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Measuring mental workload: ocular astigmatism aberration as a novel objective

index
Article in Ergonomics · October 2017

DOI: 10.1080/00140139.2017.1395913
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Ergonomics
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Measuring mental workload: ocular astigmatism aberration

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as a novel objective index

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Journal: Ergonomics
Manuscript ID TERG-2017-0314.R1
Manuscript Type: Original Article

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Date Submitted by the Author: 15-Sep-2017
Complete List of Authors: Jimenez, Raimundo; University of Granada, Optics

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Cárdenas, David; University of Granada, Physical Education and Sport;

University of Granada, Sport and Health Mixed Institute
Gonzalez Anera, Rosario; University of Granada, Optics
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Jiménez, José Ramón; University of Granada, Optics

Vera, Jesús; University of Granada, Optics; University of Granada, Sport
and Health Mixed Institute
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ocular physiology, optical quality, astigmatism aberration, pupil size,

Keywords:
mental workload
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URL: http://mc.manuscriptcentral.com/terg E-mail: ergonomics@tandf.co.uk

Page 1 of 37 Ergonomics
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3 Title: Measuring mental workload: ocular astigmatism aberration as a novel objective index
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6 Running head: Mental workload modulates astigmatism aberration
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Authors: Raimundo Jiménez1, David Cárdenas2,3, Rosario G. Anera1, José R. Jiménez1, Jesús
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11 Vera1,2.
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Affiliations:
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16 1. Department of Optics, University of Granada, Spain.
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19 2. Mixed University Sport and Health Institute (iMUDS), University of Granada, Spain.
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22 3. Department of Physical Education and Sport, University of Granada, Spain
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24 Conflict of interest: No conflicting interests for any author.
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26
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27 Corresponding author: Jesús Vera, Department of Optics, University of Granada, Campus de

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29 Fuentenueva, 18001 Granada, Spain. Tel: +34 958244067; fax: +34 958248533. E-mail:
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31 jesusvv@correo.ugr.es
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37 Funding: This work was supported in part by the Spanish Ministry of Economy and
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39 Competitiveness under grant [number DEP2013-48211-R]; and under grant [number FIS2013-
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41 42204-R]; and CEMIX (Centro Mixto UGR-MADOC, Army of Spain) under grant [number
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43 PIN 11].
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46 Acknowledgments: The authors thank all the volunteers who selflessly participated in the study
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48 and the Indo Optical company (Barcelona, Spain) for the assignment of the Refractive
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50 Power/Corneal Analyzer used in this study.
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1 URL: http://mc.manuscriptcentral.com/terg E-mail: ergonomics@tandf.co.uk
Ergonomics Page 2 of 37
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3 Abstract
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6 This study assessed the effect of two perceptually matched mental tasks with different levels of
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8 mental demand on ocular aberrations in a group of young adults. We measured ocular aberration
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10 with a wave-front sensor, and total, internal, and corneal RMS (root mean square) aberrations
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12 were calculated from Zernike coefficients, considering natural and scaled pupils (5, 4.5, and 4
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14 mm). We found that total, internal, and corneal astigmatism RMS showed significant differences
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16 between mental tasks with natural pupils (p<.05), and this effect was maintained with 5 mm
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18 scaled pupils (total RMS astigmatism, p<.05). Consistently, pupil size, intraocular pressure,
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20 perceived mental load, and cognitive performance were influenced by the level of mental
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22 complexity (p<.05 for all). The findings suggest that ocular astigmatism aberration, mediated by
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24 intraocular pressure, could be an objective, valid, reliable index to evaluate the impact of
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26 cognitive processing in conjunction with others physiological markers in real world contexts.
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32 Keywords: ocular physiology, optical quality, astigmatism aberration, pupil size, mental
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34 workload.
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40 Practitioner Summary: The search continues for a valid, reliable, convenient method of
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42 measuring mental workload. In this study we found ocular astigmatism aberration is sensitive to
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44 the cumulative effect of mental effort. It shows promise of being a novel ocular index which
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46 may help to assess mental workload in real situations.

