The Effects of Whole-Corneal and Whole-Eye Higher Order Aberrations on the Discrepancy Between Refractive and Corneal Astigmatism in Otherwise Healthy Candidates for Refractive Surgery

Purpose: To evaluate the effect of different whole-corneal and whole-eye higher order aberrations (HOAs) on levels of axis discrepancy. Methods: This was a retrospective study including healthy candidates for refractive surgery, with one eye being randomly selected. A total of 360 eyes were included. Whole-corneal and whole-eye HOAs were measured twice with a Pentacam AXL Wave (Oculus Optikgeräte GmbH), and subjective manifest refraction was obtained. Axis discrepancy was defined as the absolute difference between Total Corneal Refractive Power flat keratometry axis and manifest refractive axis. Two multiple linear regression models that sought to explore the effect of HOAs in predicting axis discrepancy while adjusting for corneal and refractive confounders were built. Results: Mean age was 29.1 ± 5.8 years and 63.9% of the patients were women. Mean manifest sphere and cylinder were −3.09 ± 2.36 and −1.45 ± 1.37 diopters (D), respectively. Mean cylinder axis discrepancy was 14.4 ± 14.5°. On multiple linear regression, the only variables significantly associated with axis discrepancy were corneal cylinder and corneal lower order aberrations [ F (5,339) = 29.746; P < .001; adjusted R 2 = 0.295]. Lower levels of corneal cylinder are by far the main contributor to astigmatism axis mismatch (ß = −1.164). There was not a single HOA, either corneal or ocular, that significantly loaded into any models. Conclusions: Astigmatism axis mismatch decreases rapidly with increasing levels of corneal astigmatism. Corneal and whole-eye HOAs have no role in astigmatism axis mismatch in healthy candidates for refractive surgery. [ J Refract Surg . 2024;40(2):e89–e97.]