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Huang CT, Lin CN, Chen ST, Kuo HY, Sun HY. An Innovative Virtual Reality System for Measuring Refractive Error. Diagnostics (Basel) 2024; 14:1633. [PMID: 39125509 PMCID: PMC11311498 DOI: 10.3390/diagnostics14151633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
In this study, we aimed to validate a novel light field virtual reality (LFVR) system for estimating refractive errors in the human eye. Fifty participants with an average age of 22.12 ± 2.2 years (range 20-30 years) were enrolled. The present study compared spherical equivalent (SE) and focal line measurements (F1 and F2) obtained by the LFVR system with those obtained by established methods, including closed-field and open-field autorefractors, retinoscopy, and subjective refraction. The results showed substantial agreement between the LFVR system and the traditional methods, with intraclass correlation coefficients (ICC) for SE ranging from 82.7% to 86.7% (p < 0.01), and for F1 and F2 from 80.7% to 86.4% (p < 0.01). Intra-repeatability for F1 and F2 demonstrated strong agreement, with ICC values of 88.8% and 97.5%, respectively. These findings suggest that the LFVR system holds potential as a primary tool for refractive error measurement in optical care, offering high agreement and repeatability compared to conventional methods.
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Affiliation(s)
- Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Optometry, College of Medical Science and Technology, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chien-Nien Lin
- Department of Optometry, College of Medical Science and Technology, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Shyan-Tarng Chen
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Optometry, College of Medical Science and Technology, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Hui-Ying Kuo
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Optometry, College of Medical Science and Technology, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Han-Yin Sun
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Optometry, College of Medical Science and Technology, Chung Shan Medical University, Taichung 40201, Taiwan
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Vineyard K, Ong J, Soares B, Osteicoechea D, Kadipasaoglu CM, Waisberg E, Tavakkoli A, Vizzeri G, Lee AG. Refractive shifts in astronauts during spaceflight: mechanisms, countermeasures, and future directions for in-flight measurements. Eye (Lond) 2024:10.1038/s41433-024-03124-y. [PMID: 38760461 DOI: 10.1038/s41433-024-03124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/11/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Affiliation(s)
- Kelsey Vineyard
- Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Benjamin Soares
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, UK.
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Gianmarco Vizzeri
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrew G Lee
- Texas A&M School of Medicine, Bryan, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Carracedo G, Carpena-Torres C, Pastrana C, Rodríguez-Lafora M, Serramito M, Privado-Aroco A, Espinosa-Vidal TM. Accuracy and precision of automated subjective refraction in young hyperopes under cycloplegia. JOURNAL OF OPTOMETRY 2023; 16:252-260. [PMID: 37019707 PMCID: PMC10518767 DOI: 10.1016/j.optom.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To assess the agreement between the Eye Refract, an instrument to perform subjective automated refraction, and the traditional subjective refraction, as the gold standard, in young hyperopes under noncycloplegic and cycloplegic conditions. METHODS A cross-section and randomized study was carried out, involving 42 participants (18.2 ± 7.7 years, range 6 to 31 years). Only one eye was chosen for the analysis, randomly. An optometrist conducted the refraction with the Eye Refract, while another different optometrist conducted the traditional subjective refraction. Spherical equivalent (M), cylindrical components (J0 and J45), and corrected distance visual acuity (CDVA) were compared between both refraction methods under noncycloplegic and cycloplegic conditions. A Bland-Altman analysis was performed to assess the agreement (accuracy and precision) between both refraction methods. RESULTS Without cycloplegia, the Eye Refract showed significantly lower values of hyperopia than the traditional subjective refraction (p < 0.009), the mean difference (accuracy) and its 95% limits of agreement (precision) being -0.31 (+0.85, -1.47) D. Conversely, there were no statistical differences between both refraction methods under cycloplegic conditions (p ≥ 0.05). Regarding J0 and J45, both refraction methods manifested no significant differences between them under noncycloplegic and cycloplegic conditions (p ≥ 0.05). Finally, the Eye Refract significantly improved CDVA (0.04 ± 0.01 logMAR) compared with the traditional subjective refraction without cycloplegia (p = 0.01). CONCLUSIONS The Eye Refract is presented as a useful instrument to determine the refractive error in young hyperopes, the use of cycloplegia being necessary to obtain accurate and precise spherical refraction.