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1
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3 Introduction
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6 Many activities require cognitive effort, across situations such as driving, air traffic control,
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8 surgical interventions, military operations, team sports, among many others. In any one of these,
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10 mental workload may be a concern. In addition to widely used subjective scaling techniques
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12 (Nygren 1991; Paas et al. 2003; Hart and Staveland 1988; Annett 2002), numerous studies have
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14 been conducted to find reliable and sensitive physiological biomarkers that objectively
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16 characterize the level of mental workload (e.g. Paas et al., 2003; Young et al., 2015). These
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18 physiological techniques include such systemic physiological measures as heart activity (e.g.
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20 heart-rate variability) (Luque-Casado et al. 2015; Mansikka et al. 2016), near infrared
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22 spectroscopy (Durantin et al. 2014), brain activity (Di Stasi et al. 2015), electrodermal activity
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24 (Ghaderyan and Abbasi 2016) or hormonal changes (Qi et al. 2016). Because ocular functioning
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26 is tightly linked to neurocognitive processes, researchers have drawn their attention to ocular
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28 variables as potential objective biomarkers of these processes. Thus, pupillary responses (De
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30 Gee, Knapen, and Donner 2014; Wang and Munoz 2015; Klingner, Tversky, and Hanrahan
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32 2011), blink rate (Rosenfield et al. 2015), accommodative response (Davies, Wolffsohn, and
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34 Gilmartin 2005; Vera et al. 2016), intraocular pressure (Brody, Erb, Veit, & Rau, 1999; Vera et
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36 al., 2016; Vera et al., 2017), critical flicker fusion (Luczak and Sobolewski 2005) or saccadic
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38 eye movements (Di Stasi, Antolí, and Cañas 2011) have been well documented.
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41 Although pupil size has been demonstrated to show a positive correlation with increasing
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43 cognitive processing demand (De Gee, Knapen, and Donner 2014; Wang and Munoz 2015;
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Klingner, Tversky, and Hanrahan 2011), the pupil is directly dependent on the illumination
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47 level, which leads to ceiling effects in dim surroundings (Wang and Munoz 2015). Also,
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49 controversial findings have been reported concerning ocular accommodation during these
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51 processes (Bullimore and Gilmartin 1988; Jainta, Hoormann, and Jaschinski 2008; Vera et al.
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53 2016; Davies, Wolffsohn, and Gilmartin 2005), and few works have addressed the effect of
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55 mental tasks on intraocular pressure (Brody et al., 1999; Vera et al., 2016; Vera et al., 2017).
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Notably, these physiological parameters are closely linked, making it difficult to monitor them
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3 independently under ecological conditions (Read et al. 2009; Brubaker 2003). Moreover, it
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5 would be helpful to find a new ocular index which includes these interactions and is sensitive to
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7 mentally demanding tasks.
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10 The quality of images of the outside world projected on the retina is limited by ocular
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12 aberrations, which reflect the imperfections of the ocular optic elements arranged along the
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14 ocular axis, such as the anterior and posterior corneal surfaces, the aqueous humour, the
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16 crystalline lens, and the vitreous humour. Ocular aberrations reduce image contrast and limit
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18 spatial frequencies available for further stages of the visual processing. The optical performance
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20 of the eye is usually described in terms of wave aberrations, which refer to the deviations of a
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22 wavefront exiting the pupil after progressing through the optics of the tested eye when
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24 compared to a reference wavefront that is aberration free. Also, there are different types of
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26 aberrations which contribute to wavefront deformation from the ideal spherical shape (see
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28 Lombardo and Lombardo 2010 for review). The most common method for describing the
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30 wavefront error of the eye is the normalized Zernike polynomial expansion. The weights of
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32 these polynomials on ocular aberrations are called the Zernike coefficients (cmn, corresponding
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34 to the radial order n and the meridional frequency m), representing the magnitude of each
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36 particular ocular aberration present in the wave aberration (Thibos et al. 2002).
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39 The number of aberrations per order increases as the order of the Zernike polynomials increases,
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41 and wavefront aberrations can be further classified based on their Zernike order as lower (n ≤ 2)
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43 or higher order aberrations (n ≥ 3). Both influence the visual performance of an individual but
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lower order aberrations, since are related to refractive error, can be easily alleviated by
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47 prescribing compensatory spectacles, contact lenses, or refractive surgery (Martin et al. 2011).
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49 However, higher order aberrations (HOA, n ≥ 3) cannot be easily corrected with these
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51 procedures and an adaptive optics system, phase plates, customized contact lenses, and
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53 customized refractive surgery are needed (Porter et al. 2006). Third order aberrations include
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55 trefoil and coma. Fourth order includes quatrefoil, secondary astigmatism and spherical
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aberration. Trefoil, coma, quatrefoil and secondary astigmatism are classified as a form of
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1
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3 irregular astigmatism which results in an irregular or distorted wavefront (Dai, 2008). Spherical
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5 aberration is influenced by pupil diameter and ocular accommodation and become to be
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7 important during dim lighting conditions, causing visual halos and night vision disturbances
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9 (Applegate et al. 2007). The fifth, sixth, seventh and eighth order aberrations are usually very
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11 small in magnitude and therefore negligible (Philip et al. 2012). However, wavefront aberrations
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13 represented with Zernike polynomials and their coefficients can be difficult to understand, and
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15 root mean square (RMS) is typically used as a global metric for optical quality (Pepose and
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17 Applegate 2005). RMS represents the deviation of the wavefront from a plane wavefront
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19 represented as a single digit (in microns [µm]) and it can be determined individually for lower
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21 or higher order aberrations or it can be calculated for the entire wavefront (Dai 2008). The
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23 higher the RMS wavefront error, the larger the wavefront aberration and the worse the optical
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25 quality. The development of wavefront sensor allows the rapid, accurate, repeatable, and
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27 objective measurements of ocular aberrations, and RMS can be calculated using the information
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29 given by the aberrometer once a measurement has been taken (Rozema, Van Dyck and
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31 Tassignon 2006). In addition, besides total ocular aberration, corneal and internal aberrations
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can also be obtained separately with good precision (Holzer, Goebels, and Auffarth, 2006).
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36 As stated above, the changes in the activity of the autonomous nervous system as consequence
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38 of cognitive processing are reflected in a variety of ocular physiological indices such as pupil
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40 size (Wang and Munoz 2015), ocular accommodation (Davies, Wolffsohn, and Gilmartin 2005)
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42 and intraocular pressure (Vera et al. 2017). Relevantly, ocular aberrations are highly dependent
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of these components (e.g. pupil size, crystalline lens, intraocular pressure), and therefore, they
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are sensitive to any modification in these ocular variables (Lombardo and Lombardo 2010; Qu
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et al. 2007). In this sense, we propose that ocular aberrations could be used to evaluate the
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effect of mentally demanding task or predict the level of autonomous activation. To date, no
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53 study has assessed the ocular optical quality, in terms of ocular aberrations, under conditions of
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55 cognitive stress.
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1
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3 The present study aimed to assess the effect of mental task complexity on ocular aberrations,
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5 using a wavefront sensor and considering three constant pupil diameters (5, 4.5, and 4 mm) and
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7 constant accommodative-demand stimulus. Pupil size, intraocular pressure, subjective
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9 questionnaires, and cognitive performance were also analysed with control purposes.
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11 Participants performed two perceptually matched mental tasks (on different days and
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13 counterbalanced order) but with different levels of mental complexity (3-back task and oddball).
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17 autonomous nervous system as a result of cognitive processing.
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20 Methods
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Participants and ethical approval
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26 The study was approved by the University of Granada (Spain) Institutional Review Board (IRB:
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28 112/CEIH/2016) and the research followed the tenets of the Declaration of Helsinki. 14
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30 participants were enrolled in this study, and they were screened according to the following
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32 inclusion criteria: (a) presenting static monocular visual acuity ≤0 log MAR (minimum angle of
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34 resolution) in both eyes with their best optical correction, (b) belonging to asymptomatic group
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36 at Conlon (Conlon et al. 1999) and CISS (Borsting, Chase, and Ridder 2007) surveys and not
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38 presenting any accommodative and binocular dysfunction, (c) presenting normal pupillary
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40 reflex to light and no anisocoria (d) not taking any medication (except contraceptives), (e)
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42 baseline intraocular pressure ≤ 21 mmHg (f) being healthy (not suffering any current illness or
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44 mental disorder), and (e) scoring ≤ 3 on the Stanford Sleepiness Scale (SSS), which measures
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46 subjective levels of arousal and fatigue, before each of the two main experimental sessions
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48 (Hoddes, Zarcone, and Dement 1972).
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51 For the screening of potential participants, autorefraction was performed and the patient’s
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53 previous clinical records were available at the time of testing and were used as a starting point
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55 for subjective refraction in most cases. Subjective refraction was conducted using a Snellen
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57 chart at 6 m on both eyes of each subject by the same investigator (JV) and was performed
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1
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3 using a trial frame and back vertex distance of 12 mm. The endpoint criteria were maximum
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5 plus sphere and minimum minus cylinder power maintaining the best visual acuity, which was
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7 recorded in logMAR (Lovie-Kitchin 2015). Visual function was evaluated following the
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9 recommendations and normative data given by Scheiman and Wick (2008). Accommodative
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11 function was tested with the amplitude of accommodation and accommodative response, while
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13 the binocular function was assessed with the near point of convergence, negative and positive
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15 fusional vergences and near stereoacuity. All participants fulfilled the inclusion criteria
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17 established in the present study. Additionally, participants were instructed to abstain from
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19 alcohol consumption 24 h and from caffeine-based drinks 12 h before each experimental
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21 session, and were asked to have at least 7 h of sleep the night prior to the study. We excluded
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23 two participants, one for sickness during the experimental session, and another for failures
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25 during data collection. Thus, we analysed data from a total of 12 naïve participants (mean ± SD;
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27 age: 22.27 ± 2.69 years, 5 women, 7 men). Being this study first of its nature, no power
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29 calculation was performed. An appropriate sample size was considered based on previous cohort
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31 studies, where statistically significant differences in ocular indices as consequence of cognitive

