Agreement and variability of subjective refraction, autorefraction, and wavefront aberrometry in pseudophakic patients

Abstract

This study shows that AR and WA measured the spherical equivalent more myopic than SR in pseudophakic patients after uneventful cataract surgery, whereas astigmatic vectors were comparable.

Automated and subjective refraction with monofocal, multifocal, and EDOF intraocular lenses: review

“…12,13 With these IOLs, the AUTOref is in good consistency with the SUBref, with differences far below 0.5 diopter (D) for the spherical equivalent and below 0.25 D for astigmatism. 16–19 It should be noted that the difference seems to increase with aspheric IOLs, with good consistency between the studies of Wolffsohn et al and Ruiss et al 17,19 Similar results were recently obtained by Or et al in a large series of eyes implanted with toric IOLs. 20 In addition, it seems that autorefractors can accurately measure the optical power of pseudophakic eyes over a wide range of different spherical refractive powers: from −3.8 D to +2.9 D in the study of Wolffsohn.…”

Refraction and defocus curves in eyes with monofocal and multifocal intraocular lenses

“…An agreement study between subjective refraction and objective refraction measured with AR (KR-8800, Topcon) and HS (Wasca, Zeiss) showed a mean bias of −0.3D in eyes with monofocal IOLs and with 5% of the measured eyes with a difference > 0.75D. 15 This bias is consistent with that obtained using SS (OPD Scan III) for a central measurement area of 2.6 mm, however a higher myopic error has been reported for larger measurement areas, also in enhanced monofocal IOLs (Tecnis Eyhance). 21 , 22 Less bias has been reported by other authors, such as around −0.14D for AR (KR-8800, Topcon) and RT (iTrace, Tracey), which increases until −0.39D for HS (LADARWave, Alcon).…”

“… 12 However, a variability of >0.75D in 5% of the cases for pseudophakic patients with VA of 0.7 decimal has also been reported. 15 For this reason, studies that compare IOL calculation formulas consider a minimum of 20/40 (0.5 decimal) VA or 20/30 (0.67 decimal) VA as an inclusion criteria. 1 , 16 …”

“…The most advanced technology is aberrometry, although conventional autorefractometry has shown equivalent or less bias as a starting point for subjective refraction in patients implanted with monofocal and multifocal IOLs. 15 , 20 Retinoscopy is a valid option; however, it relies on clinician experience and takes more time than autorefractometry. 11 …”

Beyond traditional subjective refraction

“…The intraoptometrist repeatability, which is the standard deviation across repetitions performed by the same optometrist evaluating the same eye, has been reported to range, in the spherical component, from AE 0.20 to AE 0.32 diopters (D) [8][9][10]11 & ,12]. The interoptometrist variability, which is the standard deviation across repetitions performed by different optometrists evaluating the same eye, is slightly higher than the intraoptometrist variability, ranging from AE 0.20 to AE 0.38D [9,10,[12][13][14].…”