p = 0.004], for the 610-nm illuminant by 0.08 logMAR [95% CI, 0.02–0.14, t(8.7) = 2.72, p = 0.024], and for the broadband illuminant by 0.09 logMAR [95% CI, 0.05–0.12; t(9.1) = 4.53; p = 0.001]. Post hoc pairwise comparisons of the estimated marginal means of visual acuity for each illuminant (i.e., the means averaged over the effects of accommodative error magnitude and sign) revealed that these differences were consistent and present across the small values of accommodative error found within the linear portion of the accommodation response curve. We found higher visual acuity thresholds for the 459-nm illuminant when compared to the 528-nm illuminant by 0.11 logMAR [95% CI, 0.02–0.20; t(8.91) = 3.87; p = 0.017], and by 0.09 LogMAR when compared to the broadband illuminant [95% CI, 0.02–0.15; t(8.74) = 4.34; p = 0.009]. Visual acuity was also lower for the 610-nm illuminant when compared to the 459-nm one by 0.08 logMAR, although this difference was not significant [95% CI, –0.01 to 0.18; t(8.91) = 2.66; p = 0.100]. This means that, over the linear portion of the accommodation response curve and for equal values of accommodative error, visual acuity was worst for the shortest wavelength illuminant than for any of the other illuminants used. No significant differences were found in pairwise comparisons between the 610-nm, 528-nm, and broadband illuminants. In other words, at least in this low luminance regime, acuity is the same for stimuli presented on the green and red primaries but is one line worse on the Snellen chart for stimuli on the blue primary.
To further explore the effect of accommodative error and the illuminants used we fitted linear mixed models on all of the data obtained, including distances that were nearer or farther away than the participant's accommodative range (see
Figure 13B, both open and filled markers). Due to the complexity of the data and the observed differences between the effect of underaccommodation (negative errors) and overaccommodation (positive errors), the dataset was separated accordingly and fitted separately. For positive accommodative errors, visual acuity thresholds seem to saturate for error magnitudes greater than 5.5 D and at around 1.2 logMAR; thus, these values (error magnitude > 5.5 D and visual acuity > 1.2 logMAR) were excluded from the analyses to improve model convergence. As with the previous model, trials where the median pupil diameter was less than 4 mm were excluded, and the pupil diameter predictor was centered so that the intercept of the model was at 4 mm. Several models were fitted to both datasets, with different combinations of accommodative error magnitude, pupil diameter, illuminant, and retinal illuminance used as separate or interacting predictors while maintaining the full structure of the random effects. Through multiple comparisons, it was determined that, for both datasets, a model with predictors of error magnitude, pupil diameter, their interaction, and illuminant had the greatest predictive power and lowest AIC. The results of the fits for both datasets are shown in
Supplementary Table S7.
For overaccommodation (
Supplementary Table S7, top), we see that the accommodative error magnitude had a significant effect on visual acuity, with thresholds worsening by 0.21 logMAR for every 1-D increase in error for a pupil diameter of 4 mm [95% CI, 0.10–0.31;
t(4.38) = 3.84;
p = 0.016]. Furthermore, for every millimeter of pupil size increase, the effect of error magnitude on visual acuity significantly increased by 0.08 logMAR [95% CI, 0.02–0.13;
t(5.39) = 2.78;
p = 0.036]. This means that, when participants have larger pupil sizes, their visual acuity is more affected as defocus increases. No significant differences in visual acuity were found between illuminants, so the differences previously observed for small accommodative errors within the linear portion of the accommodation response curve are not present for positive accommodation errors of larger magnitude.
For underaccommodation (
Supplementary Table S7, bottom), we see that increases in error magnitude had a smaller effect on visual acuity that did not reach significance, with thresholds only worsening by 0.06 logMAR [95% CI, 0.00–0.12;
t(9.97) = 1.82;
p = 0.098] for every diopter of increase in error and a pupil diameter of 4 mm. For each 1 mm of increase in pupil diameter, the effect of accommodative error increased by 0.04 logMAR per diopter; however, the CIs are wide, and the effect is not significant [95% CI, –0.02 to 0.11;
t(3.53) = 1.31;
p = 0.268]. Finally, visual acuity thresholds were higher (i.e., acuity was worse) for the 459-nm illuminant when compared to the 528-nm illuminant by 0.07 logMAR [95% CI, 0.01–0.14;
t(7.31) = 2.16;
p=0.066] and the broadband illuminant by 0.07 (95% CI, 0.01–0.14;
t(4.38) = 2.15;
p = 0.086]; however, these differences only reach significance at the 0.10 level.
The differences in results between both models could be explained by the fact that the negative accommodative errors were found mainly over the linear portion of the accommodation response curve, as the nearest distance used was not sufficient to reach the upper limit of the accommodative range of most participants. Indeed, we can see the similarities between the results for the linear portion of the accommodation response curve and for all of the negative accommodative errors data. On the contrary, most participants did reach the lower limit of their accommodative range before the farthest distances used, so there was a wider range of data for the positive accommodative errors fit. However, it is possible that some of the differing results found were due to inherent differences in the effect of the accommodative error sign, as we see that for one of the two participants who reached their upper accommodative limit visual acuity thresholds increased with a shallower slope when underaccommodating to the stimuli (see
Supplementary Figure S5, subject 2).