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Reduced Image Quality Impairs Monocular Blur-Driven Accommodation in Keratoconus.

Tithi Bhakta1,2, Ketakee Jain1,2, Priyanka Sudanabonia3

  • 1Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Telangana, India.

Investigative Ophthalmology & Visual Science
|June 26, 2026
PubMed
Summary

Accommodation is reduced in keratoconus due to poorer image quality. Correcting aberrations did not improve vision, suggesting blur is not the only factor affecting accommodative responses in keratoconus.

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Area of Science:

  • Ophthalmology
  • Vision Science
  • Optometry

Background:

  • Keratoconus is a progressive eye condition affecting corneal shape.
  • Image quality (IQ) degradation is a hallmark of keratoconus.
  • Accommodation, the eye's ability to focus on near objects, may be impaired in keratoconus.

Purpose of the Study:

  • To investigate if reduced accommodative response in keratoconus is due to weaker defocus-blur signals from degraded IQ.
  • To determine if correcting higher-order aberrations (HOAs) in keratoconus or inducing them in controls affects accommodative performance.

Main Methods:

  • Compared monochromatic IQ and accommodative responses in 15 keratoconus patients and 15 controls.
  • Used an adaptive optics visual simulator to correct lower-order aberrations (LOAs) and HOAs.
  • Induced keratoconus-like HOAs in control participants.

Main Results:

  • IQ degradation was significantly lower in keratoconus patients.
  • Accommodative responses were reduced in keratoconus (0.6 D) compared to controls (2.6 D).
  • Correcting HOAs in keratoconus did not significantly change accommodation; inducing HOAs in controls attenuated accommodation.

Conclusions:

  • Reduced accommodation in keratoconus aligns with weakened defocus-blur signals.
  • The lack of accommodative improvement with optical correction suggests defocus may not be the sole cue, or neural sensitivity to blur is reduced.