Less is more: optimal recording time for measuring the steady-state accommodative response

Clinical Relevance Background: Steady-state accommodation is frequently evaluated with open-field autorefractors; however there is no consensus regarding the optimal test duration. Our results allow us to standardise the procedure followed for the assessment of the steady-state accommodative response in clinical and laboratory settings and may be of great relevance in time-constrained situations.

BACKGROUND

The present study aims to determine the optimal recording time to assess the magnitude and variability of the accommodative response with a binocular open-field autorefractor.

METHODS

The steady-state accommodative response of 84 healthy undergraduate students was dynamically measured using the Grand Seiko WAM-5500 autorefractor at 500 cm, 40 cm and 20 cm for 90 s while participants maintained focus on a stationary target. We examined the reliability and level of agreement between four time intervals (the first 10-s, 30-s, 60-s and 90-s) at three accommodative demands (0.2D, 2.5D and 5D).

RESULTS

The magnitude of accommodation showed an excellent level of reliability (intraclass correlation coefficient [ICC]> 0.90) for the comparisons between the 90-s, 60-s and 30-s time intervals at the three viewing distances tested. However, when including the 10-s interval, there was a moderate reduction of the reliability indices and an increase of the mean difference between two time intervals (intra-class correlation [ICC] ranging from 0.89 to 0.97; and ESs ranging from 0.16 to 0.42). For the variability of accommodation, we observed an excellent reliability for the comparisons of the 90-s and 60-s measures at the three accommodative demands (ICC: 0.95-0.96), whereas for the rest of comparisons we observed from moderate to good levels of reliability.

CONCLUSION

Our data indicate that of 30-s and 60-s are enough to accurately assess the magnitude and variability of the accommodative response with the WAM-5500 autorefractor, respectively.

Open versus closed view autorefraction in young adults

PURPOSE

While there are numerous studies comparing open-view autorefractors to subjective refraction or other open-view autorefractors, most studies between closed and open-view autorefraction tend to focus on children rather than young adults. The aim of this study was to determine the concordance in non-cycloplegic refractive error between two modern objective autorefractors: the closed-view monocular Topcon TRK-2P and the binocular open-view Grand Seiko WR-5500.

METHODS

Fifty young adults aged 20-29 years (mean age 22 ± 1.6 years) underwent non-cycloplegic autorefraction using the Grand Seiko WAM-5500 (open view) and Topcon TRK-2P (closed-view) autorefractors on both eyes. Findings were expressed as the isolated spherical component and were also converted from clinical to vector notation: Mean Spherical Error (MSE) and the astigmatic components J0 and J45.

RESULTS

Mean MSE ± SD was -1.00 ± 2.40D for the Grand Seiko WAM-5500 compared to -1.23 ± 2.29D for the Topcon TRK-2P. Up to seventy-six percent of the cohort had mean spherical errors from the Topcon TRK-2P which fell within ±0.50D of the Grand Seiko reading and 58% fell within ±0.25D. Mean differences between the two instruments were statistically significant for all components (J0, spherical, and MSE) (p < 0.01), except J45 (p > 0.05).

CONCLUSIONS

The differences in non-cycloplegic MSE between these two instruments are small, but statistically significant. From a clinical perspective the Topcon TRK-2P may serve as a useful starting point for subjective refraction, but additional work is needed to help further minimise differences between the instruments.

Variant myopia: A new presentation?

Purpose:

Variant myopia (VM) presents as a discrepancy of >1 diopter (D) between subjective and objective refraction, without the presence of any accommodative dysfunction. The purpose of this study is to create a clinical profile of VM.

Methods:

Fourteen eyes of 12 VM patients who had a discrepancy of >1D between retinoscopy and subjective acceptance under both cycloplegic and noncycloplegic conditions were included in the study. Fourteen eyes of 14 age- and refractive error-matched participants served as controls. Potential participants underwent a comprehensive orthoptic examination followed by retinoscopy (Ret), closed-field autorefractor (CA), subjective acceptance (SA), choroidal and retinal thickness, ocular biometry, and higher order spherical aberrations measurements.

