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Hernández CS, Gil A, Zaytouny A, Casares I, Poderoso J, de Lara A, Wehse A, Dave SR, Lim D, Lage E, Alejandre-Alba N. Ametropia detection using a novel, compact wavefront autorefractor. Ophthalmic Physiol Opt 2024; 44:311-320. [PMID: 38084770 DOI: 10.1111/opo.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Despite the well-known reproducibility issues of subjective refraction, most studies evaluating autorefractors compared differences between the device and subjective refraction. This work evaluated the performance of a novel handheld Hartmann-Shack-based autorefractor using an alternative protocol, which considered the inherent variability of subjective refraction. METHODS Participants underwent an initial measurement with a desktop autorefractor, two subjective refractions (SR1 and SR2) and a final measurement with the QuickSee Free (QSFree) portable autorefractor. Autorefractor performance was evaluated by comparing the differences between the QSFree and each of the subjective refractions with the difference between the subjective refractions (SR1 vs. SR2) using Bland-Altman analysis and percentage of agreement. RESULTS A total of 75 subjects (53 ± 14 years) were enrolled in the study. The average difference in the absolute spherical equivalent (M) between the QSFree and the SR1 and SR2 was ±0.24 and ±0.02 D, respectively, that is, very similar or smaller than the SR1 versus SR2 difference (±0.26 D). Average differences in astigmatic components were found to be negligible. The results demonstrate that differences between QSFree and both subjective refractions in J0 and J45 were within ±0.50 D for at least 96% of the measurements. The limits of agreement (LOAs) of the differences between QSFree and SR1, as well as QSFree and SR2, were higher than those observed between SR1 and SR2 for M, J0 and J45 . CONCLUSIONS A protocol was designed and validated for the evaluation of a refractive device to account for the variability of subjective refraction. This protocol was used to evaluate a novel portable autorefractor and observed a smaller difference between the device and subjective refractions than the difference between the two subjective refraction measurements in terms of mean bias error, although the standard deviation was higher.
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Affiliation(s)
- Carlos S Hernández
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- PlenOptika, Inc., Boston, Massachusetts, USA
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
| | - Andrea Gil
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- PlenOptika, Inc., Boston, Massachusetts, USA
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
| | - Amal Zaytouny
- PlenOptika, Inc., Boston, Massachusetts, USA
- Instituto de Óptica "Daza de Valdes", Spanish National Research Council, CSIC, Madrid, Spain
| | - Ignacio Casares
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
| | - Jesús Poderoso
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
| | - Alfonso de Lara
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
| | - Alec Wehse
- PlenOptika, Inc., Boston, Massachusetts, USA
| | | | - Daryl Lim
- PlenOptika, Inc., Boston, Massachusetts, USA
| | - Eduardo Lage
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- PlenOptika, Inc., Boston, Massachusetts, USA
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
| | - Nicolas Alejandre-Alba
- Instituto de Investigación Sanitaria de la Fundación Jiménez Diaz, Madrid, Spain
- Ophthalmology Department, Fundación Jiménez Diaz Hospital, Madrid, Spain
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Emmerich L, Ohlendorf A, Leube A, Suchkov N, Wahl S. Development and Testing of a Compact Autorefractor Based on Double-Pass Imaging. SENSORS (BASEL, SWITZERLAND) 2022; 23:362. [PMID: 36616960 PMCID: PMC9823743 DOI: 10.3390/s23010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Autorefraction is an objective way to determine the refractive error of the eye, without the need for feedback by the patient or a well-educated practitioner. To make refractive measurements more accessible in the background of the growing prevalence of myopia, a compact autorefractor was built, containing only few optical components and relying on double-pass imaging and the physical properties of the point-spread function and digital image processing instead. A method was developed to analyze spherical defocus as well as the defocus and angle of astigmatism. The device was tested using calibrator eye models in a range of ± 15 D spherical defocus and -3 D astigmatic defocus. Reliable results could be achieved across the whole measurement range, with only a small increase in deviation toward high values of refractive errors, showing the feasibility of a PSF-based approach for a compact and low-cost solution for objective measurements of refractive error.
