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Ozgur E, Blanche PA, Bedrick EJ, Conway MD, Peyman GA, Peyghambarian NN. Accuracy of an objective binocular automated phoropter for providing spectacle prescriptions. Clin Exp Optom 2024; 107:698-703. [PMID: 37844333 DOI: 10.1080/08164622.2023.2266498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
CLINICAL RELEVANCE Currently eye examinations are usually based on autorefraction followed by subjective refraction (SR) with a phoropter. An automated phoropter that can also perform autorefraction may facilitate the optometric workflow. BACKGROUND The efficiency and feasibility of an objective autorefraction and correction system are assessed by comparing objective refractive measurements with SR on the same subjects and evaluating the visual acuity (VA) values obtained after the objective refractive measurement and correction. METHODS Objective autorefraction and correction was performed on 41 subjects using an automated binocular phoropter system. The auto-phoropter performs autorefraction by wavefront measurement and corrects the spherical and cylindrical errors with tunable fluidic lenses while the patient looks at a visual display inside the instrument. The instrument outputs are optometric constants of spherical and cylindrical aberrations. After measurement and automated correction of the refractive errors, the VA values were assessed by having the subjects look at an integrated Snellen chart. The objective measurement results were statistically compared with their SR. RESULTS The correlations between SR and objective autorefraction and correction spherical equivalents (M) were 0.98 (0.97-0.99) and 0.96 (0.93-0.98), the vertical Jackson cross cylinder (J0) were 0.96 (0.92-0.98) and 0.95 (0.91-0.97), and the oblique Jackson cross cylinder (J45) were 0.73 (0.55-0.85) and 0.82 (0.69-0.90), for the right and left eyes, respectively, with the 95% confidence interval (CI) values in parentheses. 89.0% of the 82 eyes had at least 6/7.5 VA. CONCLUSIONS A significant agreement between the SR and objective autorefraction and correction was observed. An all-objective refractive assessment with instantaneous verification may improve the precision of eye prescriptions and possibly reduce the procedure time.
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Affiliation(s)
- Erol Ozgur
- Wyant College of Optical Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Mandi D Conway
- College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Gholam A Peyman
- Wyant College of Optical Sciences, University of Arizona, Tucson, AZ, USA
- College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
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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] [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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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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Rodríguez-Vallejo M, Rocha-de-Lossada C, Fernández J. Comment on: Automated and subjective refraction with monofocal, multifocal, and EDOF intraocular lenses: review. J Cataract Refract Surg 2023; 49:1081. [PMID: 37769178 DOI: 10.1097/j.jcrs.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Manuel Rodríguez-Vallejo
- From the Qvision, Department of Ophthalmology, VITHAS Almería Hospital, Almería, Spain (Rodríguez-Vallejo, Rocha-de-Lossada, Fernández); Ophthalmology Department, VITHAS Málaga, Málaga, Spain (Rocha-de-Lossada); Hospital Regional Universitario de Málaga, Málaga, Spain (Rocha-de-Lossada); Área de Oftalmología, Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain (Rocha-de-Lossada)
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Bossie T, Reilly J, Vera-Diaz FA. Comparison of a Novel Binocular Refraction System with Standard Digital Phoropter Refraction. Optom Vis Sci 2023; 100:451-458. [PMID: 37369097 PMCID: PMC10417206 DOI: 10.1097/opx.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
SIGNIFICANCE New refractive technologies are consistently emerging in the optometry market, necessitating validation against current clinical standards. PURPOSE This study aimed to compare the refractive measurements between standard digital phoropter refraction and the Chronos binocular refraction system. METHODS Standardized subjective refraction was conducted on 70 adult participants using two separate refraction systems. The final subjective values from both devices were compared for M , J0 , and J45 . The time taken to complete refraction and patient's comfort were also evaluated. RESULTS Good agreement was found between the standard and Chronos refraction, with narrow mean differences (including 95% confidence intervals) and no significant bias for M (0.03 D, -0.05 to 0.11 D), J0 (-0.02 D, -0.05 to -0.01 D), and J45 (-0.01 D, -0.03 to 0.01 D). The bounds of the limits of agreement of M were -0.62 (lower bound; -0.76 to -0.49) and 0.68 (upper bound; 0.54 to 0.81), those of J0 were -0.24 (lower bound; -0.29 to -0.19) and 0.19 (upper bound; 0.15 to 0.24), and those of J45 were -0.18 (lower bound; -0.21 to -0.14) and 0.16 (upper bound; 0.12 to 0.19). No significant differences were noted between the two techniques for any of the refraction components ( M standard = -3.03 ± 2.42 D, M novel = -3.06 ± 2.37 D, z = 0.07, P = .47; J0 standard = 0.12 ± 0.40 D, J0 novel = 0.15 ± 0.41 D, z = 1.32, P = .09; J45 standard = -0.04 ± 0.19 D, J45 novel = -0.03 ± 0.19 D, z = 0.50, P = .31). The Chronos was significantly faster than the standard technique, with an average difference of 19 seconds (standard, 190 ± 44 seconds; novel, 171 ± 38 seconds; z = 4.91; P < .001). CONCLUSIONS The final subjective refraction end points of the standard technique and the Chronos were well aligned in this group of adult participants, and no statistically or clinically significant differences were noted in M , J0 , or J45 components. The Chronos offered improved efficiency, meeting the demands of eye care.
