Objective accommodation measurement with the Grand Seiko and Hartinger coincidence refractometer

Subjective push-up tests and dynamic retinoscopy are standard clinical accommodation tests. These are inadequate for assessing if accommodation can be restored in presbyopes. Commercially available clinical autorefractors offer potentially reliable methods for objective accommodation measurement. This study evaluated accuracy and reliability of the Grand Seiko WR-5100K autorefractor for objective accommodation measurement in young adults.

Twenty-two subjects, aged 21 to 30 years (mean 25.6 +/- 2.26) participated. Three methods were used to stimulate and measure accommodation: (1) subjective push-up test in free space, (2) a near target pushed-up on a near-point rod and the response measured with the WR-5100K and a Hartinger coincidence refractometer (HCR), and (3) a distant target viewed through increasing powered negative trial lenses and the response measured with the WR-5100K and the HCR. Trial lens calibration procedures were also used to test the accuracy of the instruments.

Average maximum accommodative amplitude with the subjective push-up test was 7.74 D +/- 0.36 D (mean +/- SE). For a 5 D stimulus, accommodation of 4.68 D +/- 0.10 D (mean +/- SE) and 4.13 D +/- 0.09 D was measured with the WR-5100K and the HCR, respectively. With a distant target viewed through a -5.00 D trial lens, the WR-5100K measured 4.07 D +/- 0.09 D and the HCR measured 4.05 D +/- 0.09 D of accommodation. Maximum mean response measured with trial lens-induced accommodation was 5.67 D +/- 0.15 D with the WR-5100K and 5.77 D +/- 0.18 D with the HCR.

The subjective push-up test overestimated accommodative amplitude relative to the objective measures. The WR-5100K showed good agreement in the responses measured for both pushed-up near targets and a distant target viewed through trial lenses with the HCR, a widely used laboratory instrument. The Grand Seiko WR-5100K, a commercially available instrument, has been demonstrated to be well suited for clinical, objective accommodation measurement using a population of normal young adults.