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Affiliation(s)
- Gonzalo Carracedo
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain.
| | - Carlos Carpena-Torres
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Cristina Pastrana
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - María Rodríguez-Lafora
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - María Serramito
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Ana Privado-Aroco
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Teresa María Espinosa-Vidal
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
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Chan HS, Tang YM, Do CW, Ho Yin Wong H, Chan LYL, To S. Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality. Digit Health 2023; 9:20552076231176638. [PMID: 37312939 PMCID: PMC10259136 DOI: 10.1177/20552076231176638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
Background Virtual reality is a relatively new intervention that has the potential to be used in the treatment of eye and vision problems. This article reviews the use of virtual reality-related interventions in amblyopia, strabismus, and myopia research. Methods Sources covered in the review included 48 peer-reviewed research published between January 2000 and January 2023 from five electronic databases (ACM Digital Library, IEEE Xplore, PubMed, ScienceDirect and Web of Science). To prevent any missing relevant articles, the keywords, and terms used in the search included "VR", "virtual reality", "amblyopia", "strabismus," and "myopia". Quality assessment and data extraction were performed independently by two authors to form a narrative synthesis to summarize findings from the included research. Results Total number of 48 references were reviewed. There were 31 studies published on amblyopia, 18 on strabismus, and 6 on myopia, with 7 studies overlapping amblyopia and strabismus. In terms of technology, smartphone-based virtual reality headset viewers were utilized more often in amblyopia research, but commercial standalone virtual reality headsets were used more frequently in myopia and strabismus-related research. The software and virtual environment were mostly developed based on vision therapy and dichoptic training paradigms. Conclusion It has been suggested that virtual reality technology offers a potentially effective tool for amblyopia, strabismus, and myopia studies. Nonetheless, a variety of factors, especially the virtual environment and systems employed in the data presented, must be explored before determining whether virtual reality can be effectively applied in clinical settings. This review is significant as the technology in virtual reality software and application design features have been investigated and considered for future reference.
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Affiliation(s)
- Hoi Sze Chan
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yuk Ming Tang
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chi Wai Do
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Horace Ho Yin Wong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lily YL Chan
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Suet To
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Abstract
PURPOSE OF REVIEW The evaluation of refractive error is probably the most important and common procedure in eye care. The gold standard method for evaluating refractive error is subjective refraction, a process that has not significantly changed in 200years. This article aims to review recent technologies and novel approaches attempting to improve this traditional procedure. RECENT FINDINGS From laboratory prototypes to commercial instruments, the proposed methods aim to perform reliable and fast subjective refractions, following different approaches: using motorized phoropters in combination with automatic algorithms or even self-refraction, hybridizing objective and subjective measurements within the same instruments, or using new visual tasks beyond letter identification of blur estimation to obtain the refractive error subjectively. SUMMARY The current trend in subjective refraction is to overcome the traditional manual blur reduction method, using automatic and self-refraction instruments, which can provide faster measurements with lower variability. Many of the technologies reported here are already in the market, and some have the potential of becoming the new standard in subjective refraction.