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Affiliation(s)
- Linus Emmerich
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
| | - Arne Ohlendorf
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
- Carl Zeiss Vision International GmbH, Turnstr. 27, 73430 Aalen, Germany
| | - Alexander Leube
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
- Carl Zeiss Vision International GmbH, Turnstr. 27, 73430 Aalen, Germany
| | - Nikolai Suchkov
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
| | - Siegfried Wahl
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
- Carl Zeiss Vision International GmbH, Turnstr. 27, 73430 Aalen, Germany
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Rao DP, Negiloni K, Gurunathan S, Velkumar S, Sivaraman A, Baig AU, B K, Murali K. Validation of a Simple-to-Use, Affordable, Portable Wavefront Aberrometry-Based Auto Refractometer in a Paediatric Population. Clin Ophthalmol 2022; 16:4281-4291. [PMID: 36578668 PMCID: PMC9792114 DOI: 10.2147/opth.s387831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose InstaRef R20 is a handheld, affordable auto refractometer based on Shack Hartmann aberrometry technology. The study's objective was to compare InstaRef R20's performance for identifying refractive error in a paediatric population to that of standard subjective and objective refraction under both pre- and post-cycloplegic conditions. Methods Refraction was performed using 1) standard clinical procedure consisting of retinoscopy followed by subjective refraction (SR) under pre- and post-cycloplegic conditions and 2) InstaRef R20. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 20 children was assessed. Results The refractive error was measured in 132 children (mean age 12.31 ± 3 years). The spherical equivalent (M) and cylindrical components (J0 and J45) of the device had clinically acceptable differences (within ±0.50D) and acceptable agreement compared to standard pre- and post-cycloplegic manual retinoscopy and subjective refraction (SR). The device agreed within ± 0.50D of retinoscopy in 67% of eyes for M, 78% for J0 and 80% for J45 and within ± 0.50D of SR in 70% for M and 77% for cylindrical components. Conclusion InstaRef R20 has an acceptable agreement compared to standard retinoscopy in paediatric population. The measurements from this device can be used as a starting point for subjective acceptance. The device being simple to use, portable, reliable and affordable has the potential for large-scale community-based refractive error detection.
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Affiliation(s)
- Divya Parthasarathy Rao
- R&D, Remidio Innovative Solutions Inc, Glen Allen, VA, USA,Correspondence: Divya Parthasarathy Rao, R&D, Remidio Innovative Solutions Inc, 11357 Nuckols Road, #102, Glen Allen, VA, 23059, USA, Tel +1 855 513-3335, Email
| | - Kalpa Negiloni
- R&D, Remidio Innovative Solutions Pvt Ltd, Bengaluru, India
| | | | | | | | | | - Kumari B
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Bengaluru, India
| | - Kaushik Murali
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Bengaluru, India
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Validation of a simple-to-use, affordable, portable, wavefront aberrometry-based auto refractometer in the adult population: A prospective study. BMC Ophthalmol 2022; 22:498. [PMID: 36536321 PMCID: PMC9764520 DOI: 10.1186/s12886-022-02684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Refraction is one of the key components of a comprehensive eye examination. Auto refractometers that are reliable and affordable can be beneficial, especially in a low-resource community setting. The study aimed to validate the accuracy of a novel wave-front aberrometry-based auto refractometer, Instaref R20 against the open-field system and subjective refraction in an adult population. METHODS All the participants underwent a comprehensive eye examination including objective refraction, subjective acceptance, anterior and posterior segment evaluation. Refraction was performed without cycloplegia using WAM5500 open-field auto refractometer (OFAR) and Instaref R20, the study device. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 40 adults was assessed. RESULTS The refractive error was measured in 132 participants (mean age,30.53 ± 9.36 years, 58.3% female). The paired mean difference of the refraction values of the study device against OFAR was - 0.13D for M, - 0.0002D (J0) and - 0.13D (J45) and against subjective refraction (SR) was - 0.09D (M), 0.06 (J0) and 0.03D (J45). The device agreed within +/- 0.50D of OFAR in 78% of eyes for M, 79% for J0 and 78% for J45. The device agreed within +/- 0.5D of SR values for M (84%), J0 (86%) and J45 (89%). CONCLUSION This study found a good agreement between the measurements obtained with the portable autorefractor against open-field refractometer and SR values. It has a potential application in population-based community vision screening programs for refractive error correction without the need for highly trained personnel.
