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

Abstract

our study. 1 They underlined the very purposes of our review that are (1) the importance of considering automated refraction only as a starting point for subjective refraction, (2) the risk of inappropriate evaluation made by ophthalmologists who are unaware of the problem, (3) the risk of inappropriate spectacle or surgical treatment, and (4) the lack of information the surgeons are given about the optics of multifocal and EDOF IOLs. To make the ophthalmology community aware about the problem related to multifocal and EDOF IOLs and automated refraction was our main purpose, and the method suggested by Rodriguez-Vallejo et al. provides an excellent and reproducible way to obtain accurate subjective refraction. 2 The adoption of defocus curvebased clinical decisions, as also suggested by Rodriguez-Vallejo et al., is certainly a good way to avoid potential errors that may range from wrong spectacle prescription to unnecessary refractive surgery, both eventually leading to patient dissatisfaction. We also believe that subjective refraction should always be included by researchers in paper discussing refractive results with multifocal and EDOF IOLs. It may also improve IOL power selection for the second eye.Neural adaptation is an important key point that we did not discuss in our review. We agree on its importance for some patients, especially in multifocal pseudophakic eyes. Another issue is the value of wavefront refraction that is important although less familiar to ophthalmologists and would require a separate investigation and discussion.