Constructing an Objective Defocus Curve from Pyramidal Wavefront Aberrometry: Mapping Objective-to-Subjective Through-Focus Response
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Updated: Oct 31, 2026
Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
Published on: September 16, 2025
Andrea Russo1, Francesco Versaci2, Vito Romano3
1Centro Oculistico Bresciano, Brescia, Italy.
Purpose:
To construct an objective defocus curve from pyramidal wavefront aberrometry and map it onto the subjective through-focus response.
Design:
Prospective multicenter case series with external validation.
Subjects, Participants, And/Or Controls:
98 eyes of 63 patients implanted with the RayOne Galaxy spiral refractive intraocular lens (IOL) at three centers (Italy, UK); 81 eyes with a wavefront pupil ≥ 4 mm were split by patient into training (56) and test (25) sets; 19 eyes with other refractive extended-depth-of-focus IOLs from a fourth center formed an external cohort.
Methods, Intervention, Or Testing:
Pyramidal aberrometry (Osiris) with numerically introduced defocus from +1.00 to -4.00 diopters (D); the second-moment radius of the geometrical point spread function was mapped to acuity by a rational function and compared with monocular ETDRS defocus curves.
Main Outcome Measures:
Root-mean-square error (RMSE), bias, and 95% limits of agreement (LoA) between mapped objective and subjective acuity; objective versus subjective depth of field (DOFi).
Results:
Internal test set: RMSE 0.095 logMAR (95% CI, 0.078-0.110), bias 0.016 logMAR (LoA, -0.168 to +0.201); external cohort: RMSE 0.092 logMAR (0.079-0.103), bias -0.021 logMAR (LoA, -0.197 to +0.155). Objective minus subjective DOFi at 0.20 logMAR was -0.10 D (LoA, -1.44 to +1.25 D) and -0.15 D (LoA, -0.98 to +0.69 D). Cohort-mean subjective DOFi was 2.43 D (Full-DOFi, continuous); corrected distance acuity was 20/20 or better in 88.8%.
Conclusions:
An objective defocus curve from one pyramidal wavefront acquisition estimated the subjective through-focus response with small bias and limits of agreement of about ±0.2 logMAR in a test set and an independent cohort of refractive IOLs; individual precision, diffractive designs, and pupil-specific curves need further work.
