Agreement And Variability Of Subjective Refraction, Autorefraction, And Wavefront Aberrometry In Pseudophakic Patients

Purpose: To evaluate the comparability and variability of subjective refraction (SR), autorefraction (AIR), and wavefront aberrometry (WA) in pseudophakic patients.Setting: Hanusch Hospital, Vienna, Austria.Design: Prospective study.Methods: Subjective refraction was performed by 2 independent examiners at 2 study visits. Furthermore, 5 meastirements of AIR and WA were performed in each patient at both visits. Agreement between the 3 refraction methods for spherical equivalent (M) and cylindrical vectors (J(0), J(45)) was analyzed using Friedman multiple comparison and Bland-Altman plots. Predictability of spherical equivalent determined by SIR from AR and WA measurements was tested with partial least squares regression and random forest regression.Results: Ninety eyes of 90 pseudophakic patients were measured. The mean absolute error and arithmetic mean difference of SR measurements of M, J(0), and J(45) were comparable between both examiners. A small mean difference was found for SR between both visits. Spherical equivalent was more negative when measured by AR [-0.87 diopters (D)] and WA (-0.90 D) compared with SR (-0.60 D), whereas astigmatic vectors agreed well. Good testretest reliability was found between all 3 refraction methods for M, J(0), and J(45). Partial east squares regression and random forest regression showed moderate predictive power for M measured by objective refraction and SR.Conclusions: Reproducibility and reliability of SR measurements in pseudophakic patients showed good agreement. AR and WA measured the spherical equivalent more myopic than SR, whereas astigmatic vectors were comparable between the 3 methods after uneventful cataract surgery.