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Affiliation(s)
| | - Carlos Dorronsoro
- Institute of Optics, Spanish National Research Council (IO-CSIC)
- 2 Eyes Vision SL, Madrid, Spain
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Hasrod N, Rubin A. Comparison of the Near Eye Tool for Refractive Assessment (NETRA) and non-cycloplegic subjective refraction. BMJ Open Ophthalmol 2022; 7:e000851. [PMID: 35452206 PMCID: PMC8977766 DOI: 10.1136/bmjophth-2021-000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The NETRA (Near Eye Tool for Refractive Assessment) is a smartphone-based refractive tool that allows for self-evaluation of refractive error. This study investigates the validity of the NETRA with and without cycloplegia to non-cycloplegic subjective refractions (SR). Methods and analysis Participants underwent NETRA measurements without cycloplegia, and again after the administration of cycloplegia (cyclopentolate hydrochloride 1%). Non-cycloplegic SR were also performed. Variation of refractive measurements in symmetric dioptric power space were investigated using stereo-pair comets, hypothesis tests for variances and means. Bland-Altman plots were applied to better understand validity of the NETRA against non-cycloplegic SR. Coefficients of repeatability and intraclass correlation coefficients were also determined. Results The sample included 22 women (64.7%) and 12 men (35.3%); most were indigenous Africans (52.9%) with mean age and SD of 20.24±1.95 years. Variation of refractive measurements were mainly stigmatic (spherical), and variation of NETRA measurements decreased after cycloplegia. The pre-cycloplegia NETRA measurements (and their means) for the right and left eyes were more negative (myopic) in power than the post-cycloplegia NETRA measurements and means. On average, eyes were approximately 1.25 D more myopic with the NETRA without cycloplegia. With cycloplegia, NETRA results were in closer agreement with non-cycloplegic SR for the same eyes. Conclusion NETRA validity to SR, even in the absence of cycloplegia, suggests the instrument may be useful in geographical regions where self-refractions might be potentially helpful in addressing limitations in eye and vision care.
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Affiliation(s)
- Nabeela Hasrod
- Department of Optometry, Faculty of Health Sciences, University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Alan Rubin
- Department of Optometry, Faculty of Health Sciences, University of Johannesburg, Johannesburg, Gauteng, South Africa
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Garcia Moraes Pagano C, de Campos Moreira T, Sganzerla D, Matzenbacher AMF, Faria AG, Matturro L, Cabral FC, Rucks Varvaki Rados D, Decavata Szortyka A, Falavigna M, Vinadé Chagas ME, Harzheim E, Gonçalves M, Umpierre R, Lutz de Araujo A. Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy. PLoS One 2021; 16:e0260594. [PMID: 34847193 PMCID: PMC8631620 DOI: 10.1371/journal.pone.0260594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022] Open
Abstract
Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25–0.25], 0.01 [95%-LoA: -0.86–0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1–0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4–4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82–0.91]; 0.97 [0.96–0.98]; 0.96 [0.95–0.97] and 0.88 [0.84–0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.
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Affiliation(s)
| | | | | | - Ana Maria Frölich Matzenbacher
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | - Erno Harzheim
- Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcelo Gonçalves
- Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Umpierre
- Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Aline Lutz de Araujo
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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A Comparison between Automated Subjective Refraction and Traditional Subjective Refraction in Keratoconus Patients. Optom Vis Sci 2021; 98:597-604. [PMID: 34081650 DOI: 10.1097/opx.0000000000001710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The performance of the Eye Refract (Luneau Technology, Chartres, France), a new instrument to perform aberrometry-based automated subjective refraction, has been previously evaluated in healthy subjects. However, its clinical implications in other ocular conditions are still unknown. PURPOSE The purpose of this study was to evaluate the agreement between the Eye Refract and the traditional subjective refraction, as the criterion standard, in keratoconus patients with and without intracorneal ring segments (ICRSs). METHODS A total of 50 eyes of 50 keratoconus patients were evaluated, dividing the sample into 2 groups: 27 eyes without ICRS (37.78 ± 9.35 years) and 23 eyes with ICRS (39.26 ± 13.62 years). An optometrist conducted the refraction with the Eye Refract, and another different optometrist conducted the traditional subjective refraction on the same day. Spherical equivalent (M), cylindrical vectors (J0 and J45), and corrected distance visual acuity were compared between both methods of refraction. In addition, Bland-Altman analysis was performed to assess the agreement between both methods of refraction. RESULTS There were no statistically significant differences (P ≥ .05) between the Eye Refract and the traditional subjective refraction for all the variables under study in either group. Without ICRS, the mean difference and 95% limits of agreement (upper, lower) were -0.20 (+1.50, -1.89) D for M, -0.14 (+1.40, -1.68) D for J0, and +0.05 (+1.23, -1.14) D for J45. With ICRS, these values worsened to -0.62 (+3.89, -5.12) D for M, +0.06 (+2.46, -2.34) D for J0, and -0.02 (+2.23, -2.28) D for J45. CONCLUSIONS The Eye Refract seems to offer similar results compared with the traditional subjective refraction in keratoconus patients not implanted with ICRS. However, some patients could show abnormal measurements, especially those with ICRS, who should be treated with caution in clinical practice.
