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Kozlov Y, Kinori M, Armarnik S, Yahalomi T, Ekshtein A, Levian L, Mezad-Koursh D, Pikkel J, Ben-Ari O. Subjective versus objective refraction in healthy young adults. BMC Ophthalmol 2024; 24:79. [PMID: 38378511 PMCID: PMC10877844 DOI: 10.1186/s12886-024-03340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE To evaluate objective and subjective refraction differences in healthy young adults. METHODS Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. RESULTS This study included 1,395 young adult participants. The average age was 22.17 years (range, 17-39, 84.8% males). The average SE was - 0.65 ± 1.19 diopter (D) compared with - 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p < 0.001). This difference was more common in older participants (p < 0.001). J0 and J45 value differences were not significant. The absolute SE value of subjective refraction was lower in the myopic (p < 0.001) and hyperopic (p < 0.001) patients. CONCLUSIONS Young hyperopic participants tended to prefer "less plus" in subjective refraction compared with autorefraction. Young myopic participants tended to prefer "less minus" in subjective refraction compared with autorefraction. All participants, but mainly older participants, preferred slightly "less Cp" than that measured using autorefraction; The astigmatic axis did not differ significantly between the methods.
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Affiliation(s)
- Yuval Kozlov
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Israeli Air Force Aeromedical Center, Tel Hashomer, Israel
| | - Michael Kinori
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Sharon Armarnik
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Tal Yahalomi
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aya Ekshtein
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Israeli Air Force Aeromedical Center, Tel Hashomer, Israel
| | - Leora Levian
- The Israeli Air Force Aeromedical Center, Tel Hashomer, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oded Ben-Ari
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Israeli Air Force Aeromedical Center, Tel Hashomer, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
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Yakar K, Kan E, Duran M. Comparison between wavefront-derived refraction and auto-refraction. Photodiagnosis Photodyn Ther 2023; 44:103712. [PMID: 37459941 DOI: 10.1016/j.pdpdt.2023.103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND This study aimed to compare objective refractive errors and keratometry measurements obtained using the Nidek OPD-Scan II aberrometer/topographer and Topcon KR 8900 autorefractokeratometer. METHODS The right eye medical records of 176 patients aged 18-35 years who were admitted to our clinic as refractive surgery candidates were tested for refractive status and keratometry measurements with a Nidek OPD-Scan II aberrometer/topographer and a standard table-top autorefractokeratometer (Topcon KR 8900) before and after the induction of cycloplegia. Patients who had undergone any eye surgery and had hereditary, ectatic, or acquired corneal pathology were excluded. Refractive data were compared as spheres, cylinders, spherical equivalents, and power vectors before and after the induction of cycloplegia. Flat and steep keratometry (K1-K2) readings were recorded in diopters (D) and axis degrees, respectively, for each eye. RESULTS The spherical, cylindrical, spherical equivalence, J0-J45 vector values and K1-K2 readings (D, axis) between the two devices were statistically significant before and after the induction of cycloplegia (p<0.05). Bland-Altman analysis identified mean differences (95%CI of limits of agreement) of 0.77 (-0,57 to 2,11) in sphere, 0.74 (-0,54 to 2,01) in spherical equivalent, -0,07 (-0,41 to 0,26) in J0 vector, 0,06 (-0,31 to 0,43) in J45 vector, -0,16 (-0,66 to 0,33) in K1, -0,23 (-0,79 to 0,33) in K2 values before induction of cycloplegia. CONCLUSION The refractive and keratometry results of the Nidek OPD Scan II system and Topcon KR 8900 standard table-top autorefractokeratometer are not interchangeable in healthy adult population before and after induction of cycloplegia.
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Affiliation(s)
- Konuralp Yakar
- Department of Ophthalmology, Medicana International Hospital, Samsun, Turkey.
| | - Emrah Kan
- Department of Ophthalmology, Medicana International Hospital, Samsun, Turkey
| | - Mustafa Duran
- Department of Ophthalmology, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey
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Wei X, Li L, Jiang L, Lu H, Huang H, Zhong D, Pan L, Wei D, Han Y, Lin H, Chen Q. Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error. BMC Ophthalmol 2023; 23:487. [PMID: 38012552 PMCID: PMC10680182 DOI: 10.1186/s12886-023-03231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening. METHODS Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A. RESULTS The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively. CONCLUSION This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.
