目的：观察不同年龄段人群在4.0mm与实测瞳孔直径下全角膜和前角膜总高阶像差(HOA)的差异。

方法：横断面研究。检测2019-03-31/05-31于我院就诊的100例受试者在2.0～7.0mm瞳孔直径下全角膜和前角膜总HOA及拟明环境下瞳孔直径，通过数学拟合曲线计算出该直径下全角膜和前角膜的总HOA值(实测HOA)，分别比较实测与4.0mm瞳孔直径下HOA(理论HOA)全角膜与前角膜HOA之间的差异。

结果：实测瞳孔直径与年龄呈负相关(r=-0.587，P<0.001)。全角膜和前角膜实测HOA与年龄均呈负相关(r=-0.191，P=0.002； r=-0.181，P=0.004)，全角膜理论HOA则与年龄呈正相关(r=0.282，P<0.001)。在40～49、60～69、70～79岁组，全角膜和前角膜实测HOA均小于对应理论HOA(P<0.05)。同样在以上年龄段，实测全角膜HOA显著高于实测前角膜HOA(P<0.05)； 在20～29岁理论全角膜HOA显著低于理论前角膜HOA(P=0.006)，在60～69岁组，结果则相反(P=0.039)。老年人群(60～69，70～79岁组)中实测全角膜HOA≥0.3μm占比显著低于理论全角膜HOA(χ²=4.300，P=0.038)。

结论：老年人群实测全角膜和前角膜HOA均显著低于对应理论HOA，这与老年人群实际平均瞳孔直径偏小有关。所测前角膜HOA不能完全代替全角膜HOA。以实测全角膜HOA为依据将有更多老年患者在选择植入多焦点人工晶状体时符合入选条件。

METHODS: A cross sectional study. A Total of 100 subjects between March, 31^th and May, 31^th in 2019 were included. Their total corneal high-order aberrations(THOA)and anterior corneal high-order aberrations(AHOA)were detected on the basis of different machine-provided pupil diameters(2.0-7.0mm)and their photopic pupil diameters were recorded as measured pupil diameters in the room with normal illumination. THOA and AHOA based on the machine-measured pupil diameter was calculated through fitting curves, and compared to the THOA and AHOA at a theoretical 4mm pupil diameter.

RESULTS: The measured pupil diameter was negatively correlated with age(r= -0.587, P<0.001). THOA and AHOA based on measured pupil diameter were both negatively correlated with age(r= -0.191, P=0.002; r=-0.181, P=0.004). At 4mm pupil diameter, THOA was positively correlated with age(r=0.282, P<0.001), while there was no obvious correlation between AHOA and age. In 40-49, 60-69 and 70-79 years old groups, their THOA and AHOA at the measured pupil diameters were significantly lower than those at 4mm pupil diameter(P<0.05), while their THOA were significantly higher than AHOA at the measured pupil diameters(P<0.05). At 4mm pupil diameter, THOA were significantly lower than AHOA in 20-29 years old groups(P=0.006), but higher than AHOA in 60-69 years old groups(P=0.039). In the aged group(include 60-69 and 70-79 years old groups), the proportion of observed value of THOA ≥0.3μm at the measured pupil diameters were significantly lower than those at 4mm pupil diameter(χ²=4.300, P=0.038).

CONCLUSION: THOA and AHOA at the measured pupil diameters in the old subjects are significantly lower than those at 4mm pupil diameter, which could be ascribed to their relatively small actual mean pupil sizes. Our study suggested that the THOA rather than AHOA should be used for the selection of multifocal intraocular lens for cataract patients at measured pupil diameter, so that more aged patients will satisfy the inclusion criteria.