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Affiliation(s)
- Timothy Bossie
- New England College of Optometry (NECO), Boston, Massachusetts
| | - Jennifer Reilly
- New England College of Optometry (NECO), Boston, Massachusetts
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Huang J, Li X, Yan T, Wen L, Pan L, Yang Z. The Reliability and Acceptability of RDx-Based Tele-Controlled Subjective Refraction Compared with Traditional Subjective Refraction. Transl Vis Sci Technol 2022; 11:16. [PMID: 36394842 PMCID: PMC9684619 DOI: 10.1167/tvst.11.11.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to compare the reliability and acceptability of tele-controlled subjective refraction supported by RDx, a new technique that involves optical software designed for controlling phoropters remotely, to traditional subjective refraction. Methods Sixty-five participants underwent tele-controlled subjective refraction and traditional subjective refraction randomly and nine of them underwent the second tele-controlled subjective refraction measurement on the same day. After their examinations, we distributed a validated satisfaction questionnaire to each participant. The elapsed time taken for refraction, sphere (S), cylinder (C), spherical equivalent (SE), vertical and oblique cylindrical vectors (J0 and J45), and best corrected visual acuity (BCVA) were compared. Age and refractive error type were included as covariates. Bland-Altman analysis was used to assess the agreement between both methods of refraction. Results The mean age was 20.5 ± 5.9 years for all participants (aged 9 to 40 years); 57% were female participants. The repeatability analysis of tele-controlled method showed no significant differences for all parameters (P > 0.05). We found no statistical differences (P > 0.05) between tele-controlled subjective refraction and traditional subjective refraction for all parameters in either group. The mean difference and 95% limits of agreement for SE, J0, and J45 were −0.03 ± 0.36 diopters (D), −0.00 ± 0.57 D, and −0.01 ± 0.79 D, respectively. The tele-controlled method took more time to perform than the traditional one (P < 0.05). Completed questionnaires were returned by 55 participants (85%), and they showed high satisfaction and acceptance of the tele-controlled method (98%). Conclusions Tele-controlled subjective refraction results agreed with traditional subjective refraction for all refraction components except for cylinder vectors. In addition, the broad acceptability of tele-controlled subjective refraction means practicability in clinical practice. Translation Relevance The RDx-based tele-controlled method can provide an alternative to subjective refraction, especially in areas that lack experienced optometrists.
