Effect of apparent depth cues on accommodation in a Badal optometer

Background: The aim was to analyse the effect of peripheral depth cues on accommodation in Badal optometers. Methods: Monocular refractions at 0.17 and 5.00 D of accommodative stimulus were measured with the PowerRef II autorefractor (Plusoptix Inc., Atlanta, Georgia, USA). Subjects looked (randomly) at four different scenes, one real scene comprising familiar objects at different depth planes (Real) and three virtual scenes comprising different two-dimensional pictures seen through a Badal lens. The first image consisted of a photograph of the real scene taken in conditions that closely mimic a healthy standard human eye performance (out-of-focus [OoF] blur); the second image was the same photograph rendered with a depth of focus to infinity (OoF sharpness); and finally the third image consisted of a fixation target and a even white surrounding (White). In all cases the field of view was 25.0° and the fixation target was a Maltese cross subtending to two degrees. Results: Twenty-eight right eyes from healthy young subjects were measured. The achieved statistical power was 0.9. At 5.00 D of accommodative stimulus, the repeated measures analysis of variance was statistically significant (p¿<¿0.05) and the corresponding Bonferroni post hoc tests showed the following mean accommodative response differences and standard deviation (p-value) between the real and the virtual scenes: real-white¿=-0.66¿±¿0.92 D (p¿<¿0.01); real-OoF sharpness¿=¿-0.43¿±¿0.88 D (p¿=¿0.07); real-OoF blur¿=-0.25¿±¿0.93 D (p¿=¿0.89). Conclusions: A stimulus poor in depth cues inaccurately stimulates accommodation in Badal optometers; however, accommodation can be significantly improved in the same Badal optometer, when displaying a realistic image rich in peripheral depth cues, even though these peripheral cues (also referred to as retinal blur cues) are shown in the same plane as the fixation target. These results have important implications in stereoscopic virtual reality systems that fail to represent appropriately retinal blur