Reliability of handheld autorefractometers in patients after cataract surgery

Accurate postoperative refraction assessment is essential for optimal visual rehabilitation after cataract surgery. Although handheld autorefractometers (HH-ARMs) are widely used in pediatric and uncooperative patients, their reliability in adults after cataract surgery remains uncertain. This study compared refractive outcomes obtained with a HH-ARM (Mediworks V100; Mediworks, Guangzhou, China) and a TB-ARM (Canon RK-F2; Canon Inc., Tokyo, Japan) to evaluate the clinical applicability of HH-ARM in this population.

This prospective study included 150 eyes of 150 patients (aged 55-85 years) who underwent uncomplicated phacoemulsification with intraocular lens (IOL) implantation. At 1 month postoperatively, spherical value (SV), cylindrical value (CV), cylindrical axis (CVA), and spherical equivalent (SE) were measured under cycloplegia with both devices. Agreement between devices was evaluated using nonparametric tests and Bland-Altman analysis.

SV and CV differed significantly between devices (p = 0.04 and p < 0.001, respectively), while no significant differences were observed in CVA (p = 0.44) or SE (p = 0.09). Bland-Altman analysis confirmed close agreement for SE (mean difference -0.08 D; 95% limits of agreement [LoA] -1.57 D to 1.42 D). Regression analysis indicated that SE values were statistically interchangeable, whereas SV and CV were not.

HH-ARM demonstrated clinically acceptable agreement with TB-ARM for SE values, making SE the most reliable parameter for postoperative refraction in adults. These findings underscore the clinical relevance of HH-ARM as a practical alternative for patients with limited mobility and represent a novel contribution by validating its use in a population where evidence has been scarce. Further studies comparing HH-ARM with subjective refraction and across diverse surgical contexts are warranted.