Aim To compare the magnitude of apparent accommodation in pseudophakic eyes with refractive against-the-rule (ATR), with-the-rule (WTR) and minimum astigmatism. Factors associated with apparent accommodation were also examined in each group.

Methods In total, 87 pseudophakic eyes (87 patients) that underwent monofocal intraocular lens (IOL) implantation after uneventful cataract surgery were included. There were 33, 24 and 30 eyes with refractive ATR, WTR and minimum (<0.5 dioptres) astigmatism, respectively. Age, time after surgery, pupil size, corneal and refractive astigmatism, axial length, IOL power, best-corrected visual acuity, corneal multifocality, ocular wavefront aberrations and apparent accommodation without cylindrical correction were compared among the three groups.

Results No significant difference was found in the amount of apparent accommodation between groups. In the ATR group, the amount of apparent accommodation was significantly correlated with pupil size (r=−0.470, p=0.005) and refractive astigmatism (r=0.529, p=0.001). In the WTR group, the amount of apparent accommodation was significantly correlated with coma Zernike term (r=0.409, p=0.047). In the minimum astigmatism group, corneal multifocality was significantly associated with apparent accommodation (r=0.464, p=0.009).

Conclusion There was no significant difference in the average amount of apparent accommodation in pseudophakic eyes with refractive ATR, WTR and minimum astigmatism. However, the factors relevant to apparent accommodation varied depending on the status of postoperative refractive astigmatism.