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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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Akhoundi F, Ozgur E, Draper C, Voorakanam R, Wycoff J, Reetz D, Blanche PA, LaComb L, Peyman G, Schwiegerling J, Peyghambarian N. Performance analysis of a compact auto-phoropter for accessible refractive assessment of the human eye. APPLIED OPTICS 2022; 61:2207-2212. [PMID: 35333235 DOI: 10.1364/ao.442769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
We present the performance analysis and specifications of a portable auto-phoropter system that can be employed for fast refractive assessment of a large population. A customized Shack-Hartmann wavefront sensor is developed to accurately measure the defocus and astigmatism of the eye within ±10D and ±6D, respectively. Three fluidic lenses are designed to correct the vision in real time. A digital Snellen chart is integrated into the system to validate the accuracy of the measurement and the correction by means of achieving 20/20 vision. The refractive error of eight subjects (16 eyes) has been measured objectively (without patient's feedback) using the proposed system and the results are compared with their clinical prescription through the Bland-Altman method. It is shown that the auto-phoropter takes less than 8 s to measure and correct the eye refractive error with an accuracy of ±0.25D.
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Gil A, Hernández CS, Nam AS, Varadaraj V, Durr NJ, Lim D, Dave SR, Lage E. Predicting subjective refraction with dynamic retinal image quality analysis. Sci Rep 2022; 12:3714. [PMID: 35260664 PMCID: PMC8904625 DOI: 10.1038/s41598-022-07786-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/22/2022] [Indexed: 01/13/2023] Open
Abstract
The aim of this work is to evaluate the performance of a novel algorithm that combines dynamic wavefront aberrometry data and descriptors of the retinal image quality from objective autorefractor measurements to predict subjective refraction. We conducted a retrospective study of the prediction accuracy and precision of the novel algorithm compared to standard search-based retinal image quality optimization algorithms. Dynamic measurements from 34 adult patients were taken with a handheld wavefront autorefractor and static data was obtained with a high-end desktop wavefront aberrometer. The search-based algorithms did not significantly improve the results of the desktop system, while the dynamic approach was able to simultaneously reduce the standard deviation (up to a 15% for reduction of spherical equivalent power) and the mean bias error of the predictions (up to 80% reduction of spherical equivalent power) for the handheld aberrometer. These results suggest that dynamic retinal image analysis can substantially improve the accuracy and precision of the portable wavefront autorefractor relative to subjective refraction.
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Affiliation(s)
- Andrea Gil
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,PlenOptika, Inc., Boston, MA, USA
| | - Carlos S Hernández
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,PlenOptika, Inc., Boston, MA, USA
| | | | - Varshini Varadaraj
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas J Durr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Eduardo Lage
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain. .,Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain. .,PlenOptika, Inc., Boston, MA, USA.
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8
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Labkovich M, Paul M, Kim E, A. Serafini R, Lakhtakia S, Valliani AA, Warburton AJ, Patel A, Zhou D, Sklar B, Chelnis J, Elahi E. Portable hardware & software technologies for addressing ophthalmic health disparities: A systematic review. Digit Health 2022; 8:20552076221090042. [PMID: 35558637 PMCID: PMC9087242 DOI: 10.1177/20552076221090042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Vision impairment continues to be a major global problem, as the WHO estimates
2.2 billion people struggling with vision loss or blindness. One billion of
these cases, however, can be prevented by expanding diagnostic capabilities.
Direct global healthcare costs associated with these conditions totaled $255
billion in 2010, with a rapid upward projection to $294 billion in 2020.
Accordingly, WHO proposed 2030 targets to enhance integration and
patient-centered vision care by expanding refractive error and cataract
worldwide coverage. Due to the limitations in cost and portability of adapted
vision screening models, there is a clear need for new, more accessible vision
testing tools in vision care. This comparative, systematic review highlights the
need for new ophthalmic equipment and approaches while looking at existing and
emerging technologies that could expand the capacity for disease identification
and access to diagnostic tools. Specifically, the review focuses on portable
hardware- and software-centered strategies that can be deployed in remote
locations for detection of ophthalmic conditions and refractive error.
Advancements in portable hardware, automated software screening tools, and big
data-centric analytics, including machine learning, may provide an avenue for
improving ophthalmic healthcare.
