Reduced aperture monovision for presbyopia and the Pulfrich effect.

Purpose: Monocular use of reduced-aperture optics in the form of a corneal inlay or contact lens may improve near vision of presbyopes by increasing their depth-of-focus (DOF). However, the associated induced interocular differences in retinal illuminance may cause distortion in spatial perception due to the Pulfrich effect. Methods: Three young subjects were used to explore the Pulfrich effect during reducedaperture monovision using afocal contact lenses (in the non-dominant eye) which were either opaque with a central clear aperture of 1.5, 2.5 or 3.5 mm diameter, or had an annular opaque stop of inner and outer diameters 1.5 and 4.0 mm, respectively. The two-alternative forced choice (2AFC) task of the subject was to state whether a 2 ◦ circular spot appeared in front or behind the plane of a central cross when moved left-to-right or right-to-left. The retinal illuminance of the dominant eye was varied using neutral density (ND) filters to establish the ND value which eliminated the Pulfrich effect for each lens. Results: The Pulfrich effect was observed with all the lenses. The ND value required to null the effect decreased as the diameter of the aperture of the lenses increased. A reasonably good agreement was found between observed ND values for the different lenses and those predicted from the relative areas of the effective pupils of the two eyes. Minor discrepancies were attributed to decentration of the contact lenses with respect to the natural pupils. Conclusions: Reduced-aperture monovision generates marked Pulfrich-type distortions in spatial perception under conditions where the visual world is changing dynamically as a result of movement.