Neural and optical limits to visual performance in myopia

We investigated the relative importance of neural and optical limitations to visual performance in myopia. A number of visual performance measures were made on all or subsets of 121 eyes of emmetropic and myopic volunteers aged 17–35 years. These tests included visual measures that are mainly neurally limited (spatial summation out to ±30° in the horizontal visual field and resolution acuity out to ±10° in the horizontal visual field) and central ocular aberrations. We found that myopia affected the neurally limited tests, but had little effect on central higher order aberration. The critical area for spatial summation increased in the temporal visual field at 0.03 log units/dioptre of myopia. Resolution acuity decreased at approximately 0.012 log units/dioptre of myopia. Losses of visual function were slightly greater in the temporal than in the nasal visual field. The observed visual deficit in myopia can be explained by either global retinal expansion with some post-receptor loss (e.g. ganglion cell death) or a posterior polar expansion in which the point about which expansion occurs is near the centre of the previously emmetropic globe.