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processing were found (Siegenthaler et al. 2014; Vera et al. 2016).
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36 Procedure
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39 Participants took part in three sessions: (a) after signing the informed consent form and filling
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41 visual questionnaires, the participants were given instructions about the mentally demanding
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43 tasks and the NASA-TLX scale. Lastly, after a verbal explanation, they were given 5 min to
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practice with both tasks (3-back and oddball), so that all volunteers were familiar with them
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47 before the commencement of the study. All participants performed the mentally demanding
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49 tasks with best spectacle correction. The second (b) and the third session (c) constituted the
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51 primary focus of the study in which two mental tasks with different levels of complexity were
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53 performed. These were separated by a minimum of 24 h and a maximum of 48 h and both
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55 sessions were scheduled at the same time of the day to avoid diurnal fluctuations that affect
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1
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3 arousal levels (Del Rio-Bermudez et al. 2014) and were performed in a counterbalanced order
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5 (see Figure 1).
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8 Stimuli and instruments
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11 The two experimental sessions were identical except from the level of mental complexity
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13 implemented (3-back, oddball). Both tasks lasted 33 min, and were displayed on a 19-in screen
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(1920 x 1080 pixels) situated 2.5 m from the participant’s eyes in order to avoid possible visual
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17 stress caused by prolonged near viewing (Jaschinsky, Heuer & Kylian, 1999; Vera et al., 2016).
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19 Visual stimuli subtended 7 min of arc, which corresponds to 0.85 logMAR visual acuity, and
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21 was thus clearly visible for any participant of this study. Mentally demanding tasks were
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interrupted for one min at minute 11 to assess the dependent variables. To make responses,
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25 participants held a clicker on their dominant hand and a distinctive sound was used as feedback
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27 for each response. The experiment was performed in a dimly lit laboratory. The illuminance of
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29 the room was quantified (in the corneal plane) with an Illuminance meter (T-10, Konica
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Minolta, Inc., Japan), and kept constant throughout the experiment [mean ± SD: 62.59 ± 1.09
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33 lux].
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36 Both tasks were divided into intervals consisting of 105 s long, and a rest period of 15s for the
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38 first two intervals and 75 s for the third one. This sequence was maintained over the entire
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40 session. All subjects performed 15 mentally demanding task intervals, and this was therefore the
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42 total number of intervals considered to check cognitive involvement and performance.
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45 Mentally demanding tasks
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48 The 3-back task (a 3-digit load version of the N-back task) (Owen et al. 2005) consisted of a
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50 series of digits (1, 2, or 3), presented randomly, one at a time and at a rate of one digit every
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52 2500 ms (each digit was presented for 1000 ms, and the inter-stimulus interval was 2000 ms). In
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54 each trial, participants were asked whether the digit currently on screen was the same as the one
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56 presented 3 positions earlier, and were instructed to press a button every time a match was
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58 observed (participants did nothing if there was no match). This task thus requires keeping the
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3 three last digits in working memory (working memory load), comparing every new digit with
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5 the earliest of them (checking), incorporating the new item and discarding the earliest one for
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7 further comparisons (updating). The task can be manipulated to augment or reduce the working
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9 memory load, depending on the number of digits the participant must keep in mind (3 in the
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11 current version of the task).
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14 The oddball condition was designed to be perceptually identical to the 3-back task (Gomez and
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16 Perea 2009). This condition allowed us to control the potential influence of stimulus setting
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18 features (e.g. stimulus duration, inter-stimulus interval, see Luque-Casado et al., 2015). Before
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20 the task started, a single digit (1, 2 or 3) was presented on screen, and the participant was
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22 instructed to press the button every time that digit appeared on the screen during that session,
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24 and to withhold the response for the other 2 digits. This task imposes little or no working-
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26 memory load, but uses exactly the same stimuli as the 3-back task, requires vigilance during the
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28 whole session, and the same rate of response (on average, one response/3 trials).
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31 Ocular aberrations
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34 Wavefront aberrations were measured before mentally demanding tasks, just after 11 min of
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36 mental effort, after finishing the 33 min of the mental task, and after 10 min of passive recovery.
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38 Aberrometry was performed under mesopic conditions without any cycloplegia or mydriasis by
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40 the OPD Scan III (Nidek Inc., Tokyo, Japan). The OPD-Scan lll is a five-in-one true refractive
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42 work station combined with a topographer, wavefront aberrometer, keratometer, and
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44 pupillometer, for which the repeatability and accuracy have been determined in previous studies
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46 (Burakgazi et al. 2006). Combined wavefront aberrometry and corneal topography can
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48 differentiate between aberrations caused by the anterior cornea or by the internal ocular system.
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50 Total ocular aberrations are the result of corneal and internal ocular aberrations.
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53 The OPD-Scan III instrument software automatically calculates internal eye aberrations from
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55 whole eye aberrometry and corneal topography data based on the assumption that the cornea
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57 contributes 75% towards the total refractive power of the eye and the crystalline lens 25%. One
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1
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3 measurement from each eye was evaluated using software that follows the standards for
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5 calculating and reporting the optical aberrations of eyes in terms of RMS. For each participant,
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7 the seat height was adjusted, and their head and chin were placed properly. The device was
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9 realigned before each imaging and this was repeated in case of map incompleteness or blinking
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11 error. The measurements were taken across a naturally dilated pupil (mesopic pupil) and we
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13 calculated the Zernike coefficients for the total ocular aberrations. Subsequently, internal and
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15 corneal aberrations were exported in the corresponding Zernike coefficients, and total, internal,
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17 and corneal aberrations were scaled to 5, 4.5, and 4 mm using the expression of Diaz et al.
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19 (2009). Higher order aberrations were measured out to the eighth Zernike order. The parameters
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21 analysed included: 1) RMS from third to eight orders of total higher order aberrations (HOA);
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23 2) RMS of the total spherical aberration (SA); 3) RMS of total coma aberration (CA); 4) RMS
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25 of total trefoil v (TA); and 5) RMS of total astigmatism aberration (AA).
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28 Subjective questionnaires (SSS and NASA-TLX)
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The Stanford Sleepiness (SSS) is a 7-point Likert scale used to evaluate individuals’ self-
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33 reported activation, which ranges from 1 “very active, alert or awake” to 7 “very sleepy”
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35 (Hoddes, Zarcone, and Dement 1972). The SSS was filled upon arrival to the lab in both
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37 experimental sessions. Meanwhile, the mental workload with the NASA-TLX scale was
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39 assessed after cognitive tasks. The NASA-TLX is composed of six subscales: Mental demand
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41 (How much mental and perceptual activity was required?), Physical demand (How much
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43 physical activity was required?), Temporal demand (How much time pressure did you feel due
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to the rate of pace at which the tasks or task elements occurred?), Performance (How sucessful
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47 do you think you were in accomplishing the goals of the task set by the experimenter?), Effort
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49 (How hard did you have to work to accomplish your level of perfomance?), and Frustratition
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51 level (How insecure, discouraged, irritated, stressed, and annoyed vs. secure, gratified, content,
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53 relaxed, and pleasant did you feel during the task? The participants had to score each subscale
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55 into 20 equals intervals anchored by a bipolar descriptor (e.g. Low/High); this score was
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multiplied by 5, resulting in a final score between 0 and 100 (Hart and Staveland 1988).
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3 Cognitive-perfomance calculation
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6 Regardless of the task (3-back or oddball) each response qualified as a hit (correct click), a false
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8 alarm (or commission error, incorrect click), a correct rejection (correctly non-clicking), or a
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10 miss (omission error, incorrectly not clicking). We calculated the hit rate h (correct button
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12 pressings /total number of go trials) and the false alarm rate f (incorrect button pressings/total
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14 number of no-go trials) for each block of the task (namely, the total number of intervals was
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16 divided in 3 equal blocks of 5 intervals (15 intervals in total), and h and f were computed for
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18 each of these three blocks) to check the cognitive performance. Larger h and smaller f values
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20 indicate better response discriminability between go and no-go trials. A composite measure of
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22 discriminability can be computed as the arcsine of f minus the arcsine of h. The larger this
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24 difference of arcsines, the better the performance of the task (Perales et al. 2005).
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28 Experimental design and statistical analysis
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A within-participant repeated-measures design was used to test the effect of mental-task
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33 complexity on ocular aberrations. The measurement moment (pre, block 1, block 2, and
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35 recovery) and mental task complexity (3-back, oddball) were the within-subject factors, and
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37 HOA, SA, CA, TA, and AA RMSs were the dependent variables. We also analysed the pupil
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39 diameter and intraocular pressure at the same points of ocular aberrations with control purposes
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41 (see Supplementary Material), and determined the participant’s subjective mental workload via
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43 standardized questionnaires and cognitive performance scores.
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46 A t-test for related samples considering mental task complexity (3-back, oddball) as the within-
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48 subjects factor was carried out to analyse the effect of task complexity on cognitive performance
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50 and perceived mental load (NASA-TLX).
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53 Finally, we analysed total aberrations under mesopic conditions for the RMS of HOA, SA, CA,
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55 TA, and AA. Then, for those total RMSs under mesopic conditions which showed statistical
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57 significance (p < .05), we also evaluated corneal and internal aberrations, and pupil diameters
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1
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3 were scaled to 5, 4.5, and 4 mm. A repeated-measures ANOVA was performed using the
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5 measurement moment (4) and the mental task complexity (2) as the within-participants factors
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7 for each pupil diameter (mesopic, 5 mm, 4.5 mm, and 4 mm) and type of aberration (total,
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9 internal, and corneal). We used the Greenhouse-Geisser adjustment to correct for the violation
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11 of the sphericity assumption, and also the Bonferroni correction for multiple comparisons was
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13 used. The significance level was set at p < .05, and standardised effect size was reported by
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15 means of the partial ƞ² for Fs and the Cohen’s d for t tests.
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18 Results
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21 Cognitive-manipulation check
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24 Cognitive performance showed a significant difference between mental-task levels [t(11) = 7.47,
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26 p < .01, d = 17.36]. The high load version (3-back) clearly displayed lower discriminability
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28 values than the low version (0.67 ± 0.02, and 1.49 ± 0.07, respectively). Still, the inspection of
29
30 confidence intervals (average +/- 2.7 standard errors) clearly shows that performance in the 3-
ev
31
32 back task was much above 0 (the level that would indicate random performance). Also, to
33
34 examine the effectiveness of mental level manipulation, we tested the subjective mental load
ie
35
36 reported in each experimental session with the NASA-TLX scale. The subjective result
37
w
38 demonstrated higher mental demand in the 3-back task (38.68 ± 3.82) than in the oddball
39
40 condition (15.07 ± 1.78) [t(11) = -7.66, p < .01, d = -8.43].
On
41
42
43 Effect of mental-task complexity on ocular aberrations
44
45
ly
46 High order RMS

