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Agreement and variability of subjective refraction, autorefraction, and wavefront aberrometry in pseudophakic patients

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First Author: M.Ruiss AUSTRIA

Co Author(s):    O. Findl   P. Draschl   A. Harrer-Seely   N. Hirnschall   -. -        

Abstract Details

Purpose:

One of the main goals of cataract surgery, beside removing the cataractous lens, is to achieve the patient’s desired post-operative refraction. Targeting this refraction depends mainly on the prediction of the post-surgical lens position, but also on the post-operative refraction itself. Reason for the contributing effect of post-surgical refraction in the error-propagation analysis is that refraction in phakic patients was shown to have only moderate reproducibility. Aim of this study was to evaluate agreement and variability of subjective refraction, autorefraction, and wavefront aberrometry in pseudophakic patients.

Setting:

Vienna Institute for Research in Ocular Surgery (VIROS), a Karl-Landsteiner Institute, Hanusch Hospital, Vienna.

Methods:

Subjective refraction of 90 eyes of 90 pseudophakic patients was performed by 2 independent examiners at 2 study visits. Furthermore, 5 autorefraction and wavefront aberrometry measurements were done in each patient at both visits. Agreement between the 3 refraction methods for spherical equivalent (M) and cylindrical vectors, J0 and J45, was analysed using Bland-Altman plots. Predictability of M determined by subjective refraction from autorefraction and wavefront aberrometry measurements was tested using Partial least squares regression and random forest regression.

Results:

Mean absolute error of subjective refraction measurements of M, J0, and J45 were comparable between both examiners and both study visits. Spherical equivalent was more myopic when measured by autorefraction (-0.87 D) and wavefront aberrometry (-0.90 D) compared to subjective refraction (-0.60), whereas astigmatic vectors agreed well. Good reliability was found between all 3 refraction methods for M, J0, and J45. Partial least squares regression and random forest regression showed moderate predictive power for M measured by objective and subjective refraction.

Conclusions:

Reproducibility and reliability of subjective refraction measurements in pseudophakic patients showed good agreement. Autorefraction and wavefront aberrometry measured the spherical equivalent more myopic than subjective refraction, whereas astigmatic vectors were comparable between the 3 methods after uneventful cataract surgery.

Financial Disclosure:

... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented