Related Experiment Video
Updated: May 2, 2026
Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
Published on: September 16, 2025
Reproducibility of manifest refraction between surgeons and optometrists in a clinical refractive surgery practice
Dan Z Reinstein1, Timothy E Yap1, Glenn I Carp1
1From the London Vision Clinic (Reinstein, Yap, Carp, Archer, Gobbe), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (Reinstein), Paris, France.
Purpose:
To measure and compare the interobserver reproducibility of manifest refraction according to a standardized protocol for normal preoperative patients in a refractive surgery practice.
Setting:
Private clinic, London, United Kingdom.
Design:
Retrospective case series.
Methods:
This retrospective study comprised patients attending 2 preoperative refractions before laser vision correction. The first manifest refraction was performed by 1 of 7 optometrists and the second manifest refraction by 1 of 2 surgeons, all trained using a standard manifest refraction protocol. Spherocylindrical data were converted into power vectors for analysis. The dioptric power differences between observers were calculated and analyzed.
Results:
One thousand nine hundred twenty-two consecutive eyes were stratified into a myopia group and a hyperopia group and then further stratified by each surgeon-optometrist combination. The mean surgeon-optometrist dioptric power difference was 0.21 diopter (D) (range 0.15 to 0.32 D). The mean difference in spherical equivalent refraction was 0.03 D, with 95% of all refractions within ±0.44 D for all optometrist-surgeon combinations. The severity of myopic or hyperopic ametropia did not affect the interobserver reproducibility of the manifest refraction.
Conclusions:
There was close agreement in refraction between surgeons and optometrists using a standard manifest refraction protocol of less than 0.25 D. This degree of interobserver repeatability is similar to that in intraobserver repeatability studies published to date and may represent the value of training and the use of a standard manifest refraction protocol between refraction observers in a refractive surgery practice involving co-management between surgeons and optometrists.
