Agreement of wavefront-based refraction, dry and cycloplegic autorefraction with subjective refraction

Abstract

Purpose To evaluate the agreement of dry, and cycloplegic autorefraction and wavefront-based refraction with subjective refraction. Method 83 subjects aged 19–57 years were included in this cross-sectional study. Refractive status was determined using four methods including subjective refraction, wavefront-based refraction, dry and cycloplegic autorefraction. Refractive data were recorded as sphere, cylinder and spherical equivalent (SE). Power vector components were used to compare the astigmatism obtained using the different methods of refraction. Results The more negative spherical, cylindrical and SE components were obtained using dry autorefraction, wavefront-based refraction and dry autorefraction, respectively. The less negative spherical, cylindrical and SE components were obtained using cycloplegic autorefraction, subjective refraction and cycloplegic autorefraction, respectively. Considering the spherical component, there was a statistically significant hyperopic shift (0.12 ± 0.29 D, p = 0.001) with cycloplegic autorefraction and a significant myopic shift (−0.17 ± 0.32 D, p < 0.001) with dry autorefraction compared to subjective refraction, while the difference between wavefront-based and subjective refraction was not significant statistically (p = 0.145). The calculated cylindrical component using subjective refraction showed statistically significant difference with dry auto-refraction (p < 0.001), cycloplegic auto-refraction (p = 0.041) and wavefront refraction (p < 0.001). The highest correlation with subjective refraction in sphere, cylinder and SE was observed for cycloplegic auto-refraction (r s = 0.967), dry auto-refraction (r s = 0.983) and cycloplegic auto-refraction (r s = 0.982), respectively. Conclusions As subjective refraction is gold standard in our study, sphere in cycloplegic auto-refraction and astigmatism in dry auto-refraction showed better agreement and correlation.

Agreement Between Retinoscopy, Autorefractometry and Subjective Refraction for Determining Refractive Errors in Congolese Children

“…The two refraction methods also overestimated the severity of myopia in similar proportions. Such a shift has been described previously with autorefractometry and retinoscopy, both in clinical- [12][13][14][16][17][18][19][20][21][22] and population-based studies. 14,[23][24][25][26][27][28][29] Specifically, non-cycloplegic refraction has been reported to overestimate the severity of myopia and underestimate that of hyperopia.…”

“…Underestimation of positive spherical and both over-and underestimation of spherical negative power by autorefractometry under non-cycloplegic conditions has been reported previously. [12][13][14][15] These studies also showed that non-cycloplegic autorefractometry tended to either underestimate 13,14 or overestimate negative cylindrical power. 12 On the contrary, SE values determined with noncycloplegic retinoscopy and autorefractometry produced more myopic measurements than the same method under cycloplegic conditions.…”

“…[12][13][14][15] These studies also showed that non-cycloplegic autorefractometry tended to either underestimate 13,14 or overestimate negative cylindrical power. 12 On the contrary, SE values determined with noncycloplegic retinoscopy and autorefractometry produced more myopic measurements than the same method under cycloplegic conditions. Although the differences in measurements obtained under non-cycloplegic and cycloplegic conditions were statistically significant with both methods, it was greater with refractometry than retinoscopy.…”

The Direct Subjective Refraction: Unsupervised measurements of the subjective refraction using defocus waves

“…Thibos et al [17] studied the precision of 33 different metrics derived from the wavefront aberration map of the eye, to predict the spherical equivalent of the refractive error. They found mean absolute differences on the spherical equivalent, compared with the subjective refraction, ranging from 0.25 to 0.48D, giving birth, in 2004, to wavefront autorefractometry, a discipline that has provided several autorefraction technologies over the years [7,10,18,[20][21][22][23][24]. Modern autorefractometers provide mean absolute differences ranging from ±0.55 to ±0.24D, depending on the autorefractometer [20,25].…”

“…A recent review [26] analyzed four portable autorefractors and reported that QuickSee provides the lowest mean absolute difference (±0.21D) [27]. Many other studies have compared subjective refraction with different types of autorefractors, reporting similar differences [10,19,21–24]. To summarize, both classic autorefraction and wavefront-based autorefraction provide high repeatability, with wavefront autorefractors providing better predictions of the spherical component of the subjective refraction (mean absolute deviations between ±0.25 and ±0.50D).…”