RESUMEN
Purpose: The purpose of this study was to determine if control observers can be used as surrogates to predict visual acuity (VA) of patients with Down syndrome (DS). Methods: Thirty adults with DS were enrolled in a clinical trial testing three refraction types: clinical refraction and two using wavefront aberration measures to optimize the metrics pupil fraction tessellated (PFSt) and visual Strehl ratio (VSX). Monocular VA was obtained through habitual refractions and each experimental refraction type. Five controls without DS viewed acuity charts simulating the retinal image produced when the corrections for each DS eye are worn, performing VA and scoring image quality of each chart. Group median VA (DS versus controls) were compared for each refraction type, and control image quality scores were compared to corresponding VA across refraction types. Results: Median VA for participants with DS ranged from 0.46 logMAR (interquartile range [IQR] = 0.32 to 0.54) with habitual correction to 0.36 logMAR (IQR = 0.28 to 0.54) with VSX, whereas controls ranged from 0.37 logMAR (IQR = 0.29 to 0.42) with habitual correction to 0.01 logMAR (IQR = -0.02 to 0.05) with VSX. Overall image quality scores were best for PFSt and VSX and showed a strong linear relationship with control VA (r = -0.91, P < 0.001), and a lesser correlation with DS VA (r = -0.33, P < 0.001). Conclusions: Using surrogate observers to judge image quality simulations of eyes with DS did not predict actual VA, suggesting additional, non-optical factors may be limiting VA in individuals with DS. Translational Relevance: Findings may guide clinical refraction practices for patients with DS.