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Affiliation(s)
- Jie Huang
- Aier School of Ophthalmology, Central South University, Changsha, China
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
| | - Xiaoning Li
- Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Xianning, China
- Changsha Aier Eye Hospital, Changsha, China
| | - Tao Yan
- Nanchang Aier Eye Hospital, Nanchang, China
| | - Longbo Wen
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
| | - Lun Pan
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha, China
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
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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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Espinosa J, Pérez J, Villanueva A. Prediction of Subjective Refraction From Anterior Corneal Surface, Eye Lengths, and Age Using Machine Learning Algorithms. Transl Vis Sci Technol 2022; 11:8. [PMID: 35404439 PMCID: PMC9034724 DOI: 10.1167/tvst.11.4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop a machine learning regression model of subjective refractive prescription from minimum ocular biometry and corneal topography features. Methods Anterior corneal surface parameters (Zernike coefficients and keratometry), axial length, anterior chamber depth, and age were posed as features to predict subjective refractions. Measurements from 355 eyes were split into training (75%) and test (25%) sets. Different machine learning regression algorithms were trained by 10-fold cross-validation, optimized, and tested. A neighborhood component analysis provided features’ normalized weights in predictions. Results Gaussian process regression algorithms provided the best models with mean absolute errors of around 1.00 diopters (D) in the spherical component and 0.15 D in the astigmatic components. Conclusions The normalized weights showed that subjective refraction can be predicted by only keratometry, age, and axial length. Increasing the topographic description detail of the anterior corneal surface implied by a high-order Zernike decomposition versus adjustment to a spherocylindrical surface is not reflected as improved subjective refraction prediction, which is poor, mainly in the spherical component. However, the highest achievable accuracy differs by only 0.75 D from that of other works with a more exhaustive eye refractive elements description. Although the chosen parameters may have not been the most efficient, applying machine learning and big data to predict subjective refraction can be risky and impractical when evaluating a particular subject at statistical extremes. Translational Relevance This work evaluates subjective refraction prediction by machine learning from the anterior corneal surface and ocular biometry. It shows the minimum biometric information required and the highest achievable accuracy. RESUMEN Objetivo El desarrollo de un modelo de regresión de aprendizaje automático prescripción refractiva subjetiva a partir de las características mínimas de la biometría ocular y la superficie corneal. Métodos Los parámetros de la superficie corneal anterior (coeficientes de Zernike y queratometría), además de longitudes axiales y de cámara anterior, edades y las refracciones subjetivas no ciclopléjicas de 355 ojos se dividieron en un conjunto de entrenamiento (75%) y otro de test (25%) y se entrenaron diferentes algoritmos de regresión de aprendizaje automático mediante validación cruzada 10 veces, se optimizaron y se probaron sobre el conjunto test. Resultados Los algoritmos de regresión del proceso gaussiano proporcionaron los mejores modelos con un error absoluto medio fue de alrededor de 1.00 D en el componente esférico y de 0.25 D en los componentes astigmáticos. Conclusiones Los pesos normalizados mostraron que la refracción subjetiva puede predecirse utilizando únicamente la queratometría, la edad y la longitud axial como características. El aumento del detalle de la descripción topográfica de la superficie corneal anterior que supone una descomposición de Zernike de alto orden frente al ajuste a una superficie esferocilíndrica realizado por queratometría no se refleja en una mejora de la predicción de la refracción subjetiva, que es pobre, en cualquier caso, principalmente en el componente esférico. Sin embargo, la máxima precisión alcanzada difiere en sólo 0,75 D de la de otros trabajos con una descripción más exhaustiva de los elementos refractivos del ojo. De todos modos, el aprendizaje automático y los datos masivos aplicados a la predicción de la refracción subjetiva pueden ser arriesgados y poco prácticos cuando se evalúa a un sujeto concreto en los extremos estadísticos, aunque los parámetros elegidos puedan no haber sido los más ineficaces. Relevancia Traslativa El trabajo evalúa la predicción de la refracción subjetiva mediante aprendizaje automático a partir de la superficie corneal anterior y la biometría ocular, mostrando la mínima información biométrica requerida y la máxima precisión alcanzable.
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Affiliation(s)
- Julián Espinosa
- IUFACyT, Universidad de Alicante, San Vicente del Raspeig, Spain.,Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Jorge Pérez
- IUFACyT, Universidad de Alicante, San Vicente del Raspeig, Spain.,Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Asier Villanueva
- IUFACyT, Universidad de Alicante, San Vicente del Raspeig, Spain
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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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Prediction Error Stabilization and Long-Term Standard Results with a Monofocal Intraocular Lens. Vision (Basel) 2022; 6:vision6010005. [PMID: 35076638 PMCID: PMC8788560 DOI: 10.3390/vision6010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the stability and differences between objective (O-Rx) and subjective (S-Rx) refraction for the assessment of the prediction error (PE). A secondary aim was to report the results of a monofocal intraocular lens (IOL). 100 subjects were included for whom S-Rx and O-Rx were obtained for all visits, and for visual performance, posterior capsular opacification incidence and Nd:YAG rates at 12 months. Either S-Rx and O-Rx showed a hyperopic shift from 1 to 6 months (p < 0.05) and stabilization after 6 months. S-Rx was related with the axial length (rho = −0.29, p = 0.007), obtaining a major tendency towards hyperopia in short eyes implanted with high-power IOLs. O-Rx showed a myopic shift in comparison to S-Rx (p < 0.05). This resulted in a decrease of the number of eyes in ±0.50 D and ±1.00 D from 79 to 67% and from 94 to 90%, respectively. The median (interquartile range) uncorrected and corrected visual acuities were 0.1 (0.29) and 0 (0.12) logMAR, respectively, and seven eyes required Nd:YAG capsulotomy at 12 months. Some caution should be taken in PE studies in which O-Rx is used or S-Rx is measured in a 1-month follow-up. Constant optimization should be conducted for this IOL after S-Rx stabilization.
