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Hou M, Ding Y, Liu L, Xu Y, Li J, Wu M. Accuracy evaluation of objective refraction using the wavefront aberrometer in pseudophakic eyes. Graefes Arch Clin Exp Ophthalmol 2020; 258:2213-2221. [PMID: 32577855 DOI: 10.1007/s00417-020-04806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the accuracy of wavefront-derived objective refraction in pseudophakic eyes. METHODS Retrospective case series. A total of 356 eyes (356 patients) that underwent phacoemulsification and posterior chamber intraocular lens implantation were included. Noncycloplegic subjective manifest refraction (MR) and objective refraction results from the wavefront aberrometer were obtained and compared. Subgroup analysis of objective refraction at 2.6-mm zone was performed based on axial length (AL) and average keratometry. RESULTS The biases (at the 2.6-mm, 3-mm, and 4-mm zones) were - 0.29 ± 0.37 D, - 0.53 ± 0.41 D, and - 0.51 ± 0.60 D for sphere; - 0.27 ± 0.36 D, - 0.52 ± 0.38 D, and - 0.53 ± 0.51 D for spherical equivalent (SE); 0.03 ± 0.20 D, 0.03 ± 0.22 D, and 0.04 ± 0.27 D for J0; and 0.01 ± 0.16 D, 0.03 ± 0.22 D, and 0.01 ± 0.22 D for J45, respectively. Objective refraction for sphere, SE, and J0 (at 2.6 mm, 3 mm, and 4 mm) was significantly different from MR (P < 0.05), while J45 values were equal. The objective refraction at 2.6 mm was the most accurate in short eyes (≤ 22.5 mm) with a minimum bias for SE (- 0.15 ± 0.28 D) and highest percentage of SE within ± 0.25 to ± 0.75 D of MR. However, there was no difference between the keratometry subgroups. CONCLUSIONS The wavefront aberrometer achieved the best accuracy at 2.6 mm in pseudophakic eyes with short AL. It still needs modification to be used as a substitute for MR in such patients.
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Affiliation(s)
- Min Hou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No.7 Jinsui Road, Guangzhou, People's Republic of China
| | - Yujie Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No.7 Jinsui Road, Guangzhou, People's Republic of China
| | - Liangping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No.7 Jinsui Road, Guangzhou, People's Republic of China
| | - Yanxin Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No.7 Jinsui Road, Guangzhou, People's Republic of China
| | - Jianbing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No.7 Jinsui Road, Guangzhou, People's Republic of China
| | - Mingxing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No.7 Jinsui Road, Guangzhou, People's Republic of China.
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Tsuneyoshi Y, Negishi K, Tsubota K. Importance of Accommodation and Eye Dominance for Measuring Objective Refractions. Am J Ophthalmol 2017; 177:69-76. [PMID: 28237412 DOI: 10.1016/j.ajo.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To explore factors affecting the difference between objective refractive data measured under monocular closed-field viewing and binocular open-field viewing. DESIGN Prospective observational case series. METHODS setting: Institutional. STUDY POPULATION Twenty-nine healthy volunteers (58 eyes; mean age, 38.4 ± 10.0 years; range, 25-60 years). OBSERVATION PROCEDURES Objective monocular refractions (MR) measured with the Nidek Auto Ref/Keratometer ARK-730A; objective binocular refractions (BR) and objective accommodative amplitude (AA) measured with the Grand Seiko Auto Ref/Keratometer WAM-5500; ocular dominance measured using the hole-in-the-card test; presence and magnitude of far/near (30 cm) phoria evaluated by the cover test and alternating cover test using a prism bar. MAIN OUTCOME MEASURE The difference between objective refractive data measured under monocular closed-field viewing and binocular open-field viewing. RESULTS The spherical equivalent (SE) of the BR was significantly (P < .001) more hyperopic by 0.51 ± 0.33 diopter (D) than the MR. The difference (BR minus MR) tended to decline with increasing age and decreasing AA (r = -0.231, P = .08; r = 0.223, P = .092, respectively). The correlation between age and difference in SE was significant in dominant eyes (r = -0.372, P = .047) but not in nondominant eyes (r = -0.102, P = .60). In nondominant eyes, the amount of near phoria was correlated significantly (r = 0.403, P = .03) with the difference in SE. The correlation was strong (r = 0.598, P = .01) in 17 subjects with more than 3 D of AA. CONCLUSIONS Binocular assessment of refraction is important for precise refractive therapy.
