This study showed that myopic subjects, in contrast to emmetropes, are generally less sensitive to negative than to positive defocus in the 20° nasal visual field in the periphery (0.14 logMAR/D compared to 0.20 logMAR/D). The difference in sensitivity to defocus is manifested as a superior acuity with imposition of negative defocus as opposed to positive defocus. A correlation was found between the difference in sensitivity and asymmetry in depth of field determined objectively from the wavefront measurements.
Similar psychophysical results showing a difference in sensitivity have previously been found foveally: Myopes were less sensitive to negative than to positive defocus, whereas emmetropes had similar sensitivity to both types of defocus.
45 The wavefront measurements presented in this study provide one explanation as to why some myopes have a larger difference in peripheral sensitivity than other myopes, as our data show a correlation between difference in sensitivity and objective asymmetry in depth of field due to aberrations.
Figure 6 shows the effect of individual Zernike coefficients on the asymmetries in depth of field (plotted as the area under the MTF for different amounts of defocus). From these graphs we conclude that spherical aberration is contributing to the asymmetry but is neither necessary nor sufficient for it to occur. On the other hand, for the subject in
Figure 6, coma plays a key role in causing the asymmetry in depth of field, although coma by itself is not enough to create an asymmetry; interaction with other aberrations is required,
15,46 which explains the lack of correlation between coma and the subjective difference in sensitivity in
Figure 5C. Therefore, caution should be used in interpretation of results consisting of individual Zernike coefficients rather than the full image quality.
It should be noted that the aberrations measured in the current group of subjects are, on average, lower than those reported for a larger population,
10 though our population is slightly younger (average age 26.5 years compared to 31.5 years in the larger study). Moreover, our myopic subjects are also younger than our emmetropic subjects (mean age 25 and 30 years, respectively). However, as the amount of peripheral aberrations increases with age, a sample with older myopes could be expected to have more aberrations resulting in an even larger asymmetry in depth of field.
23 A potential weakness of our study is the fact that the wavefront measurements took place under different circumstances than the psychophysical measurements, 6 months later. Another shortcoming is that 7 of 32 subjects were classified as unreliable. However, some unreliable results are to be expected with naïve subjects, as peripheral psychophysical tasks are demanding. Furthermore, the results showing a larger difference in sensitivity for myopes also remained when unreliable subjects were not included. Adaptation in the periphery is not a well-understood phenomenon, but two factors make it an unlikely explanation for the differences in sensitivity observed for the myopes. First, the correlation found between the difference in sensitivity and the asymmetry caused by aberrations suggests differences in optics as a more likely explanation. Secondly, the difference in sensitivity arose from a decreased sensitivity to negative defocus. However, nearly all subjects had relative peripheral myopia or emmetropia and are therefore normally exposed to positive or no defocus, and any adaptation would be to positive defocus.
The difference in peripheral sensitivity for myopes can be understood in the broader context of emmetropization and can assist in reconciling the seemingly contradicting results from different studies. Animal studies have shown that imposition of peripheral hyperopic defocus will trigger eye growth leading to myopia.
31–33 Meanwhile, some studies on humans have shown that relative peripheral hyperopia is a consequence, not a cause, of foveal myopization.
18,21,22 Additionally, young, growing, foveally hyperopic eyes have been found to have relative peripheral myopia, which means that, with accommodation, their peripheral image will have myopic defocus.
18,20,21,47 If the peripheral refractive state can drive myopization, the eye is therefore supposed to grow under both peripheral myopia and peripheral hyperopia. Our suggestion is that a large enough peripheral defocus can trigger eye growth regardless of whether the defocus is hyperopic or myopic. In line with what was proposed by Howland
48 and developed in a review by Charman,
49 we believe that the relationship between the blur for “tangential” and “radial” neurons may control growth. The detected blur for these neurons differs due to oblique astigmatism.
6,7 An inhibition of growth could arise when the difference in blur output from the two sets of neurons approaches zero, indicating peripheral emmetropia. The basis of this interpretation is that myopia progresses through axial elongation.
18,20,21,50,51 This would mean that an initially foveally hyperopic eye with peripheral myopia grows due to the difference in blur between the neuron groups. As the eye grows axially longer, its relative peripheral myopia decreases, eventually becoming close to emmetropia, which would then normally inhibit growth. If the peripheral image quality is less affected by hyperopic than myopic blur, due to aberrations, the growth process will have to continue longer than otherwise needed to achieve a state of equal blur.