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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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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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Abstract
Subjective refraction is the gold-standard for prescribing refractive correction, but its accuracy is limited by patient’s subjective judgment about their clarity of vision. We asked if an involuntary eye movement, optokinetic nystagmus (OKN), could serve as an objective measure of visual-clarity, specifically measuring the dependence of OKN—elicited by drifting spatial-frequency filtered noise—on mean spherical equivalent (MSE) refractive error. In Experiment 1 we quantified OKN score—a measure of consistency with stimulus-direction—for participants with different MSEs. Estimates of MSE based on OKN scores correlate well with estimates of MSE made using autorefraction (r = 0.878, p < 0.001, Bland–Altman analysis: mean difference of 0.00D (95% limits of agreement: − 0.85 to + 0.85D). In Experiment 2, we quantified the relationship between OKN gain (ratio of tracking eye-movement velocity to stimulus velocity) and MSEs (− 2.00, − 1.00, − 0.50, 0.00 and + 1.00D) induced with contact lenses for each participant. The mean difference between measures of MSE based on autorefraction or on OKN gain was + 0.05D (− 0.90 to + 1.01D), and the correlation of these measures across participants was r = 0.976, p < 0.001. Results indicate that MSE attenuates OKN gain so that OKN can be used as an objective proxy for patient response to select the best corrective lens.
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Venkataraman AP, Sirak D, Brautaset R, Dominguez-Vicent A. Evaluation of the Performance of Algorithm-Based Methods for Subjective Refraction. J Clin Med 2020; 9:jcm9103144. [PMID: 33003297 PMCID: PMC7599794 DOI: 10.3390/jcm9103144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: To evaluate the performance of two subjective refraction measurement algorithms by comparing the refraction values, visual acuity, and the time taken by the algorithms with the standard subjective refraction (SSR). Methods: The SSR and two semi-automated algorithm-based subjective refraction (SR1 and SR2) in-built in the Vision-R 800 phoropter were performed in 68 subjects. In SR1 and SR2, the subject’s responses were recorded in the algorithm which continuously modified the spherical and cylindrical component accordingly. The main difference between SR1 and SR2 is the use of an initial fogging step in SR1. Results: The average difference and agreement limits intervals in the spherical equivalent between each refraction method were smaller than 0.25 D, and 2.00 D, respectively. For the cylindrical components, the average difference was almost zero and the agreement limits interval was less than 0.50 D. The visual acuities were not significantly different among the methods. The times taken for SR1 and SR2 were significantly shorter, and SR2 was on average was three times faster than SSR. Conclusions: The refraction values and the visual acuity obtained with the standard subjective refraction and algorithm-based methods were similar on average. The algorithm-based methods were significantly faster than the standard method.
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Effect of Instrument Design and Technique on the Precision and Accuracy of Objective Refraction Measurement. J Clin Med 2020; 9:jcm9103061. [PMID: 32977411 PMCID: PMC7597959 DOI: 10.3390/jcm9103061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To evaluate the precision and accuracy of objective refraction measurement obtained with combinations of instrument design and technique. We also compared the performance of the instruments with subjective refraction measurements. Method and analysis: The objective refraction was measured in 71 subjects with three autorefractometers that have different designs and measurement principles (binocular with fogging, binocular without fogging, and monocular with fogging). Repeatability and reproducibility metrics were calculated for the objective refraction measurements. The agreement of the objective refraction measurements between the three instruments and the agreement with the subjective refraction measurements were evaluated. RESULTS All three autorefractometers had repeatability and reproducibility limits smaller than 0.70D. The smallest difference (0.10D) in the spherical equivalent was seen between the two binocular instruments. Compared with the subjective refraction, the binocular without fogging technique had the smallest mean difference in spherical equivalent (<0.20D) whereas the binocular fogging technique had the smallest limit of agreement interval (1.00D). For all comparisons, the mean difference and limit of agreement interval for the cylindrical components were lower than 0.10D and 0.75D, respectively. CONCLUSION All three instruments evaluated had good repeatability and reproducibility. The binocular fogging technique provided the best agreement with subjective refraction.
