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Assessment of subjective refraction with a clinical adaptive optics visual simulator

Purpose: To clinically validate an adaptive optics visual simulator (VAO) that measures subjective refraction and visual acuity.

Setting: Optics Laboratory, University of Murcia, Murcia, Spain.

Design: Prospective case series.

Methods: Using the adaptive optics visual simulator, 2 examiners measured the subjective refraction and visual acuity in healthy eyes of volunteers; 1 examiner also used a trial frame as a gold standard. The interexaminer reproducibility and agreement with the gold standard were estimated using the following statistical parameters: limits of agreement from Bland-Altman analysis, significance between differences (P value), and intraclass correlation
coefficient (ICC).

Results: Seventy-six eyes of 38 volunteers were measured. Interexaminer reproducibility for subjective refraction was excellent (ICC R0.96; P > .05), with low 95% confidence interval (CI) values for the power vectors M (spherical equivalent of the given refractive error),J0 (Jackson cross-cylinder, axes at 180 degrees and 90 degrees), and J45 (Jackson cross-cylinder, axes at 45 degrees and 135 degrees) (G0.51 diopter [D], G0.14 D, and G0.14 D, respectively). No significant differences in subjective refraction and visual acuity were found between the visual simulator and gold standard (P > .05), with 95% CIs for M, J0, and J45 (subjective refraction) of G0.67 D, G0.14 D, and G0.16 D, respectively, and a G0.10 logarithm of the minimum angle of resolution (visual acuity).

Conclusion: Subjective refraction results using the adaptive optics visual simulator agreed with those of the gold standard and can be used as the baseline for visual simulation of any optical corneal profile or intraocular lens design for refractive surgery patients.

J Cataract Refract Surg 2018;-:-–-Q 2018 The Authors. Published by Elsevier Inc. on behalf of ASCRS and ESCRS. This is an open access article under the CC BY license (


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