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Affiliation(s)
- Xianxian Wei
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
- Guilin Medical University, Guilin, China
| | - Lili Li
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Li Jiang
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Haiyan Lu
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Huiyao Huang
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Dedong Zhong
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Liang Pan
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Diefeng Wei
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yun Han
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Hong Lin
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Qi Chen
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China.
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Pérez-Sanz L, Charbel C, Poyales F, Garzón N. Influence of isofocal intraocular lenses on objective refraction based on autorefraction and aberrometry. Graefes Arch Clin Exp Ophthalmol 2023; 261:2863-2872. [PMID: 37171601 DOI: 10.1007/s00417-023-06102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To evaluate and compare the objective refractions obtained by autorefraction and aberrometry under different lighting conditions with an isofocal intraocular lens (Isopure, BVI medical, Liége, Belgium) compared to a monofocal control lens (Micropure, BVI medical, Liége, Belgium) with the same platform and material. METHODS Prospective, comparative and randomized study on patients undergoing cataract surgery and bilateral isofocal or monofocal IOL implantation. A total of 44 subjects were randomly assigned to either the isofocal group (n = 22) or the Micropure (n = 22). Manifest refraction (MR) was always performed under the same lighting conditions for all the patients. For objective refraction the autorefractor KR8800 and the aberrometer OPD-Scan III (Nidek Inc., Tokyo, Japan.) were used. For each eye included in the study, six result sets were collected: MR, AR (autorefraction measured with the autorefractor), WF-P and WF-M (Zernike-coefficients-based objective refraction, photopic and mesopic pupil size), OPD-C and OPD-M (autorefraction measured with the aberrometer in photopic and mesopic conditions). RESULTS The mean sphere for MR was 0.03 ± 0.32D for the Isopure group and 0.24 ± 0.22D for the monofocal group (p = 0.013). For the Isopure group, Friedman analysis showed statistically significant differences for sphere measured with WF-P (p = 0.035), WF-M (p = 0.018) and OPD-M (p = 0.000), and SE measured with OPD-M (p = 0.004). In the Micropure lens group, the Friedman analysis showed differences for all values studied (p < 0.05). Correlation coefficients showed that AR is the objective method with the strongest correlation values for all components of refraction for both groups. CONCLUSION The modification of the surfaces of the isofocal lens does not have a negative impact on the refraction obtained by AR compared to a standard monofocal intraocular lens.
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Affiliation(s)
| | - Carla Charbel
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | | | - Nuria Garzón
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
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Guo X, Shakarchi AF, Block SS, Friedman DS, Repka MX, Collins ME. Noncycloplegic Compared with Cycloplegic Refraction in a Chicago School-Aged Population. Ophthalmology 2022; 129:813-820. [PMID: 35245603 DOI: 10.1016/j.ophtha.2022.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences. DESIGN Cross-sectional, retrospective study. PARTICIPANTS Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye. METHODS Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least -0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models. MAIN OUTCOME MEASURES Differences between noncycloplegic and cycloplegic autorefraction measurements. RESULTS The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18-1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18-1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10-1.36) and those with hyperopia (OR range, 4.20-13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild-moderate-high myopia or moderate-high hyperopia. CONCLUSIONS Three quarters of school-aged individuals had < 1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children.
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Affiliation(s)
- Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.
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Pei R, Liu Z, Rong H, Zhao L, Du B, Jin N, Zhang H, Wang B, Pang Y, Wei R. A randomized clinical trial using cyclopentolate and tropicamide to compare cycloplegic refraction in Chinese young adults with dark irises. BMC Ophthalmol 2021; 21:256. [PMID: 34112149 PMCID: PMC8194231 DOI: 10.1186/s12886-021-02001-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the necessity of cycloplegia for epidemiological studies of refraction in Chinese young adults (aged 17-22 years) with dark irises, and to compare the cycloplegic effects of 1% cyclopentolate and 0.5% tropicamide in them. METHODS A total of 300 young adults (108 males and 192 females) aged 17 to 22 years (mean 19.03 ± 1.01) were recruited from Tianjin Medical University from November 2019 to January 2020. Participants were randomly divided into two groups. In the cyclopentolate group, two drops of 1% cyclopentolate eye drop were administrated (one drop every 5 min), followed by autorefraction and subjective refraction 30 to 45 min later. In the tropicamide group, four drops of 1% Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) eye drop were given (one drop every 5 min), followed by autorefraction and subjective refraction 20 to 30 min later. The participants and the examiners were masked to the medication. Distance visual acuity, intraocular pressure (IOP), non-cycloplegic and cycloplegic autorefraction (Topcon KR-800, Topcon Co. Tokyo, Japan), non-cycloplegic and cycloplegic subjective refraction and ocular biometry (Lenstar LS-900) were performed. RESULTS The values of spherical equivalent (SE) and sphere component were significantly different before and after cycloplegia in the cyclopentolate group and the tropicamide group (p < 0.05). The mean difference between noncycloplegic and cycloplegic autorefraction SE was 0.39 D (±0.66 D) in the cyclopentolate group and 0.39 D (±0.34 D) in the tropicamide group. There was no significant difference in the change of SE and sphere component after cycloplegia between the cyclopentolate group and the tropicamide group (p > 0.05). In each group, no significant difference was found between autorefraction and subjective refraction after cycloplegia (p > 0.05). We also found that more positive or less negative cycloplegic refraction was associated with the higher difference in SE in each group. CONCLUSIONS Cycloplegic refractions were generally more positive or less negative than non-cycloplegic refractions. It is necessary to perform cycloplegia for Chinese young adults with dark irises to obtain accurate refractive errors. We suggest that cycloplegic autorefraction using tropicamide may be considered as a reliable method for epidemiological studies of refraction in Chinese young adults with dark irises. TRIAL REGISTRATION The study was registered on September 7, 2019 (Registration number: ChiCTR1900025774 ).