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Abstract
PURPOSE Accommodation can mask hyperopia and reduce the accuracy of non-cycloplegic refraction. It is, therefore, important to minimize accommodation to obtain a measure of hyperopia as accurate as possible. To characterize the parameters required to measure the maximally hyperopic error using photorefraction, we used different target types and distances to determine which target was most likely to maximally relax accommodation and thus more accurately detect hyperopia in an individual. METHODS A PlusoptiX SO4 infra-red photorefractor was mounted in a remote haploscope which presented the targets. All participants were tested with targets at four fixation distances between 0.3 and 2 m containing all combinations of blur, disparity, and proximity/looming cues. Thirty-eight infants (6 to 44 weeks) were studied longitudinally, and 104 children [4 to 15 years (mean 6.4)] and 85 adults, with a range of refractive errors and binocular vision status, were tested once. Cycloplegic refraction data were available for a sub-set of 59 participants spread across the age range. RESULTS The maximally hyperopic refraction (MHR) found at any time in the session was most frequently found when fixating the most distant targets and those containing disparity and dynamic proximity/looming cues. Presence or absence of blur was less significant, and targets in which only single cues to depth were present were also less likely to produce MHR. MHR correlated closely with cycloplegic refraction (r = 0.93, mean difference 0.07 D, p = n.s., 95% confidence interval +/-<0.25 D) after correction by a calibration factor. CONCLUSIONS Maximum relaxation of accommodation occurred for binocular targets receding into the distance. Proximal and disparity cues aid relaxation of accommodation to a greater extent than blur, and thus non-cycloplegic refraction targets should incorporate these cues. This is especially important in screening contexts with a brief opportunity to test for significant hyperopia. MHR in our laboratory was found to be a reliable estimation of cycloplegic refraction.
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Ahn JM, Ahn HS, Seo KY, Kim EK, Kim TI. Comparison of the Refractive Error Measurement Using Different Methods in Wavefront-Guided LASEK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.9.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Min Ahn
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
| | - Hyun Seok Ahn
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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du Toit R, Soong K, Brian G, Ramke J. Quantification of Refractive Error: Comparison of Autorefractor and Focometer. Optom Vis Sci 2006; 83:582-8. [PMID: 16909083 DOI: 10.1097/01.opx.0000230270.39804.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The advantages of a focometer (FOCOMETER) over other methods of refraction for use in developing countries are that it is lightweight, compact, relatively inexpensive, fairly quick, and easy to use with minimal training. This clinical trial compared the repeatability, validity, and ease of use of the focometer with an autorefractor. METHODS The refractive status of the right eye of 80 participants was determined with an autorefractor (Canon RK3). Three measurements were also taken with the focometer. RESULTS The spherical equivalent (M) of the focometer was 0.25 D more positive than the autorefractor (p < 0.001) and 84% of measurements were within 0.75 D of the autorefractor. The autorefractor detected astigmatism in 91% (73) of the eyes, whereas the focometer identified only 32% (26). The design of the clock target restricts cylinder axis accuracy to the nearest 15 degrees . There was evidence of a learning effect for the focometer: the second and third measurements were more repeatable in the untrained group. There were no differences between the mean (1.03 +/- 2.28) and third focometer (-1.05 +/- 2.32) measurements (p = 0.34). However, using the third focometer measurement, 94% of participants had visual acuities of at least 6/12(-2). CONCLUSIONS This study highlighted the focometer's restricted power range, inaccuracy of astigmatism and axis determination, and dependence on subject understanding and compliance. Therefore, in most clinical settings, the focometer would not be adequate for quantifying refractive error, but the focometer spherical equivalent was within acceptable limits of the autorefractor, and the visual acuity with lenses determined by the focometer indicates its potential usefulness in public health settings, especially where only spherical ready-made spectacles are dispensed. There may be more cost-effective ways to determine refractive error in these circumstances. A potentially important enhancement in focometer methodology that improves its ease of use was identified: use only the third measurement for each eye.