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Li Z, Huo G, Feng Y, Ma Z. Application of Virtual Reality Based on 3D-CTA in Intracranial Aneurysm Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9913949. [PMID: 34136112 PMCID: PMC8179785 DOI: 10.1155/2021/9913949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
As a popular technology in the field of human-computer interaction, virtual reality (VR) brings a brand new sensory experience to users by generating the environment. In recent years, while introducing the application of virtual reality technology, researchers have done a lot of work around virtual reality in many fields, such as the application of virtual reality technology in medical procedures. Combining the immersive and expandable features of virtual reality can improve the safety and accuracy of surgery. This article mainly introduces the application of 3D-CTA virtual reality technology in intracranial aneurysm surgery and aims to provide some ideas and directions for the improvement and progress of intracranial aneurysm surgery. This paper presents a research method based on virtual reality technology 3D-CTA in intracranial aneurysm surgery, including the application overview of 3D-CTA in intracranial aneurysm surgery and the virtual reality algorithm based on 3D-CTA for intracranial arteries. In addition, there is also the application of virtual reality CTA technology in the design of the intracranial aneurysm application system. Experimental results show that the average accuracy of 3D-CTA diagnosis based on virtual reality is 90.81%, and it can be put into use in the next step.
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Affiliation(s)
- Zhilei Li
- Department of Neurosurgery, The First Hospital of Yulin, Yulin 719000, Shaanxi, China
| | - Guojin Huo
- Department of Neurosurgery, The First Hospital of Yulin, Yulin 719000, Shaanxi, China
| | - Yi Feng
- Department of Neurosurgery, The First Hospital of Yulin, Yulin 719000, Shaanxi, China
| | - Zhulin Ma
- Department of Neurosurgery, The First Hospital of Yulin, Yulin 719000, Shaanxi, China
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Iskander M, Ogunsola T, Ramachandran R, McGowan R, Al-Aswad LA. Virtual Reality and Augmented Reality in Ophthalmology: A Contemporary Prospective. Asia Pac J Ophthalmol (Phila) 2021; 10:244-252. [PMID: 34383716 PMCID: PMC9167643 DOI: 10.1097/apo.0000000000000409] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Most published systematic reviews have focused on the use of virtual reality (VR)/augmented reality (AR) technology in ophthalmology as it relates to surgical training. To date, this is the first review that investigates the current state of VR/AR technology applied more broadly to the entire field of ophthalmology. METHODS PubMed, Embase, and CINAHL databases were searched systematically from January 2014 through December 1, 2020. Studies that discussed VR and/or AR as it relates to the field of ophthalmology and provided information on the technology used were considered. Abstracts, non-peer-reviewed literature, review articles, studies that reported only qualitative data, and studies without English translations were excluded. RESULTS A total of 77 studies were included in this review. Of these, 28 evaluated the use of VR/AR in ophthalmic surgical training/assessment and guidance, 7 in clinical training, 23 in diagnosis/screening, and 19 in treatment/therapy. 15 studies used AR, 61 used VR, and 1 used both. Most studies focused on the validity and usability of novel technologies. CONCLUSIONS Ophthalmology is a field of medicine that is well suited for the use of VR/AR. However, further longitudinal studies examining the practical feasibility, efficacy, and safety of such novel technologies, the cost-effectiveness, and medical/legal considerations are still needed. We believe that time will indeed foster further technological advances and lead to widespread use of VR/AR in routine ophthalmic practice.
