Optimal astigmatism to enhance depth of focus after cataract surgery

A small amount of myopic astigmatism can enhance the depth of focus of the pseudophakic eye, optimally providing at least 20/30 visual acuity for both near and distance fixation. For given spherocylindrical refractive errors and fixation distances, the cross-sectional area of Sturm's conoid at the retina was calculated for a schematic eye. These data were used to determine the optimal astigmatic error needed to obtain maximum depth of focus and least theoretical blur for any given spherical equivalent refractive error. Optimal depth of focus was obtained when the plus cylindrical component equaled negative sphere - 0.25 diopters. The near and distance visual acuities of ten pseudophakic patients with induced refractive errors were highly correlated with this model. Low myopic astigmatism after cataract surgery may represent an alternative to multifocal intraocular lenses by providing spectacle independence.