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Affiliation(s)
- Rènée du Toit
- International Centre for Eyecare Education (ICEE), Sydney, Australia.
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Jorge J, Queiros A, González-Méijome J, Fernandes P, Almeida JB, Parafita MA. The influence of cycloplegia in objective refraction. Ophthalmic Physiol Opt 2005; 25:340-5. [PMID: 15953119 DOI: 10.1111/j.1475-1313.2005.00277.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to compare refractions measured with an autorefractor and by retinoscopy with and without cycloplegia. The objective refractions were performed in 199 right eyes from 199 healthy young adults with a mean age of 21.6 +/- 2.66 years. The measurements were performed first without cycloplegia and repeated 30 min later with cycloplegia. Data were analysed using Fourier decomposition of the power profile. More negative values of component M and J(0) were given by non-cycloplegic autorefraction compared with cycloplegic autorefraction (p < 0.0001). However more positive values for the J(45) vector were given by non-cycloplegic autorefraction, although this difference was not statistically significant (p = 0.233). By retinoscopy, more negative values of component M were obtained with non-cycloplegic retinoscopy (p < 0.0001); for the cylindrical vectors J(0) and J(45) the retinoscopy without cycloplegia yields more negative values (p = 0.234; p = 0.112, respectively). Accepting that differences between cycloplegic and non-cycloplegic retinoscopy are only due to the accommodative response, the present results confirm that when performed by an experienced clinician, retinoscopy is a more reliable method to obtain the objective starting point for refraction under non-cycloplegic conditions.
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Affiliation(s)
- J Jorge
- Department of Physics (Optometry), School of Sciences, University of Minho, Braga, Portugal.
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Kinge B, Midelfart A, Jacobsen G. Clinical evaluation of the Allergan Humphrey 500 autorefractor and the Nidek AR-1000 autorefractor. Br J Ophthalmol 1996; 80:35-9. [PMID: 8664229 PMCID: PMC505381 DOI: 10.1136/bjo.80.1.35] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS/BACKGROUND The intentions of this study were to estimate agreement between two different autorefractors and standard subjective refraction techniques and to evaluate the clinical implications of relying on the autorefractor measurements. METHODS Subjective refraction was carried out on 448 cycloplegic eyes and compared with cycloplegic readings with the Allergan Humphrey 500 autorefractor (448 eyes) and the Nidek AR-1000 autorefractor (160 eyes). Each refraction was followed by clinical visual acuity measurement. The study population comprised 224 healthy students, 107 men and 117 women, with a mean age of 20.6 (SD 1.1) years. RESULTS Both the Nidek and Humphrey autorefractors measured more negative or less positive refractive values compared with subjective refraction and these biases were statistically significant (Humphrey right eye -0.23 D, p = 0.0001, left eye -0.20 D, p = 0.0001), (Nidek right eye -0.13 D, p = 0.0001, left eye -0.11 D, p = 0.0002). Comparing the results of autorefraction with subjective refraction, the Nidek was better than the Humphrey autorefractor in several ways: a smaller mean difference, better agreement between spherical equivalent values, narrower limits of agreements, and better visual acuity obtained with the autorefraction. On the other hand, the Humphrey autorefractor agreed better with subjective refraction concerning cylinder axis. CONCLUSION The results show that both autorefractors represent a valuable complement to subjective refraction, but cannot be used as a replacement.