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Comparison of Two Wavefront Autorefractors: Binocular Open-Field versus Monocular Closed-Field. J Ophthalmol 2020; 2020:8580471. [PMID: 31976087 PMCID: PMC6961603 DOI: 10.1155/2020/8580471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose To evaluate the agreement and repeatability between a new commercially available binocular open-field wavefront autorefractor, as part of the Eye Refract system, and a monocular closed-field wavefront autorefractor (VX110). Methods A cross-sectional, randomized, and single-masked study was performed. Ninety-nine eyes of 99 healthy participants (37.22 ± 18.04 years, range 8 to 69 years) were randomly analyzed. Three measurements with the Eye Refract and the VX110 were taken on three different days, under noncycloplegic conditions. Mean spherical equivalent (MSE), cylindrical vectors (J0 and J45), and binocular corrected distance visual acuity (BCDVA) were compared between both autorefractors. An intersession repeatability analysis was done considering the values of repeatability (Sr) and its 95% limit (r). Results The VX110 showed more negative values (P < 0.001) in terms of MSE in comparison with the Eye Refract (0.20 D). Regarding cylindrical vectors, J45 showed statistically significant differences (P=0.001) between both wavefront autorefractors, but they were not clinically relevant (<0.05 D). In BCDVA, there were no statistically significant differences (P=0.667) between both wavefront autorefractors. Additionally, the Eye Refract was more repeatable than the VX110 in terms of both MSE (SrEYE REFRACT = 0.21 D, SrVX110 = 0.53 D) and J0 (SrEYE REFRACT = 0.12 D, SrVX110 = 0.35 D). Conclusions The Eye Refract provided enough accuracy and reliability to estimate refractive errors in different age groups, achieving better results than the VX110. Therefore, the Eye Refract proved to be a useful autorefractor to be incorporated into clinical practice.
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Shetty N, Dadachanji Z, Narasimhan R, Kundu G, Khamar P, Ahuja P, Kumar V, Kumar V, Shetty R, Nuijts RMMA, Sinha Roy A. Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK. J Refract Surg 2019; 35:624-631. [PMID: 31610003 DOI: 10.3928/1081597x-20190916-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/16/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during accommodation simultaneously with ocular aberrometry in eyes after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and transepithelial photorefractive keratectomy (TransPRK). METHODS Ocular aberrometry (Tracey Technologies, Houston, TX) was performed 3 months after LASIK (n = 95), SMILE (n = 73), and TransPRK (n = 35). While measuring the aberrations, VA was measured at distance (20 ft), intermediate (60 cm), and near (40 cm) targets. The examinations were done monocularly. A parallel group of age-matched normal eyes (n = 50) with 20/20 Snellen distance VA also underwent aberrometry. RESULTS Distribution of residual spherical error of LASIK eyes matched the normal eyes the best, followed by SMILE and TransPRK. However, the distribution of cylindrical error of the SMILE eyes was distinctly different from the rest (P < .05). The SMILE eyes tended to be undercorrected by approximately 0.25 diopters (D) on average at all reading targets compared to LASIK eyes (P < .05). The undercorrection was greater when the magnitude of the preoperative cylinder exceeded 0.75 D (P < .05). The VA of LASIK and SMILE eyes was similar to normal eyes at all targets, but the TransPRK eyes were marginally inferior (P < .05). Only the ocular defocus changed differentially between the study groups during accommodation and the magnitude of change was least for TransPRK eyes (P < .05). However, postoperative near and intermediate accommodation of LASIK eyes were similar to normal eyes, followed by SMILE eyes and then TransPRK eyes. CONCLUSIONS The refractive and aberrometric status of the LASIK eyes was closest to the normal eyes. The SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. [J Refract Surg. 2019;35(10):624-631.].
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