47
48
Firstly, total HO RMS with natural pupils yielded no statistical significance for the mental task,
49
50
the measurement moment and the interaction [F(1,11) = 2.05, p = .18; F(3,33) = 1, p = .403; and
51
52
F(3,33) = 2.53, p = .103, respectively].
53
54
55 Spherical RMS
56
57
58
59
60
1
2
3 Total spherical RMS with natural pupils displayed no significant differences for the mental task
4
5 [F(1,11) = 1.10, p = .316], and neither for measurement moment or the interaction [F < 1 in
6
7 both].
8
9
10 Coma RMS
11
12
13 For its part, total coma RMS exhibited no statistical differences for the mental task,
14
measurement moment, and the interaction [F < 1 in the three analysis].
Fo
15
16
17
Trefoil RMS
18
rP
19
20 Considering natural pupils, the total trefoil RMS showed no statistical significance for the
21
22 mental task, the measurement moment, or the interaction, [F(1,11) = 2.37, p = .152; F(3,33) =
ee
23
24
2.11, p = .118; and F(3,33) = 2.77, p = .059, respectively].
25
26
rR
27 Astigmatism RMS
28
29
30 Total astigmatism RMS with natural pupils proved to be significant for the mental task and the
ev
31
32 interaction [F(1,11) = 7.45, p = .02, ƞp² = .70; and F(3,33) = 3.17, p = .037, ƞp²=.68,
33
34 respectively], whereas no effect was found for the measurement moment [F < 1]. Due to the
ie
35
36 interactive effect, two separate ANOVAs showed that the 3-back task revealed a marginally
37
w
38 significant effect in total astigmatism RMS whereas the oddball condition showed no statistical
39
40 significance [F(3,33) = 2.39; p =.086, ƞp² = .36 vs. F(3,33) = .76, p = .487]. Internal astigmatism
On
41
42 RMS yielded a significant effect for the mental task complexity [F(1,11) = 4.33, p = .049, ƞp² =
43
44 .48] and no effect for the measurement moment or interaction [F(3,33) = 1.58, p = .223; and
45
ly
46 F(3,33) = 1.80, p = .167, respectively]. Similarly, corneal astigmatism RMS showed