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Affiliation(s)
- Margarita Labkovich
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan Paul
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eliott Kim
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Randal A. Serafini
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Aly A Valliani
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew J Warburton
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aashay Patel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davis Zhou
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Bonnie Sklar
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, PA, USA
| | - James Chelnis
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ebrahim Elahi
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ruggeri M, Belloni G, Chang YC, Durkee H, Masetti E, Cabot F, Yoo SH, Ho A, Parel JM, Manns F. Combined anterior segment OCT and wavefront-based autorefractor using a shared beam. BIOMEDICAL OPTICS EXPRESS 2021; 12:6746-6761. [PMID: 34858678 PMCID: PMC8606132 DOI: 10.1364/boe.435127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 05/30/2023]
Abstract
We have combined an anterior segment (AS) optical coherence tomography (OCT) system and a wavefront-based aberrometer with an approach that senses ocular wavefront aberrations using the OCT beam. Temporal interlacing of the OCT and aberrometer channels allows for OCT images and refractive error measurements to be acquired continuously and in real-time. The system measures refractive error with accuracy and precision comparable to that of clinical autorefractors. The proposed approach provides a compact modular design that is suitable for integrating OCT and wavefront-based autorefraction within the optical head of the ophthalmic surgical microscope for guiding cataract surgery or table-top devices for simultaneous autorefraction and ocular biometry.
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Affiliation(s)
- Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Giulia Belloni
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, Modena, MO 41125, Italy
| | - Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Ettore Masetti
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, Modena, MO 41125, Italy
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2033, Australia
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
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Joseph S, Varadaraj V, Dave SR, Lage E, Lim D, Aziz K, Dudgeon S, Ravilla TD, Friedman DS. Investigation of the Accuracy of a Low-Cost, Portable Autorefractor to Provide Well-Tolerated Eyeglass Prescriptions: A Randomized Crossover Trial. Ophthalmology 2021; 128:1672-1680. [PMID: 34111444 DOI: 10.1016/j.ophtha.2021.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare patient preferences for eyeglasses prescribed using a low-cost, portable wavefront autorefractor versus standard subjective refraction (SR). DESIGN Randomized, cross-over clinical trial. PARTICIPANTS Patients aged 18 to 40 years presenting with refractive errors (REs) to a tertiary eye hospital in Southern India. METHODS Participants underwent SR followed by autorefraction (AR) using the monocular version of the QuickSee device (PlenOptika Inc). An independent optician, masked to the refraction approach, prepared eyeglasses based on each refraction approach. Participants (masked to refraction source) were randomly assigned to use SR- or AR-based eyeglasses first, followed by the other pair, for 1 week each. At the end of each week, participants had their vision checked and were interviewed about their experience with the eyeglasses. MAIN OUTCOME MEASURES Patients preferring eyeglasses were chosen using AR and SR. RESULTS The 400 participants enrolled between March 26, 2018, and August 2, 2019, had a mean (standard deviation) age of 28.4 (6.6) years, and 68.8% were women. There was a strong correlation between spherical equivalents using SR and AR (r = 0.97, P < 0.001) with a mean difference of -0.07 diopters (D) (95% limits of agreement [LoA], -0.68 to 0.83). Of the 301 patients (75.2%) who completed both follow-up visits, 50.5% (n = 152) and 49.5% (n = 149) preferred glasses prescribed using SR and AR, respectively (95% CI, 45.7-56.3; P = 0.86). There were no differences in demographic or vision characteristics between participants with different preferences (P > 0.05 for all). CONCLUSIONS We observed a strong agreement between the prescriptions from SR and AR, and eyeglasses prescribed using SR and AR were equally preferred by patients. Wider use of prescribing based on AR alone in resource-limited settings is supported by these findings.
