Relationship Between Recovery Rate in Refractive Amblyopia and Ocular High-Order Aberrations: The HARD Pilot Investigation

Abstract

Background: Higher-order aberrations (HOAs) are known to influence retinal image quality and may affect the functional improvement of amblyopic eyes. This study aimed to explore the association between best-corrected visual acuity (BCVA) recovery rate and specific HOA parameters obtained using a next-generation wave front aberrometer.

Methods: A prospective case series was conducted involving children aged 3–7 years diagnosed with refractive amblyopia (Snellen equivalent <0.8). Each participant was monitored for a minimum of 6 months following complete optical correction. BCVA and HOAs were assessed with the iDesign aberrometer under non-cycloplegic and cycloplegic conditions at baseline, and at 3-month intervals thereafter. The relationship between BCVA improvement rate over 6 months and average HOA parameters was analyzed. Based on recovery velocity, subjects were categorized into fast and slow recovery groups for comparative analysis of HOA values.

Results: A total of 24 eyes from 12 children [mean age: 4.46 years (range, 3–6)] were evaluated. The baseline mean BCVA was 0.335 log MAR (Snellen equivalent 0.46), improving to 0.193 log MAR (Snellen equivalent 0.64) after 6 months of full optical correction. A significant correlation was identified between recovery rate and pre-cycloplegic tetrafoil values (p = 0.045). Children in the faster recovery group exhibited significantly lower baseline tetrafoil aberrations.

Conclusion: Specific HOA components, particularly tetrafoil aberrations measured by an advanced aberrometer, may serve as potential indicators of visual recovery speed in refractive amblyopia. These findings suggest that HOA assessment could contribute to the development of customized optical interventions, such as HOA-corrected contact lenses, for persistent cases of refractive amblyopia.