47
48
significance for the mental task [F(1,11) = 4.89, p = .045, ƞp² = .52], and no effect was found for
49
50
the measurement moment or the interaction [F(3,33) = 1.52, p=.239; and F(3,33) = 2.25, p =
51
52
.101, respectively] (Figure 2).
53
54
55 Then, we analysed astigmatism RMS for a 5-mm pupil. Total astigmatism RMS yielded an
56
57 effect for the mental task and the measurement moment [F(1,11) = 5.02, p = .047, ƞp²=.53;
58
59
60
1
2
3 F(3,33) = 5.15, p < .01, ƞp²=.89, respectively] whereas no effect was found for the interaction [F
4
5 < 1]. Subsequently, the condition with high level of complexity (3-back) increased total
6
7 astigmatism RMS [F(3,33) = 3.36, p = .03, ƞp²=.71] against no changes for the oddball task
8
9 [F(3,33) = 1.16, p = .34]. Internal astigmatism RMS showed no effect for mental task,
10
11 measurement moment or the interaction of both factors [F(1,11) = 2.01, p = .184; F(3,33) =
12
13 1.61, p = .217; and F(3,33) = 1.99, p = .151, respectively]. Corneal astigmatism RMS also
14
Fo
15 showed no effect for any factor (mental task and measurement moment) or the interaction
16
17 [F(1,11) = 1.52, p = .243; F(3,33) = 1.37, p = .274; and F(3,33) = 1.20, p = .323, respectively].
18
rP
19
20 For pupil scaled to 4.5-mm, total astigmatism RMS showed an effect for the measurement
21
22 moment and a marginal effect for the mental task [F(3,33) = 4.46, p = .01, ƞp²=.84; and F(1,11)
ee
23
24 = 3.78, p = .078, ƞp²=.43, respectively] but no effect for the interaction [F(3,33) = 1.59, p = .22].
25
26 Separate analysis for each condition showed a significant effect for the 3-back condition,
rR
27
28 whereas no effect was detected for the oddball task [F(3,33) = 3.44, p=.028, ƞp²=.72; and
29
30 F(3,33) = 1.09, p = .366, respectively]. For its part, internal astigmatism RMS yielded no effect
ev
31
32 for the two main factors [F<1, for both] and for the interaction [F(3,33) = 1.82, p = .171].
33
34 Corneal astigmatism RMS also showed no effect for mental task, measurement moment, or
ie
35
36 interaction [F(1,11) = 1.08, p = .322; F(3,33) = 1, p = .389; and F(3,33) = 1.33, p = .282,
37
w
38 respectively].
39
40
On
41 Finally, total, internal, and corneal astigmatism RMS were calculated for 4-mm pupils. Total
42
43 astigmatism RMS demonstrated no effect for mental task, measurement moment and interaction
44
45
ly
[F(1,11) = 2.21, p = .165; and F(3,33)=1.76, p = .175; and F(3,33) < 1, respectively]. No effect
46
47 was found for either condition when analysed separately [F(3,33) = 1.41, p = .264 low-load
48
49 condition; and F(3,33) < 1 high-load condition]. Similarly, internal astigmatism RMS showed
50
51 no effect for any factor (mental task and measurement moment) nor for the interaction [F(1,11)
52
53 = 1.40, p = .261; F(3,33) < 1; and F(3,33) = 2.40, p = .125, respectively]. Corneal astigmatism
54
55 RMS also displayed no effect for either of the two main factors or the interaction [F(1,11) =
56
57
1.50, p = .246 for mental task; F(3,33) < 1 for the measurement moment; and F(3,33) = 2.11,
58
59
60
1
2
3 p=.158 for the interaction]. All the astigmatism RMSs with scaled pupil sizes are displayed in
4
5 Figure 3.
6
7
8 Discussion
9
10
11 Based on the fact that psychological stress has demonstrated to modify the ocular physiology
12
13 (e.g. pupil size [Wang and Munoz 2015], ocular accommodation [Davies, Wolffsohn, and
14
Gilmartin 2005], and intraocular pressure [Vera et al. 2017]). Here, we investigated the effect of
Fo
15
16
17 mental-task complexity on optical quality in terms of higher order aberrations RMSs, which are
18
rP
19 tightly linked to the different components and structures of the human eye such as the pupil size,
20
21 crystalline lens or intraocular pressure (Lombardo and Lombardo 2010; Qu et al. 2007). To do
22
this, participants performed two matched experimental sessions, where the only difference was
ee
23
24
25 the level of mental demand (3-back task and oddball version). We found that performing the
26
rR
27 condition with high level of complexity (3-back) impacts the total AA RMS and promotes
28
29 lowered optical quality, which was maintained when pupils were scaled to 5-mm.
30
ev
31
32 A successful mental task complexity manipulation was corroborated with the cognitive
33
34 performance score and subjective response (NASA-TLX), showing significant differences in the
ie
35
36 two measures, which indirectly indicated that the 3-back task was more difficult than the
37
w
38 oddball condition (Karavidas et al. 2010; Luque-Casado et al. 2015). In the same line, we have
39
40 used the pupil size, a classical physiological indicator of cognitive demand-effort (Wang and
On
41
42 Munoz 2015; Klingner, Tversky, and Hanrahan 2011) and intraocular pressure (Vera et al. 2017)
43
44 as control indices (see Supplementary Material in the Appendix). Our results show that pupil
45
ly
46 size and intraocular pressure are modulated by cognitive process, with greater pupil size and
47
48 higher intraocular pressure values at a high workload level (p < .05), and both quickly
49
50 diminishing once processing is terminated, in agreement with findings by numerous authors
51
52 (Hess and Polt 1964; Wang and Munoz 2015; Klingner, Tversky, and Hanrahan 2011; Vera et al.
53
54 2017; Brody et al. 1999). Due to the close relationship between pupil size and ocular
55
56 aberrations, which has been widely noted in the literature, higher aberrations with larger pupils
57
58
59
60
1
2
3 would be expected (Applegate et al. 2007; Wang et al. 2003). To avoid this interdependence,
4
5 which would limit the use of ocular aberrations in real-world contexts where illumination
6
7 conditions are uncontrollable (Wang and Munoz 2015), we have assessed the ocular aberrations
8
9 under different scaled pupil sizes, as we will discuss below.
10
11
12 Total ocular HOA, SA, CA, and TA RMSs showed no changes with the increase of mental-task
13
14 complexity with natural pupils. We found this effect only on AA RMS, with the amount of total
Fo
15
16 AA increasing with higher mental complexity. This variation was also found for internal and
17
18 corneal AA, demonstrating a dual effect from both. When pupils were scaled to 5 mm, similar
rP
19
20 results were found only for total AA, but no for internal and corneal AA. However, with 4.5 and
21
22 4 mm pupils, no effect of mental task complexity was detected. Our results agree with those of
ee
23
24 Liang (1997), who stated that AA play a substantial role in retinal-image quality when the pupil
25
26 is large but this effect is insignificant with small pupils.
rR
27
28
29 Ocular accommodation depends mainly on the accommodative-demand stimuli and also it has
30
been established that autonomous variations due to cognitive processing can play an additional
ev
31
32
33 role in the variation of accommodative response (Vera et al. 2016; Davies, Wolffsohn, and
34
ie
35 Gilmartin 2005). Corneal and lens changes occur during accommodation, which could affect the
36
37 aberration pattern. The change in corneal shape and curvature shows contradictory results
w
38
39 (Yasuda, Yamaguchi, and Ohkoshi 2003; Pierścionek, Popiołek-Masajada, and Kasprzak 2001;
40
On
41 Buehren et al. 2003), and despite these possible changes, it seems that the modification of
42
43 corneal HOA aberration is relatively small (He et al. 2003). On the other hand, variations in
44
45
ly
lower order aberrations (defocus and astigmatism) (Mutti, Enlow, and Mitchell 2001), and in
46
47 higher order aberrations (Atchison et al. 1995; Cheng et al. 2004; Ninomiya et al. 2002) occur
48
49 mainly because the shape, position, and refractive index gradient of the crystalline lens changes
50
51 (Garner and Yap 1997; Koretz, Cook, and Kaufman 2002). However, several authors have
52
53 indicated that high accommodative levels (greater than 3 diopters [D]) are necessary to induce
54
55 significant changes on the RMS of the total higher order (Atchison et al. 1995; Ninomiya et al.
56
57
2002), and spherical aberrations (Cheng et al. 2004). In the present study, the stimulus distance
58
59
60
1
2
3 was maintained constant with a small accommodative demand (0.4 D) over the entire
4
5 experiment, and thus, the possible changes in astigmatism aberrations could not be clearly
6
7 explained by dynamic changes in accommodation due to cognitive processing, since we have
8
9 found no significant changes in the others aberrations (e.g. high order or spherical) with respect
10
11 to level of mental task complexity.
12
13
14 Rosales et al. (2008) have shown, in rhesus monkey, that while accommodating a significant tilt
Fo
15
16 or vertical shift of the crystalline lens around the horizontal axis occurs, and it seems feasible
17
18 that it can be extrapolated in human eyes, with resulting changes in coma and astigmatism
rP
19
20 aberrations (Cheng et al. 2004). With respect to the coma aberration, the direction and
21
22 magnitude of the change varies greatly between subjects and no clear trends have been observed
ee
23
24 during accommodation (He, Burns, and Marcos 2000; Atchison et al. 1995), so that coma
25
26 aberration would not be an appropriate candidate to capture the effect of mental workload (He,
rR
27
28 Burns, and Marcos 2000; Atchison et al. 1995). In the present study, coma aberration did not
29
30 show any significant changes between tasks. The only ocular aberration that proved to be
ev
31
32 sensitive to mental task complexity manipulation was ocular astigmatism aberration even when
33
34 the pupil size was scaled up to 5 mm. Small pupils diminish the amount of astigmatism
ie
35
36 aberrations (Liang and Williams 1997), and similar to our case, we found that scaling pupils
37
w
38 under 4.5 mm masked the possible effect of the mental workload level in this parameter. Here,
39
40 we have not assessed any parameter of accommodative function (i.e. accommodative response)
On
41
42 in both experimental sessions, and therefore, no solid conclusions can be draw about the role of
43
44
ocular accommodation in the RMS astigmatism aberration changes found in the current study.
45
ly
46
Nevertheless, based on the available literature, which states that 3 D or more are necessary to
47
48
induce significant changes on ocular aberrations (Atchison et al. 1995; Ninomiya et al. 2002),
49
50
51
we consider that the influence of the possible accommodative changes induced by mental effort
52
53 may be minimal.
54
55 Another factor that may influence ocular aberrations is intraocular pressure (i.e. the pressure
56
57
exerted by the aqueous humor against the outer layer of the eye [Kiel et al. 2011]), which has
58
59
60
1
2
3 been demonstrated to fluctuate during cognitive tasks (Brody et al. 1999; Vera et al. 2016; Vera
4
5 et al. 2017). In this regard, Mierdel et al. (2004) reported an association between several Zernike
6
7 coefficients and changes of intraocular pressure. Along the same line, intraocular pressure has
8
9 been associated ocular aberrations, indicating some effect of the pressure exerted by the
10
11 contents of the eyeball (i.e. intraocular pressure) on the pattern of ocular aberrations (Asejczyk-
12
13 Widlicka and Pierscionek 2007; Qu et al. 2007). Increased intraocular pressure is produced by
14
Fo
15 impeded aqueous humor outflow, and this impeded outflow is asymmetrical, in other words,
16
17 some areas around the circumference of the aqueous humor outflow pathway present a higher
18
rP
19 blockage of outflow (i.e. high outflow resistance) than others (Carreon et al. 2016). The
20
21 intraocular pressure rise induced by mental effort would exacerbate this segmental (i.e.
22
ee
23 asymmetrical) outflow and provoke an asymmetric pressure of aqueous humor against the
24
25 ocular structures (e.g. cornea and lens shapes). It would lead to asymmetric changes along the
26
rR
27 optical axis, and thus, to ocular astigmatism aberrations. As a result, we conjecture that the
28
29 intraocular pressure increase found during the condition with high mental task complexity (see
30
ev
31 Supplementary Material) could have an effect on the astigmatism aberration changes obtained in
32
33
the present study.
34
ie
35