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Affiliation(s)
- B Kinge
- Faculty of Medicine, University of Trondheim, Norway
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Maier M, Lanzl I, Obermaier M, Schmidt T. Wie zuverlässig ist die objektive Refraktometrie mit dem Nidek AR 800 Autorefraktometer verglichen mit dem Koinzidenzrefraktometer nach Hartinger? SPEKTRUM DER AUGENHEILKUNDE 1995. [DOI: 10.1007/bf03164020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Villada JR, Raj PS, Lewis AE, Joyce PW, Watson A. Comparative evaluation of the Allergan Humphrey 570 and Canon RK-1 autorefractors: II. Objective autorefraction in pseudophakes. Eye (Lond) 1992; 6 ( Pt 3):287-9. [PMID: 1446761 DOI: 10.1038/eye.1992.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Fifty patients (50 eyes) with posterior chamber intraocular lenses and a best corrected visual acuity of at least 6/12 were studied. The Allergan-Humphrey 570 (AH-570) and Canon RK-1 autorefractors were compared in terms of ease of operation, time taken and their accuracy relative to clinical refraction. Both the autorefractors were equally easy to operate but the AH-570 was quicker. The AH-570 had a higher percentage of eyes within 11 degrees of clinically determined cylinder axis while the Canon RK-1 had a higher percentage of patients within 0.51 diopters of spherical equivalence, sphere power and cylinder power as determined by clinical refraction. This difference in the accuracy of objective autorefraction was not statistically significant; the clinical significance is uncertain.
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Affiliation(s)
- J R Villada
- Department of Ophthalmology, District General Hospital, Southport, England
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Raj PS, Villada JR, Lewis AE, Joyce PW, Watson A. Comparative evaluation of the Allergan Humphrey 570 and Canon RK-1 autorefractors: I. Objective autorefraction in normal subjects. Eye (Lond) 1992; 6 ( Pt 3):284-6. [PMID: 1446760 DOI: 10.1038/eye.1992.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Fifty normal subjects were studied comparing objective autorefraction using the Allergan Humphrey 570 (AH 570) and Canon RK-1 autorefractors in terms of ease of operation, the time taken and their accuracy compared with clinical refraction. Both the autorefractors were equally easy to operate but the AH 570 was quicker. Objective autorefraction with the AH 570 was more accurate than using the Canon RK-1 especially with respect to spherical equivalence, sphere power and cyclinder axis: approximately 80% of the values were within 0.51 dioptres or 11 degrees of clinical refraction compared to approximately 60% for the Canon RK-1. The possible reasons for the superior performance of the AH 570 are discussed.
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Affiliation(s)
- P S Raj
- Department of Ophthalmology, District General Hospital, Southport
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Salvesen S, Køhler M. Automated refraction. A comparative study of automated refraction with the Nidek AR-1000 autorefractor and retinoscopy. Acta Ophthalmol 1991; 69:342-6. [PMID: 1927317 DOI: 10.1111/j.1755-3768.1991.tb04825.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A prospective study was performed on 46 eyes to compare results of different methods of objective refraction, namely automated refraction with the Nidek AR-1000 autorefractometer and retinoscopy in cycloplegia. We found that automated refraction in cyclopentolate cycloplegia gave results that differed little from results of retinoscopy in atropine cycloplegia both with respect to sphere and cylinder. Axis determination was even better with automated refraction. Dry automated refraction gave inaccurate results for the spheric component presumably because of suboptimal control of accommodation in this group of young patients. We recommend automated refraction in cyclopentolate cycloplegia as an easy, rapid, accurate and convenient method for obtaining an objective refraction where accommodative disorders are suspected.