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Affiliation(s)
- Ruxia Pei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Zhuzhu Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Hua Rong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Liqiong Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Bei Du
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Na Jin
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Hongmei Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Biying Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Yi Pang
- Illinois College of Optometry, 3241 S, Michigan Ave, Chicago, IL, 60616, USA.
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China.
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Otero C, Aldaba M, Pujol J. Clinical evaluation of an automated subjective refraction method implemented in a computer-controlled motorized phoropter. J Optom 2019; 12:74-83. [PMID: 30389250 PMCID: PMC6449872 DOI: 10.1016/j.optom.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/30/2018] [Accepted: 09/17/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To investigate a new algorithm to perform an automated non-cycloplegic refraction in adults. METHODS Fifty healthy subjects were measured twice (test-retest) with the new automated subjective refraction method and with the conventional clinician subjective refraction procedure. Objective refraction was also measured with the Grand Seiko WAM-5500 autorefractor. The new automated method was inspired on the root finding bisection algorithm and on the Euclidean distances in the power vector domain. The algorithm was implemented in a computer that was synchronized with a customized motorized phoropter. Repeatability was mainly assessed with the within-subject standard deviation (Sw) and accuracy was mainly assessed with the limits of agreement. RESULTS The within-subject standard deviations of the power vector components (M, J0, J45) obtained for the right eye are (±0.13, ±0.04, ±0.05)D and (±0.17, ±0.03, ±0.07)D, respectively, for the clinical and the automated subjective refraction methods. The limits of agreement (with the clinical method) for the automated and the objective methods are, respectively (±0.56, ±0.18, ±0.31)D and (±0.77, ±0.15, ±0.18)D. Similar results are obtained for the left eye. CONCLUSIONS The proposed automated method is repeatable and more accurate than objective techniques in healthy adults. However, it is not accurate enough to replace the clinical subjective refraction yet and it should be tested in a wider population in terms of age, refraction and different ocular conditions. Despite these important limitations, this method has been shown to be a potentially valuable method to improve the access to primary eye care services in developing countries.
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Affiliation(s)
- Carles Otero
- Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge, UK; Center for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa, Spain.