36 Numerous indices have been investigated to objectively evaluate the level of mental workload
37
w
38 (Di Stasi, Antolí, and Cañas 2011; Paas et al. 2003). The pupil response is considered one of the
39
40 most valid and reliable ocular biomarkers to assess mental workload (Wang and Munoz 2015;
On
41
42 Klingner, Tversky, and Hanrahan 2011; de Gee, Knapen, and Donner 2014), but it depends on
43
44
the illumination levels, presenting practical caveats in ecological settings outside well-
45
ly
46
controlled laboratory conditions. Therefore, other studies have recently focused their attention
47
48
on finding accurate ocular indices sensitive to cognitive load, such as accommodative response
49
50
51
(Vera et al. 2016; Davies, Wolffsohn, and Gilmartin 2005), intraocular pressure (Brody et al.
52
53 1999; Vera et al. 2017), and saccadic movements (Di Stasi, Antolí, and Cañas 2011). Notably,
54
55 the present work proposes a promising ocular candidate, i.e. astigmatism aberration with scaled
56
57 pupils up to 5 mm, to assess mental workload that is not dependent on surrounding illumination.
58
59
60
1
2
3 Although the lapses between mental task performance and aberration measures are minimal, the
4
5 lack of having monitored the ocular aberrations measures during the experimental session may
6
7 be a limitation to our results. As Young et al. (2015) stated the main challenge is the application
8
9 of objective indices of mental workload in applied contexts (e.g., car drivers or aircraft pilots
10
11 [Borghini et al. 2014; Fallahi et al. 2016]), however, innovative solutions and development
12
13 engineering are needed to allow ocular aberrations monitoring during task performance in
14
Fo
15 laboratory and applied conditions. The investigation of new neuropsychological techniques has
16
17 been gaining popularity in recent years, and therefore future research is guaranteed in this
18
rP
19 regard. In addition, our results should be checked with larger sample size from different age
20
21 groups, and deepen in other RMSs aberrations such as trefoil aberration to assess mental
22
ee
23 workload, due to the marginal significant effect revealed in this study.
24
25
26 In summary, we have shown that the execution of a mentally demanding task modulates
rR
27
28 astigmatism aberrations. These findings may open new possibilities concerning the use of
29
30 astigmatism aberrations as an additional indicator of mental workload level, and suggest that
ev
31
32 ocular indices have the potential to capture the variation of person´s levels of activation. We
33
34 encourage future studies to test this objective index in complex and ecological settings (e.g.
ie
35
36 driving, flight operations, surgical procedures).
37
w
38
39
40
On
41
42
43
44
45
ly
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
1
2
3
4
5
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40 Figure 1. Schematic illustration of the experimental setting for the two conditions. On panel A
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42 (left side) the condition with high mental workload (3-back) is represented (in red). On panel B
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44 (right side) the oddball condition is shown (in blue). Mental tasks were divided in intervals of
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46 105 s long with a 15-s rest periods between trials, excepting a 75-s rest period after the third
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48 trail. This sequence was maintained for the entire experimental session. For the 3-back task
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50 (panel A), participants read “press the button when the number on the screen matches the
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52 number presented three positions before”. In our illustration, participants were asked to press
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54 the button since the number (1) matched with number presented 3 positions before. For the
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56 oddball condition (panel B), participants read the instructions “press the button when the
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3 number X (from 1 to 3, in our example the number randomly chosen was 3) appears on the
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10 Figure 2. Effects of mental-task complexity on astigmatism RMS for total, internal, and corneal
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12 aberrations with natural pupils. Data from the 3-back condition represented with black-filled
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14 diamonds, and from the oddball task with open squares. The x-axis shows the four measurement
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16 moments, with the measurement before mental workload, the measurements after 11 min and 33
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20 differences between task-complexity levels (p-value < .05). Error bars represent the standard
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22 error (SE), and all values were calculated across participants (n=12).
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25 Figure 3. Effects of mental-task complexity on astigmatism RMS for total, internal, and corneal
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27 aberrations with 5-, 4.5-, and 4-mm scaled pupils. The top, middle, and bottom rows represent
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29 astigmatism RMS in 5, 4.5, and 4 mm scaled pupils, respectively. The left, middle, and right
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columns represent total, internal, and corneal astigmatism RMS aberrations, respectively. Data
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33 from the 3-back condition are represented with black-filled diamonds, and from the oddball task
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35 with open squares. The x-axis shows the four measurement moments, with the measurement
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37 before mental workload, the measurements after 11 min and 33 min of mental workload, and the
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39 recovery measurement (10 min). # indicates statistical differences between task-complexity
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41 levels (p-value < .05). Error bars represent the standard error (SE). All values are calculated
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43 across participants (n=12).
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46 Figure S1. The effect of mental task complexity on pupil size (Panel A) and intraocular
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48 pressure (Panel B). Mean value for each measurement moment for the 3-back condition
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50 (black-filled diamonds) and for the oddball condition (open squares) (left y-axis). The x-axis
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52 shows the four measurement moments, with the measurement before mental workload, the
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54 measurements after 11 min and 33 min of mental workload, and the recovery measurement (10
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56 min). # and $ indicate statistical significance for the mental task and the interaction mental task
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3 x measurement moment, respectively (p-value < .05). Errors bars represent the Standard Error
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5 Mean across participants (n=12). All values are calculated across participants (n=12).
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Figure 1. Schematic illustration of the experimental setting for the two conditions. On panel A (left side) the
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27 condition is shown (in blue). Mental tasks were divided in intervals of 105 s long with a 15-s rest periods
28 between trials, excepting a 75-s rest period after the third trail. This sequence was maintained for the entire
29 experimental session. For the 3-back task (panel A), participants read “press the button when the number
30 on the screen matches the number presented three positions before”. In our illustration, participants were
asked to press the button since the number (1) matched with number presented 3 positions before. For the
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32 oddball condition (panel B), participants read the instructions “press the button when the number X (from 1
to 3, in our example the number randomly chosen was 3) appears on the screen”.
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16 Figure 2. Effects of mental-task complexity on astigmatism RMS for total, internal, and corneal aberrations
17 with natural pupils. Data from the 3-back condition represented with black-filled diamonds, and from the
18 oddball task with open squares. The x-axis shows the four measurement moments, with the measurement
before mental workload, the measurements after 11 min and 33 min of mental workload, and the recovery
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19 measurement (10 min); # indicates statistical differences between task-complexity levels (p-value < .05).
20 Error bars represent the standard error (SE), and all values were calculated across participants (n=12).
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31 with 5-, 4.5-, and 4-mm scaled pupils. The top, middle, and bottom rows represent astigmatism RMS in 5,
32 4.5, and 4 mm scaled pupils, respectively. The left, middle, and right columns represent total, internal, and
33 corneal astigmatism RMS aberrations, respectively. Data from the 3-back condition are represented with
black-filled diamonds, and from the oddball task with open squares. The x-axis shows the four measurement
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moments, with the measurement before mental workload, the measurements after 11 min and 33 min of
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35 mental workload, and the recovery measurement (10 min). # indicates statistical differences between task-
36 complexity levels (p-value < .05). Error bars represent the standard error (SE). All values are calculated
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6 The effect of mental task complexity on pupil size response
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Pupil size (PS) was obtained at the same measurement moments that ocular aberrations, using
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11 the OPD Scan III (Nidek Inc., Tokyo, Japan). The same protocol used to measure ocular
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13 aberrations was carried out for PS assessment (see 2.4.2 Ocular aberrations section for more
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Mental task complexity manipulation produced significant differences for PS. Mental task
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showed a significant effect [F(1,11)=4.859, MSE=.364, p=.048, ƞp²=.524], whereas the
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22 measurement moment and the interaction displayed no signification [F(3,33)=2.47, MSE=.058,
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24 p=.079, ƞp²=.561; and F(3,33)=2.262, MSE=.098, p=.1, ƞp²=.521, respectively]. Two separate
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26 one-way ANOVAs for each mental task showed that the 3 back task promoted a significant
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28 increase for PS [F(3,33)=4.047, MSE=.065, p=.015, ƞp²=.795] whereas the oddball condition
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30 did not induce any significant change [F(3,33)=1.106, MSE=.098, p=.358] (see Figure S1, panel
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32 A).
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35 The effect of mental task complexity on intraocular pressure

