Related Experiment Video
Updated: Apr 25, 2026
Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
Published on: September 16, 2025
Overview of the repeatability, reproducibility, and agreement of the biometry values provided by various ophthalmic
Jos J Rozema1, Kristien Wouters2, Danny G P Mathysen1
1Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine and Health Science, University of Antwerp, Wilrijk, Belgium.
Purpose:
To present an overview of the measurement errors for various biometric devices, as well as a meta-analysis of the agreement between biometric devices using the Pentacam, Orbscan, and IOL Master as a reference.
Design:
Meta-analysis of the literature.
Methods:
The meta-analysis is based on data from 216 articles that compare a total of 24 different devices with the reference devices for the following 9 parameters: mean, steep and flat curvature of the anterior and posterior cornea; central corneal thickness; anterior chamber depth; and axial length. After the weighted average difference between devices has been determined, the "two one-sided t test" was used to test for equivalence between devices within certain thresholds defined by the measurement errors and the influence of these differences on the calculated refraction.
Results:
In only 17 of the 70 comparisons a device was equivalent with the reference device within the thresholds set by the measurement error. More lenient thresholds, based on a change in calculated refraction of ±0.25 diopter, increased this number to a maximum of 25/50 comparisons (excluding pachymetry). High degrees of inconsistency were seen in the reported results, which could partially explain the low agreement between devices.
Conclusion:
As a rule, biometry measurements taken by different devices should not be considered equivalent, although several exceptions could be identified. We therefore recommend that clinical studies involving multiple device types treat this as a within-subject variable to avoid bias. The follow-up of individual patients using different devices should be avoided at all times.