| | - Mikel Aldaba
- Center for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Jaume Pujol
- Center for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa, Spain
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Gordon-Shaag A, Piñero DP, Kahloun C, Markov D, Parnes T, Gantz L, Shneor E. Validation of refraction and anterior segment parameters by a new multi-diagnostic platform (VX120). J Optom 2018; 11:242-251. [PMID: 29526690 PMCID: PMC6147758 DOI: 10.1016/j.optom.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/17/2017] [Accepted: 12/27/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND The VX120 (Visionix Luneau, France) is a novel multi-diagnostic platform that combines Hartmann-Shack based autorefraction, Placido-disk based corneal-topography and anterior segment measurements made with a stationary-Scheimpflug camera. We investigate the agreement between different parameters measured by the VX120 with accepted or gold-standard techniques to test if they are interchangeable, as well as to evaluate the repeatability and reproducibility. METHODS The right-eyes of healthy subjects were included in the study. Autorefraction of the VX120 was compared to subjective refraction. Agreement of anterior segment parameters was compared to the Sirius (CSO, Italy) including autokeratometry, central corneal thickness (CCT), iridiocorneal angle (IA). Inter and intra-test repeatability of the above parameters was assessed. Results were analyzed using Bland and Altman analyses. RESULTS A total of 164 eyes were evaluated. The mean difference between VX120 autorefraction and subjective refraction for sphere, spherical equivalent (SE), and cylinder was 0.01±0.43D, 0.14±0.47D, and -0.26±0.30D, respectively and high correlation was found to all parameter (r>0.75) except for J45 (r=0.61). The mean difference between VX120 and the Sirius system for CCT, IA, and keratometry (k1 and k2) was -3.51±8.64μm, 7.6±4.2°, 0.003±0.06mm and 0.004±0.04mm, respectively and high correlation was found to all parameter (r>0.97) except for IA (r=0.67). Intrasession repeatability of VX120 refraction, CCT, IA and keratometry yielded low within-subject standard deviations. Inter-session repeatability showed no statistically significant difference for most of the parameters measured. CONCLUSIONS The VX120 provides consistent refraction and most anterior segment measurements in normal healthy eyes, with high levels of intra and inter-session repeatability.
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Affiliation(s)
- Ariela Gordon-Shaag
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - David P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain
| | - Cyril Kahloun
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - David Markov
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Tzadok Parnes
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Liat Gantz
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Einat Shneor
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
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9
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Abstract
Purpose: To determine repeatability and agreement of the ARK-30 handheld autorefractor with retinoscopy under cycloplegic and noncycloplegic conditions in children. Methods: Three consecutive autorefractor measurements (with and without cycloplegia) and retinoscopy were performed and compared in 30 randomized eyes of 30 children (mean age of 6.7 ± 2.7 years with spherical equivalent [SE] refraction from ‒4.01 to +7.38 D) in a cross-section and masked study. Bland–Altman analysis of autorefractor measurements (with and without cycloplegia) and agreement with retinoscopy were calculated with conventional notation (sphere [Sph] and cylinder [Cyl]) and vector notation (SE, J0, and J45 coefficients). Results: ARK-30 measurements without cycloplegia were lower than under cycloplegic conditions (Sph: ‒0.52 ± 2.37 D vs + 0.86 ± 2.60 D, P < 0.01; Cyl: ‒0.83 ± 0.80 D versus ‒0.78 ± 0.77 D, P = 0.37; and SE: ‒0.94 ± 2.19 D vs + 0.47 ± 2.44 D, P < 0.01, respectively) and statistically different (P < 0.03) from retinoscopy (Shp: +0.83 ± 2.66 D; Cyl: ‒0.71 ± 0.87 D; SE: +0.51 ± 2.49 D). Without statistical differences were in J0 and J45 coefficients. Cyloplegic autorefraction measures were not found to be statistically significantly different to retinoscopy measures. ARK-30 under cycloplegia shows better repeatability with lower limits of agreement (LoA) in Sph (LoA: ‒0.66 to +0.69 D), and SE (LoA: ‒0.66 to +0.65 D) than without cycloplegia (LoA: ‒1.45 to +1.77 D, and ‒1.38 to +1.74 D, respectively). Conclusion: Under noncycloplegic conditions, ARK-30 autorefractor has low repeatability and a tendency toward minus over correction in children. However, repeatability and agreement with retinoscopy under cycloplegic conditions allow use of ARK-30 in children to estimate refraction but not to substitute gold standard retinoscopic refraction.
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Affiliation(s)
- Laura Hernandez-Moreno
- Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, Valladolid, Spain; Vision Rehabilitation Lab, Department of Physics and Optometry, University of Minho, Braga, Portugal
| | - Ana Vallelado-Alvarez
- Universidad de Valladolid, Instituto Universitario de Oftalmobiología Aplicada (IOBA); Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Raul Martin
- Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid; Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain; School of Health Professions, Plymouth University, Derriford Road, Plymouth, UK
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10
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Shirzadi K, Shahraki K, Yahaghi E, Makateb A, Khosravifard K. Comparison of Manual Refraction Versus Autorefraction in 60 Diabetic Retinopathy Patients. Med Arch 2016; 70:280-283. [PMID: 27703289 PMCID: PMC5034982 DOI: 10.5455/medarh.2016.70.280-283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022] Open
Abstract
Aim: The purpose of the study was to evaluate the comparison of manual refraction versus autorefraction in diabetic retinopathy patients. Material and Methods: The study was conducted at the Be’sat Army Hospital from 2013-2015. In the present study differences between two common refractometry methods (manual refractometry and Auto refractometry) in diagnosis and follow up of retinopathy in patients affected with diabetes is investigated. Results: Our results showed that there is a significant difference in visual acuity score of patients between manual and auto refractometry. Despite this fact, spherical equivalent scores of two methods of refractometry did not show a significant statistical difference in the patients. Conclusion: Although use of manual refraction is comparable with autorefraction in evaluating spherical equivalent scores in diabetic patients affected with retinopathy, but in the case of visual acuity results from these two methods are not comparable.
