Subjective and Objective Refraction Using Autorefraction and Two Wavefront-based Aberrometers in...

Area of Science:

• Ophthalmology
• Optometry
• Biomedical Engineering

Background:

• Intraocular lenses (IOLs) are crucial for vision correction after cataract surgery.
• Extended-depth-of-focus (EDOF) and simultaneous vision intraocular lenses (SVIOLs) offer advanced visual rehabilitation.
• Accurate refractive outcomes are essential for patient satisfaction and visual function.

Purpose of the Study:

• To compare subjective refraction (SR) with objective refraction (OR) using autorefractors and aberrometers post-EDOF/SVIOL implantation.
• To evaluate the agreement between SR and OR measurements.
• To identify biometric factors influencing refractive outcome discrepancies.

Main Methods:

• Prospective comparative assessment of agreement between SR and OR.
• Objective refraction measured using autorefractor (AR), Hartmann-Shack aberrometer, and ray-tracing aberrometer.
• Analysis of spherical/cylindrical error, spherical equivalent (SE), and vector components.
• Biometric parameters including axial length, pupil size, IOL power, and toricity were assessed.

Main Results:

• Significant differences observed between SR and OR for most refractive parameters, except vector components.
• Intraclass correlation coefficients between SR and OR were generally poor to moderate.
• Ray-tracing aberrometry showed higher agreement (≤0.50 D difference) in the EDOF group (79.5%), while AR was superior in the SVIOL group (96.4%).
• Pupil size and IOL toricity impacted SE differences, particularly with Hartmann-Shack aberrometry.

Conclusions:

• Objective refraction measurements are not interchangeable with subjective refraction after EDOF/SVIOL implantation.
• Agreement between SR and OR was greater for SVIOLs compared to EDOF IOLs.
• Pupil size and IOL toricity are significant influencing factors on refractive outcome discrepancies.