Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter

Summary

The binocular wavefront optometer agrees well with traditional refraction techniques in both objective and subjective refraction measurements, offering superior accuracy and clinical utility. Its standardized protocol reduces optometrist workload and provides a more accurate refractive assessment for post-refractive surgery individuals.

Abstract

The aim is to evaluate the agreement and accuracy of refraction using a binocular wavefront optometer with the autorefractor and phoropter. To do this, 1 month after corneal refractive surgery, the right eyes of 125 subjects were enrolled in this cross-sectional study. Objective and subjective refractions were measured using a binocular wavefront optometer, an autorefractor, and a phoropter in a noncycloplegic condition. The differences and agreement of refractive data were analyzed using the Wilcoxon signed-rank test and Bland-Altman plots. The differences between sphere (Z=-0.872, p=0.38), J₀ (Z=-0.065, p=0.95), J₄₅ (Z=-1.199, p=0.23), and SE (Z=-1.316, p=0.19), objectively detected by binocular wavefront optometer and autorefractor, were not statistically significant. The differences between J₀ (Z=-0.533, p=0.59), J₄₅ (Z=-0.724, p=0.47), and SE (Z=-0.933, p=0.35), subjectively detected by binocular wavefront optometer and phoropter, were not statistically significant, whereas sphere (Z=-3.699, p<0.0001) had statistically significant differences. The Bland-Altman plots showed agreement between binocular wavefront optometer objective refraction and autorefractor in sphere (95% LoA: -1.00 D to 0.89 D), J₀ (95% LoA: -0.47 D to 0.47 D), J₄₅ (95% LoA: -0.55 D to 0.58 D), and SE (95% LoA: -0.89 D to 0.96 D). The Bland-Altman plots also showed agreement between binocular wavefront optometer subjective refraction and phoropter in sphere (95% LoA: -0.59 D to 0.82 D), J₀ (95% LoA: -0.47 D to 0.43 D), J₄₅ (95% LoA: -0.47 D to 0.43 D), and SE (95% LoA: -0.66 D to 0.74 D). Conclusively, the binocular wavefront optometer is an effective instrument, demonstrating good agreement between its objective and subjective refraction results and those obtained from autorefractor and phoropter, its smaller refractive intervals presenting a high accuracy in refractive error detection.

Introduction

Corneal refractive surgery has become one of the main modalities for correcting refractive error due to its safety, efficacy, and predictability¹. Accurate measurement of refractive error is an important indicator for evaluating changes in visual quality after refractive surgery². Currently, objective refraction measurements in clinical practice are usually detected by the autorefractor, and they are used as a starting point for subjective refraction. Subjective refraction is usually assessed by an optometrist operating the phoropter, and this optometrist-obtained subjective refraction is used as the gold standard for ev....

Protocol

The study adhered to the tenets of the Declaration of Helsinki and was approved by the Medical Ethics Committee of the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine [Approval No. HEC-HY-2023005KY]. Informed consent was obtained from all participants. All participants who were eligible under the inclusion criteria agreed to take part. Registration Date: 2024-05-28 00:00:00; Registration number: ChiCTR2400084952; Registration database: Chinese Clinical Trial Registry.

1. Patient selection

NOTE: This cross-sectional study included 125 participants (63 males and 62 fema....

Results

To demonstrate the accuracy of the binocular wavefront optometer in refractive measurements through refraction analysis and agreement analyses, while illustrating its advantages in improving visual outcomes through best corrected visual acuity and trial lens results.

Refraction analysis
There were no significant differences in sphere (Z=-0.87, p=0.38), J₀ (Z=-0.07, p=0.95), J₄₅ (Z=-1.20, p=0.23), and SE (Z=-1.32, p=0.19) between non-cycloplegic object.......

Discussion

The binocular wavefront optometer used in this cross-sectional study is an integrated subjective-objective optometric device. The results suggested that the difference between the objective refraction measured by the binocular wavefront optometer and autorefractor was not statistically significant, and the Bland-Altman agreement plots demonstrated good agreement between the two instruments. Objective refraction measured by the binocular wavefront optometer is biased towards myopic drift compared to autorefractor results;.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
autorefractor	Nidek Ltd	AR-310A	A device to detect objective refraction
binocular wavefront optometer	Aizhitong Medical Technology Co., Ltd	ZJAZT/BQYGY-1	A device with simultaneous subjective and objective optometry and wavefront aberration analysis
phoroptor	Nidek Ltd	Nidek RT-600 and Nidek SSC-350	A device to detect subjective refraction
trial case lens	Danyang Huahui Optical Instrument Co., Ltd	266-B	trial lens in 0.25 D increments used for the phoroptor
trial lens	Aizhitong Medical Technology Co., Ltd	AZT-203	trial lens in 0.05 D increments used for the binocular wavefront optometer