Accuracy, Repeatability, and Clinical Application of Spherocylindrical Automated Refraction Using Time-based Wavefront Aberrometry Measurements

Purpose: To evaluate the clinical utility of spherocylindrical automated refraction (AR) based on time-based wavefront technology compared with subjective manifest refraction (MR) for the purpose of prescribing eyeglasses.

Design: Prospective observational case series.

Participants: A convenience sample of 105 eyes of 53 patients (ages 19 to 87) with corrected acuity no worse than 20/40(-2).

Methods: Manifest refraction was performed on all subjects followed by three consecutive wavefront measurements at both a 4-mm and 6-mm optical zone using the 3D Wave OPD Scan ARK 10,000 aberrometer.

Main Outcome Measures: Repeatability of multiple consecutive ARs; difference in the sphere, cylinder, and axis of AR compared with MR; difference between the corrected visual acuity based on AR- and MR-derived acuity.

Results: Repeatability analysis showed that the initial wavefront refraction was not significantly different from the mean of the three refractions. At the 4-mm zone, the absolute value (+/- standard deviation) of the difference between the initial AR compared with the MR was 0.34+/-0.28 diopters (D) for sphere, 0.22+/-0.21 D for cylinder, and 12.5+/-15.8 degrees for axis. At the 6-mm zone, these values were 0.32+/-0.29 D for sphere, 0.25+/-0.24 D for cylinder, and 11.8+/-14.6 degrees for axis. When 4-mm AR visual acuity was superior to MR acuity (19.0% of eyes) it was 0.28+/-0.24 Snellen lines better, and when inferior (53.3% of eyes) it was 0.47+/-0.37 lines worse. When 6-mm AR acuity was superior to MR acuity (16.2% of eyes) it was 0.32+/-0.22 Snellen lines better, and when inferior (60.0% of eyes) it was 0.48+/-0.48 lines worse. The absolute value of the difference in spherical equivalent of the first AR measurement at the 4-mm zone compared with the MR value was 0.33+/-0.23 D, and at the 6-mm zone it was 0.30+/-0.27 D.

Conclusions: The wavefront-derived AR values reflect the physical optical system, but not necessarily subjectively derived values, and the impact of this disagreement on patient satisfaction is unknown. Future studies evaluating this technology and its role in clinical ophthalmology are warranted.