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Affiliation(s)
- Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Varshini Varadaraj
- The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Eduardo Lage
- PlenOptika, Inc, Boston, Massachusetts; Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigacion Sanitaria Fundación Jiménez Diaz, Madrid, Spain
| | - Daryl Lim
- PlenOptika, Inc, Boston, Massachusetts
| | - Kanza Aziz
- The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sarah Dudgeon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thulasiraj D Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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11
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Evaluation of a Portable Wavefront Aberrometer for Community Screening Refraction in the Elderly. Optom Vis Sci 2021; 98:289-294. [PMID: 33633020 DOI: 10.1097/opx.0000000000001651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The SVOne may prove useful to quickly and easily assess refractive correction needs in community screenings and low-resource settings, but not all subjects were testable with the device. PURPOSE This study aimed to compare the SVOne handheld, smartphone-based wavefront aberrometer with a tabletop autorefractor in identifying refractive errors in elderly subjects. METHODS Participants 50 years or older at community eye screenings with visual acuity worse than 20/40 in either eye underwent autorefraction followed by two SVOne trials. Power vectors of right eye data were analyzed. RESULTS Of 84 subjects who underwent autorefraction, 67 (79.8%) were successfully autorefracted with the SVOne, of whom 82.1% (55/67) had a successful repeat reading. Mean M (spherical equivalent) values from tabletop and handheld autorefraction were -0.21 D (95% confidence interval [CI], -0.71 to +0.29 D) and -0.29 D (95% CI, -0.79 to +0.21 D), respectively (P > .05). Mean astigmatism values from tabletop and handheld devices were +1.06 D (95% CI, 0.87 to 1.26 D) and +1.21 D (95% CI, 0.99 to 1.43 D), respectively (P > .05). Intraclass correlation coefficients between devices were 0.95 (95% CI, 0.93 to 0.97) for M, 0.78 (95% CI, 0.66 to 0.86) for J0, and 0.45 (95% CI, 0.24 to 0.63) for J45 (P < .05 for all). Excellent test-retest correlation between SVOne measurements was noted for M (Pearson correlation [r] = 0.96; P < .05), but a weaker correlation was noted for J0 and J45 (r = 0.67 and r = 0.63 [P < .05 for both], respectively). CONCLUSIONS The SVOne provided strong agreement for M, with the majority of readings within ±1.00 D of each other, when compared with the tabletop autorefractor. A weaker but still good correlation was noted for astigmatism. Similar findings were noted when assessing repeatability.
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Padhy D, Bharadwaj SR, Nayak S, Rath S, Das T. Does the Accuracy and Repeatability of Refractive Error Estimates Depend on the Measurement Principle of Autorefractors? Transl Vis Sci Technol 2021; 10:2. [PMID: 33505769 PMCID: PMC7794271 DOI: 10.1167/tvst.10.1.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to determine the accuracy and repeatability of refractive errors obtained using three autorefractors based on different measurement principles, vis-à-vis, gold-standard retinoscopy. Methodology Accuracy of noncycloplegic, sphero-cylindrical refractive error of 234 eyes was obtained using the rotary prism-based RM-8900 closed-field autorefractor, photorefraction based Spot vision screener, wavefront aberrometry based E-see, and streak retinoscopy by four different examiners, masked to the results of each other. Intersession repeatability of autorefractors was determined by repeat measurements in a subset of 40 subjects. Results Retinoscopy values of M, J0, and J45 power vectors for the cohort ranged from -10.2 to 8 D, -1.4 to 1.8 D, and -0.9 to 1.2 D, respectively. Across autorefractors, the interequipment bias of M and J0 power vectors were statistically insignificant (< ±0.5 D; P > 0.05) but the corresponding limits of agreement were ±2.5 and ±1 D, respectively, without any trend across instruments or the patient's age (P > 0.5). Repeatability of M and J0 power vectors were ±0.75 D and ±0.40 D, respectively, across autorefractors. The range of J45 power vector was too narrow for any meaningful analysis. Conclusions Refractive errors measured using autorefractors operating on different principles show minimal bias and good short-term repeatability but relatively large agreement limits, vis-à-vis, retinoscopy. Among them, the wavefront aberrometry based E-see autorefractor performs relatively better in all measurement parameters evaluated here. Translational Relevance Although autorefractor estimates of noncycloplegic refractive error appears independent of their measurement principle, their relatively poor agreement with gold-standard retinoscopy warrants caution while used for screening and quantification of refractive errors.
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Affiliation(s)
- Debananda Padhy
- Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.,Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Shrikant R Bharadwaj
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Suryasmita Nayak
- Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.,Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Suryasnata Rath
- Ophthalmic Plastics, Orbit and Ocular Oncology Services, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
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Gil A, Hernández CS, Pérez-Merino P, Rubio M, Velarde G, Abellanas-Lodares M, Román-Daza Á, Alejandre N, Jiménez-Alfaro I, Casares I, Dave SR, Lim D, Lage E. Assesment of the QuickSee wavefront autorefractor for characterizing refractive errors in school-age children. PLoS One 2020; 15:e0240933. [PMID: 33112912 PMCID: PMC7592806 DOI: 10.1371/journal.pone.0240933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the performance of an open-view binocular handheld aberrometer (QuickSee) for diagnosing refractive errors in children. Methods 123 school-age children (9.9 ± 3.3 years) with moderate refractive error underwent autorefraction (AR) with a standard desktop device and subjective refraction (SR), with or without cycloplegia to determine their eyeglass prescription. Measurements with QuickSee (QS) were taken in 62 of these patients without cycloplegia (NC), and in 61 under cycloplegia (C). Differences in refraction values (AR vs SR vs QS) as well as the visual acuity (VA) achieved by the patients with each method (QS vs SR) were used to evaluate the performance of the device in measuring refractive error. Results The spherical equivalent refraction obtained by QS agreed within 0.5 D of the SR in 71% (NC) and 70% (C) of the cases. Agreement between the desktop autorefractor and SR for the same threshold was of 61% (NC) and 77% (C). VA resulting from QS refractions was equal to or better than that achieved by SR procedure in 77% (NC) and 74% (C) of the patients. Average improvement in VA with the QS refractions was of 8.6 and 13.4 optotypes for the NC and C groups respectively, while the SR procedure provided average improvements of 8.9 (NC) and 14.8 (C) optotypes. Conclusions The high level of agreement between QuickSee and subjective refraction together with the VA improvement achieved in both study groups using QuickSee refractions suggest that the device is a useful autorefraction tool for school-age children.