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We measured intraocular pressure with a portable rebound tonometer (Icare Tonometer, Tiolat,
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Oy, INC. Helsinki, Finland) in both eyes, and the first measured eye was randomly selected,
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using the same order for all subsequent IOP measures. Intraocular pressure was taken just before
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44 each ocular aberrations assessment. This apparatus has been used in related investigations (see
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46 Vera, Jiménez, García, & Cárdenas, 2017 for a detailed description). Summing up, six rapid
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48 consecutive measurements are taken against the central cornea while the participants are looking
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50 at a distance target, and subsequently, the device displays the average intraocular pressure
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52 reading.
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55 In agreement with the study of Vera et al. 2017, intraocular pressure showed significance for the
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57 measurement moment and the mental task x measurement moment [F(3,33) = 4.97, p < .001,
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3 ƞp²= .31; and F(3,33) = 3.06, p = .042, ƞp² = .22, respectively], whereas the mental task did not
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5 reach significance [F(1,11) = 1.30, p = .279]. Two separate one-way ANOVAs for each mental
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7 task demonstrated significant differences for the 3 back task [F(3,33) = 5.92, p = .002, ƞp²=
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9 .35], showing an intraocular pressure rise after performing the mental task, whereas the oddball
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11 task did not show any change [F (3,33) < 1] (see Figure S1, panel B).
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20 Figure S1. The effect of mental task complexity on pupil size (Panel A) and intraocular pressure (Panel
21 B). Mean value for each measurement moment for the 3-back condition (black-filled diamonds) and for the
22 oddball condition (open squares) (left y-axis). The x-axis shows the four measurement moments, with the
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23 measurement before mental workload, the measurements after 11 min and 33 min of mental workload, and
24 the recovery measurement (10 min). # and $ indicate statistical significance for the mental task and the
25 interaction mental task x measurement moment, respectively (p-value < .05). Errors bars represent the
26 Standard Error Mean across participants (n=12). All values are calculated across participants (n=12).
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Measuring mental workload: ocular astigmatism aberration as a novel objective