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Affiliation(s)
- Keyvan Shirzadi
- Department of Ophthalmology, AJA University of Medical Sciences, Tehran, Iran
| | - Kourosh Shahraki
- Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Emad Yahaghi
- Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Makateb
- Department of Ophthalmology, AJA University of Medical Sciences, Tehran, Iran
| | - Keivan Khosravifard
- Department of Ophthalmology, AJA University of Medical Sciences, Tehran, Iran
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11
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Yalcın E, Sultan P, Yılmaz S, Pallikaris IG. A Comparison of Refraction Defects in Childhood Measured Using Plusoptix S09, 2WIN Photorefractometer, Benchtop Autorefractometer, and Cycloplegic Retinoscopy. Semin Ophthalmol 2016; 32:422-427. [PMID: 27142192 DOI: 10.3109/08820538.2015.1118135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare Plusoptix (Gmbh, Nuremberg, Germany), 2WIN (Adaptica, Padua, Italy), the benchtop refractometer (Auto-Kerato-Refractometer KR-8900; Topcon Co, Tokyo, Japan), and retinoscopy with regard to the consistencies. MATERIALS AND METHODS In our prospective study, 200 eyes of 100 patients were included. We analyzed the demographics and characteristics of the patients, the percentage of patients from whom measurements could not be obtained, the measurements from both patients' eyes of pupil diameter, spherical, cylindrical, axis, and spherical equivalence. RESULTS The mean age ± SD was 7.8±4.5 years (range, 1-18 years). Pupil diameter measurements were found to be consistent (Cronbach's alpha value >0.8). The sphere and spherical equivalence measurements for both eyes were found to be consistent with each other in all apparatus (Cronbach's alpha value >0.8). However, consistency was found to be lower in cylindrical values and the Jackson cross-cylinder measurements at 0° and 45° axis were found to be inconsistent with each other (Cronbach's alpha value <0.8). CONCLUSIONS While consistency was observed in all methods in terms of sphere and spherical equivalence, consistency dropped in cylindrical values and no consistency was observed in axis values. It is important to take this point into consideration, especially in axis measurements.
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Affiliation(s)
| | - Pinar Sultan
- b Istanbul Training and Research Hospital , Ophthalmology Department , Istanbul , Turkey
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12
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Rajavi Z, Sabbaghi H, Baghini AS, Yaseri M, Sheibani K, Norouzi G. Accuracy and Repeatability of Refractive Error Measurements by Photorefractometry. J Ophthalmic Vis Res 2016; 10:221-8. [PMID: 26730305 PMCID: PMC4687253 DOI: 10.4103/2008-322x.170360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To determine the accuracy of photorefraction and autorefraction as compared to cycloautorefraction and to detect the repeatability of photorefraction. Methods: This diagnostic study included the right eyes of 86 children aged 7-12 years. Refractive status was measured using photorefraction (PlusoptiX SO4, GmbH, Nürnberg, Germany) and autorefraction (Topcon RM800, USA) with and without cycloplegia. Photorefraction for each eye was performed three times to assess repeatability. Results: The overall agreement between photorefraction and cycloautorefraction was over 81% for all refractive errors. Photorefractometry had acceptable sensitivity and specificity for myopia and astigmatism. There was no statistically significant difference considering myopia and astigmatism in all comparisons, while the difference was significant for hyperopia using both amblyogenic (P = 0.006) and nonamblyogenic criteria (P = 0.001). A myopic shift of 1.21 diopter (D) and 1.58 D occurred with photorefraction in nonamblyogenic and amblyogenic hyperopia, respectively. Using revised cut-off points of + 1.12 D and + 2.6 D instead of + 2.00 D and + 3.50 D improved the sensitivity of photorefractometry to 84.62% and 69.23%, respectively. The repeatability of photorefraction for measurement of myopia, astigmatism and hyperopia was acceptable (intra-cluster correlation [ICC]: 0.98, 0.94 and 0.77, respectively). Autorefraction results were significantly different from cycloautorefraction in hyperopia (P < 0.0001), but comparable in myopia and astigmatism. Also, noncycloglegic autorefraction results were similar to photorefraction in this study. Conclusion: Although photorefraction was accurate for measurement of myopia and astigmatism, its sensitivity for hyperopia was low which could be improved by considering revised cut-off points. Considering cut-off points, photorefraction can be used as a screening method.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