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Affiliation(s)
- Mina Iskander
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
| | - Titilola Ogunsola
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
| | - Rithambara Ramachandran
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
| | - Richard McGowan
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, New York, New York, US
| | - Lama A. Al-Aswad
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
- Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
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Repeatability of Aberrometry-Based Automated Subjective Refraction in Healthy and Keratoconus Subjects. J Ophthalmol 2021; 2020:4831298. [PMID: 33489331 PMCID: PMC7803284 DOI: 10.1155/2020/4831298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose To compare the intersession repeatability of the Eye Refract, a new instrument to perform aberrometry-based automated subjective refraction, on healthy and keratoconus subjects. Materials and Methods A cross-sectional and randomized study was performed. A total of 64 participants were evaluated in the study, selecting one eye per participant randomly. The sample was divided into two different groups: 33 healthy subjects (38.85 ± 13.21 years) and 31 with keratoconus (37.29 ± 11.37 years). Three refractions per participant with the Eye Refract were performed on three different days, without cycloplegia. The repeatability analysis of refractive variables (M, J0, and J45), binocular corrected distance visual acuity (BCDVA), and spent time in refraction was performed in terms of repeatability (Sr), its 95% confidence interval (r), and intraclass correlation coefficient (ICC). Results There were no statistically significant differences (P ≥ 0.05) between sessions in both groups for all refractive variables (M, J0, and J45) and BCDVA. Spent time in refraction was reduced as the sessions went by (P < 0.05). The Eye Refract was more repeatable for refractive errors assessment in healthy subjects (M : Sr = 0.27 D; J0 : Sr = 0.09 D; J45 : Sr = 0.06 D) compared to those with keratoconus (M : Sr = 0.65 D; J0 : Sr = 0.29 D; J45 : Sr = 0.24 D), while it was similar for BCDVA. Conclusions The Eye Refract offered better repeatability to assess refractive errors in healthy subjects compared to those with keratoconus. Despite measurements being also consistent in keratoconus subjects, they should be treated with caution in clinical practice.
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Tabernero J, Otero C, Pardhan S. A Comparison Between Refraction From an Adaptive Optics Visual Simulator and Clinical Refractions. Transl Vis Sci Technol 2020; 9:23. [PMID: 32832229 PMCID: PMC7414619 DOI: 10.1167/tvst.9.7.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The Visual Adaptive Optics (VAO) is an adaptive optics visual simulator with an embedded Hartmann–Shack aberrometer that can give objective and subjective refraction measures. The aim of the present study was to compare the findings of the objective and subjective refractions from the VAO with a commercial autorefractometer (Topcon Corp., Tokyo, Japan) and a subjective refraction by an optometrist. The influence of age, refractive error type, and presence of ocular diseases was ascertained. Methods The refractive error was obtained in 469 participants using the four techniques mentioned. Data were analyzed with power vectors mean spherical equivalent, the vertical Jackson-Cross-Cylinder, and the oblique Jackson-Cross-Cylinder. Age, refractive error type (myopia, emmetropia, hyperopia) and presence of ocular diseases (yes, no) were included as covariates. Agreement was assessed using the 95% interval of agreement. Results The median spherical equivalent difference and the interval of agreement for all the participants with the VAO subjective, VAO objective, and autorefraction with the clinical subjective refraction were (+0.13, 1.80 diopters [D]), (+0.38, 1.80 D), and (−0.38, 2.10 D), respectively. When considering only healthy participants, the results were (+0.06, 1.70 D), (+0.38, 1.60 D) and (−0.25, 1.80 D), respectively. When considering only those participants with any ocular condition, the results with VAO subjective, VAO objective and autorefraction were (+0.13, 2.50 D), (+0.31, 2.70 D), and (−0.50, 4.80 D), respectively. Conclusions The VAO subjective refraction is more accurate than VAO objective refraction and autorefraction, regardless of refractive error, age, or the presence of ocular conditions. The presence of ocular conditions significantly deteriorates the accuracy of all refraction methods. Translational Relevance Reported clinical comparisons between different types of standard refraction methods and a new adaptive optics refraction instrument (VAO) are in good agreement and support the further development of this method to increase refraction accuracy and to refract quicker than standard procedures.
