Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens

Abstract

ABSTRACT.Purpose: To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). Methods: This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. Results: The difference of mean spherical measurement was +0.98D AE 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D AE 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being À0.09D AE 0.43, and the J45 of +0.04D AE 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r 2 = 0.067, r 2 = 0.078, r 2 = 0.018 and r 2 = 0.015, respectively, all of which point to a low correlation between the AR and the MR. Conclusion: Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used.

Influence of trifocal intraocular lenses on standard autorefraction and aberrometer-based autorefraction

“…A similar tendency has been found for bifocal IOLs to a greater or lesser extent and, more specifically, a stronger trend toward myopia has been observed for refractive bifocal IOLs than for diffractive ones. 4,17 As for sectorial refractive IOLs, van der Linden et al 2 and Albarr an-Diego et al 1 found a systematic shift toward more negative values for autorefraction, between 1.00 D and 1.25 D, compared with subjective refraction, with poor correlation for cylinder values. Bissen-Miyajima et al 3 reported similar issues with refractive IOLs, hypothesizing that pupil size might confound autorefraction outcomes; actually, the geometry of the lens could be the main factor causing measurement inaccuracy.…”

“…15 Several methods are available to estimate refractive error after lens extraction and IOL implantation; these include keratometry, retinoscopy, and autorefraction; however, manifest refraction is still considered the gold standard. Autorefraction's accuracy has been found to decrease in the presence of a multifocal IOL, 2,4,16 whereas retinoscopy becomes more complicated to perform with some of these lensesdsuch as refractive sectorial IOLs dbecause of the presence of two opposite retinoscopy shadows. 1 Several authors have compared objective and subjective refraction values in refractive and bifocal diffractive IOL 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 wearers; however, to our knowledge, this is the first attempt to perform such a comparison with the more complex trifocal IOLs, which have three foci (for far, intermediate, and near distances).…”

“…The accuracy of autorefraction can 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 be compromised by previous corneal refractive surgeries, media opacities, a small pupil size, and the presence of multifocal IOLs. [1][2][3][4][5] In this context, the purpose of this study was to evaluate the agreement between manifest refraction and the objective refraction readings provided by the aforementioned automated devices in eyes that had diffractive trifocal IOL implantation.…”

Agreement Between Autorefraction and Subjective Refraction in Keraring-Implanted Keratoconic Eyes

“…27 This finding suggests an improved agreement between autorefraction measurements and subjective refraction in keratoconic eyes following keraring implantation, such as that both techniques can then be used interchangeably. It should be noted that the autorefractor may overestimate the negative cylinder by about 1.00 D.…”

“…12 Although early versions of autorefractors were found to be similar in performance to subjective refraction, 26 the specifications and performance of the recent models, such as those used in this study, are better. [27][28][29] For instance, like the recent autorefractors, 4,7,30 the RC-5000 is a multifunctional device, because in addition to refraction, it incorporates a keratometry facility. The device acquires radius of curvature measurements in the flat and steep meridians on a 3.0 and 6.0-mm diameter field of the central cornea.…”