Results:

In the VM eyes, a statistically and clinically significant difference was noted between the Ret and CA and Ret and SA under both cycloplegic and noncycloplegic conditions (multivariate repeated measures analysis of variance, P < 0.0001). A statistically significant difference was observed between the VM eyes, non-VM eyes, and controls for choroidal thickness in all the quadrants (Univariate ANOVA P < 0.05). The VM eyes had thinner choroids (197.21 ± 13.04 μ) compared to the non-VM eyes (249.25 ± 53.70 μ) and refractive error-matched controls (264.62 ± 12.53 μ). No statistically significant differences between groups in root mean square of total higher order aberrations and spherical aberration were observed.

Conclusion:

Accommodative etiology does not play a role in the refractive discrepancy seen in individuals with the variant myopic presentation. These individuals have thinner choroids in the eye with variant myopic presentation compared to the fellow eyes and controls. Hypotheses and clinical implications of variant myopia are discussed.

Spherical subjective refraction with a novel 3D virtual reality based system

PURPOSE

To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction.

METHODS

For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions.

RESULTS

With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was -0.034D (±0.454D). The corresponding 95% Limits of Agreement (LoA) were (-0.856D, 0.924D). In relation to precision, intra-observer mean difference for the M component was 0.034±0.195D for the Subj.C, 0.015±0.177D for the WAM and 0.072±0.197D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25D) in all instruments.

CONCLUSIONS

The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way.

Comparing the relative peripheral refraction effect of single vision and multifocal contact lenses measured using an autorefractor and an aberrometer: A pilot study

PURPOSE

To compare the contributions of single vision (SVCL) and multifocal contact lenses (MFCL) to the relative peripheral refraction (RPR) profiles obtained via an autorefractor and an aberrometer in a pilot study.

METHODS

Two instruments, Shin-Nippon NVision K5001 (SN) and COAS-HD, were modified to permit open field PR measurements. Two myopic adults (CF, RB) were refracted (cycloplegia) under eight conditions: baseline (no CL); three SVCLs: Focus Dailies(®) (Alcon, USA), PureVision(®) (Bausch & Lomb, USA) and AirOptix(®) (Alcon, USA); and four MFCLs: AirOptix(®) (Alcon, USA), Proclear(®) Distant and Near (Cooper Vision, USA), and PureVision(®) (Bausch & Lomb, USA). CLs had a distance prescription of -2.00D and for MFCLs, a +2.50D Add was selected. Five independent measurements were performed at field angles from -40° to +40° in 10° increments with both instruments. The COAS-HD measures were analyzed at 3mm pupil diameter. Results are reported as a change in the relative PR profile, as refractive power vector components: M, J180, and J45.

RESULTS

Overall, at baseline, M, J180 and J45 measures obtained with SN and COAS-HD were considerably different only for field angles ≥±30°, which agreed well with previous studies. With respect to M, this observation held true for most SVCLs with a few exceptions. The J180 measures obtained with COAS-HD were considerably greater in magnitude than those acquired with SN. For SVCLs, the greatest difference was found at -40° for AirOptix SV (ΔCF=3.20D, ΔRB=1.56D) and for MFCLs it was for Proclear Distance at -40° (ΔCF=2.58D, ΔRB=1.39D). The J45 measures obtained with SN were noticeably different to the respective measures with COAS-HD, both in magnitude and sign. The greatest difference was found with AirOptix Multifocal in subject RB at -40°, where the COAS-HD measurement was 1.50D more positive. In some cases, the difference in the RPR profiles observed between subjects appeared to be associated with CL decentration.

CONCLUSION

For most test conditions, distinct differences were observed between the RPR measures obtained with the two modified instruments. The differences varied with CL design and centration. Although the pilot study supports the interchangeable use of the two instruments for on- and off-axis refraction in unaided eyes or eyes corrected with low/no spherical aberration; we advocate the use of the COAS-HD over the SN for special purposes like refracting through multifocal CLs.