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Affiliation(s)
- Andrea Gil
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos S. Hernández
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- PlenOptika, Inc., Boston, MA, United States of America
| | - Pablo Pérez-Merino
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Marcos Rubio
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- PlenOptika, Inc., Boston, MA, United States of America
| | | | | | - Ángeles Román-Daza
- Department of Ophthalmology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Nicolás Alejandre
- Department of Ophthalmology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Jiménez-Alfaro
- Department of Ophthalmology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Casares
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- PlenOptika, Inc., Boston, MA, United States of America
| | | | - Daryl Lim
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Lage
- Department of Electronics and Communications Technology, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- PlenOptika, Inc., Boston, MA, United States of America
- * E-mail:
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Samanta A, Shetty A, Nelson PC. Better one or two? A systematic review of portable automated refractors. J Telemed Telecare 2020; 28:404-411. [PMID: 32778005 DOI: 10.1177/1357633x20940140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION More than 400 million people suffer from visual impairment globally, with more than half due to uncorrected refractive error. Autorefraction (AR) is the most common examination performed prior to prescribing glasses. As technology advances, so has the accuracy and number of portable autorefractors available. Portable technology has become acutely important with the coronavirus disease 2019 pandemic and the conversion of in-person clinical evaluations to remote telemedicine encounters. Patients and providers want to do as much as possible remotely. The aim of this study was to conduct a systematic literature review of the accuracy and effectiveness of available portable automated refractors compared to the current standard of care, subjective refraction (SR). METHODS A literature search of PubMED, Embase and ClinicalTrials.gov 97 unique publications in English on portable autorefractors. Twelve studies comparing a portable AR device to at least one form of SR were systematically included in this review. RESULTS There were four portable autorefractors (Netra, Quicksee, Retinomax and SVOne) studied against SR. There was high patient acceptance of glasses prescriptions by the Quicksee alone, with 87% subjects seeing the same or better than SR. Quicksee was more accurate than Netra and Retinomax. SVOne was preferred over Netra and outperformed Retinomax in multiple measures, despite Retinomax being the fastest test. DISCUSSION There are numerous portable autorefractors available, but few were compared against SR. Quicksee and SVOne are the most accurate and patient-preferred devices. Quicksee was the most accurate, and it performed clinically the same as SR in some reports.
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Affiliation(s)
- Anindya Samanta
- Department of Internal Medicine, Allegheny Health Network, USA
| | | | - Patricia C Nelson
- Ophthalmology, Department of Surgery Texas Tech University Health Sciences Center El Paso, USA
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Akondi V, Dubra A. Average gradient of Zernike polynomials over polygons. OPTICS EXPRESS 2020; 28:18876-18886. [PMID: 32672177 PMCID: PMC7340383 DOI: 10.1364/oe.393223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/03/2020] [Accepted: 05/25/2020] [Indexed: 05/23/2023]
Abstract
Wavefront estimation from slope sensor data is often achieved by fitting measured slopes with Zernike polynomial derivatives averaged over the sampling subapertures. Here we discuss how the calculation of these average derivatives can be reduced to one-dimensional integrals of the Zernike polynomials, rather than their derivatives, along the perimeter of each subaperture. We then use this result to derive closed-form expressions for the average Zernike polynomial derivatives over polygonal areas, only requiring evaluation of polynomials at the polygon vertices. Finally, these expressions are applied to simulated Shack-Hartmann wavefront sensors with 7 and 23 fully illuminated lenslets across a circular pupil, with their accuracy and calculation time compared against commonly used integration methods.
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