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Affiliation(s)
- Juan Tabernero
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK.,Departamento de Electromagnetismo y Electrónica, Facultad de Química, Universidad de Murcia, Murcia, Spain
| | - Carles Otero
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
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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. JOURNAL OF OPTOMETRY 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] [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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Carracedo G, Carpena-Torres C, Serramito M, Batres-Valderas L, Gonzalez-Bergaz A. Comparison Between Aberrometry-Based Binocular Refraction and Subjective Refraction. Transl Vis Sci Technol 2018; 7:11. [PMID: 30087806 PMCID: PMC6075791 DOI: 10.1167/tvst.7.4.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/13/2018] [Indexed: 11/27/2022] Open
Abstract
Purpose We evaluate the efficacy of a new system of binocular refraction, mainly based on ocular aberrometry (EYER) and compare it with the traditional subjective refraction as gold standard. Methods A prospective, double blind, and transversal study was performed on 99 subjects (35 men, 64 women; mean age 37.22 ± 18.04 years; range, 7–70 years). Refractive surgery or irregular cornea were considered exclusion criteria. Subjective refraction was performed by three different optometrists and EYER by other optometrists on three different days randomly. The binocular best corrected visual acuity (BBCVA), subjective vision evaluated with visual analogue scale (VAS), refraction spent time, and mean spherical equivalent (MSE), and vertical and oblique cylindrical components (J0 and J45) were analyzed. Results A positive strong correlation between EYER and subjective refraction was found for MSE (Pearson, 0.984; P < 0.001) and J0 and J45 (Pearson, 0.837; P < 0.001 and Pearson, 0.852; P < 0.001, respectively) in the total group. There were no statistically significant differences for BBCVA (P < 0.05). The VAS scores were 84.29 ± 12.29 with the EYER and 86.89 ± 12.38 with subjective refraction (P = 0.031). The spent time to perform the refraction was statistically lower (P < 0.05) with the EYER compared to conventional subjective refraction for all groups. Conclusions The EYER system showed similar results in terms of spherical and cylindrical components, visual acuity being the spent time in the refraction lower than conventional subjective refraction. Translational Relevance This new objective refraction system provides less chair spent time with similar results than subjective refraction.
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Affiliation(s)
- Gonzalo Carracedo
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.,Ocupharm Diagnostics Group Research, Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Carpena-Torres
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Serramito
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Batres-Valderas
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Anahi Gonzalez-Bergaz
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
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Steps towards Smarter Solutions in Optometry and Ophthalmology-Inter-Device Agreement of Subjective Methods to Assess the Refractive Errors of the Eye. Healthcare (Basel) 2016; 4:healthcare4030041. [PMID: 27417629 PMCID: PMC5041042 DOI: 10.3390/healthcare4030041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Purpose: To investigate the inter-device agreement and mean differences between a newly developed digital phoropter and the two standard methods (trial frame and manual phoropter). Methods: Refractive errors of two groups of participants were measured by two examiners (examiner 1 (E1): 36 subjects; examiner 2 (E2): 38 subjects). Refractive errors were assessed using a trial frame, a manual phoropter and a digital phoropter. Inter-device agreement regarding the measurement of refractive errors was analyzed for differences in terms of the power vector components (spherical equivalent (SE) and the cylindrical power vector components J0 and J45) between the used methods. Intraclass correlation coefficients (ICC’s) were calculated to evaluate correlations between the used methods. Results: Analyzing the variances between the three methods for SE, J0 and J45 using a two-way ANOVA showed no significant differences between the methods (SE: p = 0.13, J0: p = 0.58 and J45: p = 0.96) for examiner 1 and for examiner 2 (SE: p = 0.88, J0: p = 0.95 and J45: p = 1). Mean differences and ±95% Limits of Agreement for each pair of inter-device agreement regarding the SE for both examiners were as follows: Trial frame vs. digital phoropter: +0.10 D ± 0.56 D (E1) and +0.19 D ± 0.60 D (E2), manual phoropter vs. trial frame: −0.04 D ± 0.59 D (E1) and −0.12 D ± 0.49 D (E2) and for manual vs. digital phoropter: +0.06 D ± 0.65 D (E1) and +0.08 D ± 0.45 D (E2). ICCs revealed high correlations between all methods for both examiner (p < 0.001). The time to assess the subjective refraction was significantly smaller with the digital phoropter (examiner 1: p < 0.001; examiner 2: p < 0.001). Conclusion: “All used subjective methods show a good agreement between each other terms of ICC (>0.9). Assessing refractive errors using different subjective methods, results in similar mean differences and 95% limits of agreement, when compared to those reported in studies comparing subjective refraction non-cylcoplegic retinoscopy or autorefraction”.
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