Article in Ergonomics · October 2017

Raimundo Jiménez Rodríguez David Cárdenas Vélez

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Measuring mental workload: ocular astigmatism aberration

as a novel objective index

Manuscript Type: Original Article

Date Submitted by the Author: 15-Sep-2017

Complete List of Authors: Jimenez, Raimundo; University of Granada, Optics

Cárdenas, David; University of Granada, Physical Education and Sport;

Jiménez, José Ramón; University of Granada, Optics

ocular physiology, optical quality, astigmatism aberration, pupil size,

URL: http://mc.manuscriptcentral.com/terg E-mail: ergonomics@tandf.co.uk

27 Corresponding author: Jesús Vera, Department of Optics, University of Granada, Campus de

46 may help to assess mental workload in real situations.

31 studies, where statistically significant differences in ocular indices as consequence of cognitive

46 High order RMS

46 F(3,33) = 1.80, p = .167, respectively]. Similarly, corneal astigmatism RMS showed

31 D. Waterworth. 1995. “Measurement of Monochromatic Ocular Aberrations of Human

Aberrations with Accommodation.” Journal of Vision 4 (4): 272–80. doi:10.1167/4.4.3.

41 Modern Optics 56 (1): 131–37. doi:10.1080/09500340802531224.

Scale (SSS).” Psychophysiology 9 (1): 150.

35 Corneal Thickness.” Journal of Refractive Surgery 20 (3): 236–42.

46 with Accommodation.” American Journal of Ophthalmology 134 (6): 924–26.

Pierścionek, B K, A Popiołek-Masajada, and H Kasprzak. 2001. “Corneal Shape Change during

Williams & Wilkins.

35 Accommodation.” Journal of Cataract & Refractive Surgery 29 (7): 1297–1301.

35 The effect of mental task complexity on intraocular pressure

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