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This study aimed to quantify the impact of blur, contrast, and ghosting on perceived overall image quality (IQ) as well as resultant predicted visual acuity, utilizing simulated acuity charts from objective refraction among eyes of individuals with Down syndrome (DS). Acuity charts were produced, simulating the retinal image when applying 16 different metric-derived sphero-cylindrical refractions for each eye of 30 adult patients with DS. Fourteen dilated adult observers (normal vision) viewed subsets of logMAR acuity charts displayed on