| | - Hamideh Sabbaghi
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Yaseri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Koroush Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
| | - Ghazal Norouzi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Bennett JR, Stalboerger GM, Hodge DO, Schornack MM. Comparison of refractive assessment by wavefront aberrometry, autorefraction, and subjective refraction. J Optom 2015; 8:109-115. [PMID: 25498534 PMCID: PMC4401825 DOI: 10.1016/j.optom.2014.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE To compare refractive assessment results obtained with an aberrometer, an autorefractor, and manual subjective refraction (SR) in a healthy population with optimal visual potential. METHODS Sixty adults aged 18-59 years with visual acuity of 20/25 or better, no media opacity, and no known corneal or retinal abnormalities were recruited during the course of routine eye examination. Refractive error in both eyes of each patient was assessed by 3 methods: manual SR, a Nidek 530-A autorefractor (AR), and a Nidek OPD-II Scan wavefront aberrometer (OPD). The order of testing was randomized. One technician collected all OPD and AR measurements, and 1 optometrist performed manual SR. Refractive measurements were converted from spherocylindrical prescriptions to power vectors and compared between methods by 2-factor repeated measures and Bland-Altman analysis. RESULTS Analysis of the power vectors followed by a log transformation showed no significant difference in refractive results between AR, OPD, and SR (P=.63). Bland-Altman analysis identified mean differences (95% CI of limits of agreement) of -0.06 (-0.67 to 0.55) for OPD vs SR, 0.001 (-0.522 to 0.524) for AR vs SR, and 0.06 (-0.541 to 0.662) for AR vs OPD. CONCLUSION Agreement between all refractive assessments was comparable to previously reported agreement between repeated measures of SR. Agreement between AR and SR was slightly stronger than between OPD and SR. Although both the OPD and AR results, in general, showed a high level of agreement with SR, results beyond ±0.50D (5.8% for AR, 10% for OPD) would discourage prescribing spectacles directly from either instrument.
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Affiliation(s)
- Jeffrey R Bennett
- Department of Ophthalmology, Mayo Clinic(1), Rochester, MN, United States.
| | - Gina M Stalboerger
- Department of Ophthalmology, Mayo Clinic(1), Rochester, MN, United States
| | - David O Hodge
- Biostatistics Unit, Mayo Clinic, Jacksonville, FL, United States
| | - Muriel M Schornack
- Department of Ophthalmology, Mayo Clinic(1), Rochester, MN, United States
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14
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Krishnacharya PS. Study on accommodation by autorefraction and dynamic refraction in children. J Optom 2014; 7:193-202. [PMID: 25130066 PMCID: PMC4213881 DOI: 10.1016/j.optom.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 06/29/2014] [Accepted: 06/29/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Childhood accommodation interferes with accurate diagnosis of the latent refractive errors. Dynamic retinoscopy offers accurate measurements of accommodative response, while an autorefractometer can predict the accommodative system activation in children. A correlation of the accommodative effort with the dynamic refraction has been investigated in emmetropic children, before and after cycloplegia. METHODS A prospective clinical study of accommodative effort in 149 emmetropic children, in the age group 3-16 years, has been conducted using TOPCON AR RM-8000B autorefractor. Dynamic refraction was performed by monocular estimation method before and after cycloplegia, using the retinoscope mirror light as target. Retinoscopic reflex produced 'with the motion' was corrected with positive spherical lenses, and that 'against the motion' was corrected with negative spherical lenses, to achieve neutralization. RESULTS Mean accommodative effort measured for 149 children included in the study was -0.63±0.69D and dynamic refraction was -0.07±0.44D before cycloplegia, while the mean was+0.52D after cycloplegia, irrespective of the method used. Autorefractor measured -0.17D of accommodative effort per unit change in dynamic refraction before cycloplegia and +0.90D after cycloplegia. CONCLUSIONS The performance of TOPCON AR RM-8000B autorefractor was comparable to dynamic retinoscopy. Presence of many children, and in turn, large number of accommodative response data in 11-13 and 14-15 years group is probably linked to prolonged reading/writing. The accuracy and the agreement of the actual accommodative measurements revealed after cycloplegia.
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