Clinical evaluation of an automated subjective refraction method implemented in a computer-controlled motorized phoropter

Otero, Carles; Aldaba, Mikel; Pujol, Jaume

doi:10.1016/j.optom.2018.09.001

Cited by 15 publications

(35 citation statements)

References 32 publications

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“…The automation of subjective refraction can optimize both the time spent on refraction and reduce examiner bias. The automated algorithms require the subjective response to be inputted during refraction and based on the response the algorithm decides the subsequent steps [ 12 , 14 ]. A previous study demonstrated a significant reduction in the time spent on subjective refraction with a semi-automatic algorithm from a binocular aberrometer incorporated with a phoropter [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Performance of Algorithm-Based Methods for Subjective Refraction

Venkataraman

Sirak

Brautaset

et al. 2020

JCM

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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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Section: Introductionmentioning

confidence: 99%

Evaluation of the Performance of Algorithm-Based Methods for Subjective Refraction

Venkataraman

Sirak

Brautaset

et al. 2020

JCM

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“…For noncycloplegic retinoscopy, Jorge et al 35 found 95% limits of agreement of ±0.65 D (interval of 1.30 D) in a sample of 192 healthy adults; similarly, Ciuffreda and Rosenfield 14 obtained 95% limits of agreement of ±0.84 D (interval of 1.64 D) in a sample of 50 participants. For autorefraction, there exist many comparison studies 3 , 7 , 12 , 14 , 25 – 27 , 29 , 31 , 35 – 37 because there are many different commercial autorefractometers. The 95% limits of agreement ranged from ±0.31 D (interval of 0.62 D) 25 to ±1.47 D (interval of 2.94 D).…”

Section: Discussionmentioning

confidence: 99%

“…Analogously to autorefraction, for wavefront sensor refractometers there are many validation studies 7 , 12 , 14 , 37 , 38 and the 95% limits of agreement ranged from ±0.56 D (interval of 1.12 D) 14 to ±1.04 D (interval of 2.08 D). 12 Finally, automated subjective refraction is not as popular as objective refraction systems; however, there exist a few studies, 25 , 27 , 29 , 36 , 38 , 39 each with a completely different automated algorithm, that found 95% limits of agreement between ±0.52 D (interval of 1.04 D) 38 to ±1.20 D (interval of 2.40 D). 39 Our results (and others) indicate that automated refraction techniques with devices such as the VAO are promising areas for applying artificial intelligence and algorithms for improving prediction of visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between Refraction From an Adaptive Optics Visual Simulator and Clinical Refractions

Tabernero

Otero

Pardhan

2020

Trans. Vis. Sci. Tech.

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Purpose The Visual Adaptive Optics (VAO) is an adaptive optics visual simulator with an embedded Hartmann–Shack aberrometer that can give objective and subjective refraction measures. The aim of the present study was to compare the findings of the objective and subjective refractions from the VAO with a commercial autorefractometer (Topcon Corp., Tokyo, Japan) and a subjective refraction by an optometrist. The influence of age, refractive error type, and presence of ocular diseases was ascertained. Methods The refractive error was obtained in 469 participants using the four techniques mentioned. Data were analyzed with power vectors mean spherical equivalent, the vertical Jackson-Cross-Cylinder, and the oblique Jackson-Cross-Cylinder. Age, refractive error type (myopia, emmetropia, hyperopia) and presence of ocular diseases (yes, no) were included as covariates. Agreement was assessed using the 95% interval of agreement. Results The median spherical equivalent difference and the interval of agreement for all the participants with the VAO subjective, VAO objective, and autorefraction with the clinical subjective refraction were (+0.13, 1.80 diopters [D]), (+0.38, 1.80 D), and (−0.38, 2.10 D), respectively. When considering only healthy participants, the results were (+0.06, 1.70 D), (+0.38, 1.60 D) and (−0.25, 1.80 D), respectively. When considering only those participants with any ocular condition, the results with VAO subjective, VAO objective and autorefraction were (+0.13, 2.50 D), (+0.31, 2.70 D), and (−0.50, 4.80 D), respectively. Conclusions The VAO subjective refraction is more accurate than VAO objective refraction and autorefraction, regardless of refractive error, age, or the presence of ocular conditions. The presence of ocular conditions significantly deteriorates the accuracy of all refraction methods. Translational Relevance Reported clinical comparisons between different types of standard refraction methods and a new adaptive optics refraction instrument (VAO) are in good agreement and support the further development of this method to increase refraction accuracy and to refract quicker than standard procedures.

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“…Although no studies evaluating repeatability of automated subjective refraction in keratoconus subjects were found in the scientific literature, some authors evaluated it in healthy subjects [ 10 – 13 , 15 ]. With the first instrument to perform automated subjective refraction, the BV-1000 (Topcon; Tokyo, Japan), Dave and Fukuma [ 10 ] found better repeatability in all the refractive variables (M, J0, and J45) than the Eye Refract in the healthy group.…”

Section: Discussionmentioning

confidence: 99%

“…Despite autorefractors allowing us to obtain previous objective refraction as a reference to facilitate subjective refraction, their main limitation is an overestimation of myopia or underestimation of hyperopia [ 2 – 9 ]. Due to the impossibility of using autorefractors to perform accurate and precise refraction as the gold standard, new devices are being developed to perform automated subjective refraction [ 10 – 15 ]. The purpose of these devices is to use an automated algorithm controlled by software to make a subjective adjustment of refraction based on previous objective refraction obtained from autorefraction.…”

Section: Introductionmentioning

confidence: 99%

Repeatability of Aberrometry-Based Automated Subjective Refraction in Healthy and Keratoconus Subjects

Carracedo

Carpena-Torres

Pastrana

et al. 2020

Journal of Ophthalmology

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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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Clinical evaluation of an automated subjective refraction method implemented in a computer-controlled motorized phoropter

Cited by 15 publications

References 32 publications

Evaluation of the Performance of Algorithm-Based Methods for Subjective Refraction

Evaluation of the Performance of Algorithm-Based Methods for Subjective Refraction

A Comparison Between Refraction From an Adaptive Optics Visual Simulator and Clinical Refractions

Repeatability of Aberrometry-Based Automated Subjective Refraction in Healthy and Keratoconus Subjects

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