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Affiliation(s)
- S Salvesen
- Department of Ophthalmology, National Hospital, Oslo, Norway
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Sunder Raj P, Villada JR, Myint K, Lewis AE, Akingbehin T. Clinical evaluation of automated refraction in anterior chamber pseudophakia. Br J Ophthalmol 1991; 75:42-4. [PMID: 1991086 PMCID: PMC504105 DOI: 10.1136/bjo.75.1.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Automated refraction with the Canon RK-1 Autoref keratometer was evaluated in 85 eyes of 85 patients with an anterior chamber intraocular lens implant and a best corrected visual acuity of at least 6/12. Autorefraction readings were obtained in 80 (94%) of these eyes. The agreement between autorefraction and clinical refraction data was 89% for spherical equivalence less than 0.51 dioptres (D), 91% for sphere power less than 0.51 D, 82% for cylinder power less than 0.51 D, and 91% for cylinder axis less than 11 degrees. Autorefraction provides acceptably accurate postoperative refraction values in anterior chamber pseudophakia.
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Affiliation(s)
- P Sunder Raj
- Department of Ophthalmology, District General Hospital, Southport
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Abstract
Automated refraction with the Canon RK-1 Autoref keratometer was evaluated in 110 eyes (110 patients) six to eight weeks after they had undergone extracapsular cataract extraction with posterior chamber intraocular lens implantation and achieved a best corrected visual acuity of at least 6/12. Autorefraction readings were obtained in 100 (91%) of these eyes. The agreement between autorefraction and clinical refraction data was 98% for spherical equivalence less than 0.51 dioptres (D), 95% for sphere power less than 0.51D, 94% for cylinder power less than 0.51D, and 85% for cylinder axis less than 11 degrees. Autorefraction can provide acceptably accurate postoperative refraction values in pseudophakic eyes.
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Affiliation(s)
- P S Raj
- Department of Ophthalmology, District General Hospital, Southport
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Alzner E, Gensluckner W. Autorefraktometrie versus Skiaskopie bei Kindern im Routinebetrieb einer Sehschule. SPEKTRUM DER AUGENHEILKUNDE 1990. [DOI: 10.1007/bf03163354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nayak BK, Ghose S, Singh JP. An evaluation of the NR-1000F Auto Refractometer in high refractive errors. Br J Ophthalmol 1987; 71:682-4. [PMID: 3663561 PMCID: PMC1041274 DOI: 10.1136/bjo.71.9.682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The manifest refractions of 37 high myopic and 16 high hypermetropic eyes in a total of 28 patients, aged 5 to 42 years, were determined on the Nikon NR-1000F Auto Refractometer. The data obtained were compared with the final clinical prescriptions for these eyes and analysed for degree of agreement for the spherical equivalents, sphere components, and cylinder powers and axes. The Auto Refractometer recordings for all the different refractive components were observed to skew towards more minus in the high myopic eyes but more plus in the high hypermetropes. The possible significance of these skewing patterns is discussed with reference to our earlier studies.
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Affiliation(s)
- B K Nayak
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
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Nayak BK, Ghose S, Singh JP. A comparison of cycloplegic and manifest refractions on the NR-1000F (an objective Auto Refractometer). Br J Ophthalmol 1987; 71:73-5. [PMID: 3814575 PMCID: PMC1041088 DOI: 10.1136/bjo.71.1.73] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The manifest (dry) and cycloplegic refractions of 50 eyes of 25 patients aged 8 to 28 years were studied on the Nikon Auto Refractometer NR-1000F (AR) and compared with the results of clinical refraction (CR) under homatropine and the final clinical acceptance on postmydriatic testing. Only patients in the younger age groups with low to moderate refractive errors were included in this study; high myopes and hypermetropes and patients with aphakia and mixed astigmatism were excluded. The degree of agreement for spherical equivalents, sphere components, and cylinder components was analysed separately for both cycloplegic and manifest refractions on the AR and CR. The results showed that the fixation target in the NR-1000F induces significant instrument myopia during manifest refraction in the younger patients with lower refractive errors. We recommend that caution should be exercised in interpreting manifest refractions on the AR, especially in younger patients. A cycloplegic automatic refraction would be acceptably accurate.
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