This study investigates relative peripheral refraction (RPR) in emmetropic and myopic eyes in the 25° nasal and temporal visual fields under far and near fixation, with control for any fluctuations in accommodation. Additional analysis of axial length and comparison with recently published eye models are also presented, constituting complementary adult data to the Stockholm Myopia Study. In the ten emmetropes, a pronounced nasal-temporal asymmetry was observed, with significantly more myopic RPR nasally and less myopic / more hyperopic RPR temporally at both accommodative states (p = 0.005). The nine myopes, in contrast, exhibited more symmetric peripheral profiles, with no significant nasal–temporal differences. Accommodation induced systematic shifts in both groups, producing increased relative myopia nasally and relative hyperopia temporally (p < 0.001). Axial length was significantly correlated with temporal hyperopic shifts during accommodation in myopes (p = 0.005), suggesting a structural contribution of ocular growth to peripheral optics. Comparison with eye models showed partial agreement, though experimental results revealed greater asymmetry than predicted in emmetropes and a weaker nasal–temporal distinction in myopes. Our findings indicate that variations in relative peripheral refraction over the horizontal visual field and with accommodation might be linked to ocular growth and are important for optical myopia control.

Purpose: Peripheral image quality is of high relevance to myopia research, yet peripheral refraction is difficult to define due to aberrations affecting the depth-of-focus. This study investigated the peripheral image quality (± 25° horizontal field) using three different image quality metrics, with added sphero-cylindrical wavefronts to find the best correction.

Methods: 19 adults (9 myopes, 10 emmetropes) and 33 children (5 myopes, 28 non-myopes) were measured using a dual angle wavefront aberrometer as part of the Stockholm Myopia Study. The optical image quality was calculated from the wavefronts, for 10,000 different sphero-cylindrical corrections around the 2^nd-order Zernike refraction, to find the best correction as well as the range of corrections with similar image quality (“depth-of-refraction”).

Results: Overall, peripheral best focus was not distinct, with a large depth-of-refraction. Emmetropes/non-myopes had larger peripheral depth-of-refraction than myopes (mean values of 2.69 D and 1.74 D, respectively (Strehl ratio metric)). For some subjects, this span of corrections was of a multifocal character. The prevalence of multifocality depended on the image quality metric but was generally more common in emmetropes/non-myopes than in myopes.

Conclusions: The peripheral visual field does not always have a clear best focus and can show multifocal properties in some individuals, with different corrections yielding similar image quality. As emmetropes/non-myopes had more multifocality and larger depth-of-refractionthan myopes, this indicates that inherent peripheral optical properties can play a role in myopia development.

This study investigates relative peripheral refraction (RPR) in emmetropic and myopic eyes in the 25° nasal and temporal visual fields under far and near fixation, with control for any fluctuations in accommodation. Additional analysis of axial length and comparison with recently published eye models are also presented, constituting complementary adult data to the Stockholm Myopia Study. In the ten emmetropes, a pronounced nasal-temporal asymmetry was observed, with significantly more myopic RPR nasally and less myopic / more hyperopic RPR temporally at both accommodative states (p = 0.005). The nine myopes, in contrast, exhibited more symmetric peripheral profiles, with no significant nasal–temporal differences. Accommodation induced systematic shifts in both groups, producing increased relative myopia nasally and relative hyperopia temporally (p < 0.001). Axial length was significantly correlated with temporal hyperopic shifts during accommodation in myopes (p = 0.005), suggesting a structural contribution of ocular growth to peripheral optics. Comparison with eye models showed partial agreement, though experimental results revealed greater asymmetry than predicted in emmetropes and a weaker nasal–temporal distinction in myopes. Our findings indicate that variations in relative peripheral refraction over the horizontal visual field and with accommodation might be linked to ocular growth and are important for optical myopia control.