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Evaluation of an open-field autorefractor's ability to measure refraction and hence potential to assess objective accommodation in pseudophakes
  1. James Stuart Wolffsohn1,
  2. Leon Nicholas Davies1,
  3. Shehzad Anjam Naroo1,
  4. Phillip Jonathan Buckhurst1,
  5. George Anthony Gibson1,
  6. Navneet Gupta1,
  7. Jennifer Patricia Craig1,2,
  8. Sunil Shah1,3,4
  1. 1Aston University, School of Life and Health Sciences, Ophthalmic Research Group, Birmingham, UK
  2. 2Department of Ophthalmology, University of Auckland, Auckland, New Zealand
  3. 3Midland Eye Institute, Birmingham, UK
  4. 4Birmingham and Midland Eye Centre, Birmingham, UK
  1. Correspondence to Professor James Stuart Wolffsohn, Aston University, Life and Health Sciences, Ophthalmic Research Group, Aston Triangle, Birmingham B4 7ET, UK; j.s.w.wolffsohn{at}


Background To evaluate the accuracy of an open-field autorefractor compared with subjective refraction in pseudophakes and hence its ability to assess objective eye focus with intraocular lenses (IOLs).

Methods Objective refraction was measured at 6 m using the Shin-Nippon NVision-K 5001/Grand Seiko WR-5100K open-field autorefractor (five repeats) and by subjective refraction on 141 eyes implanted with a spherical (Softec1 n=53), aspherical (SoftecHD n=37) or accommodating (1CU n=22; Tetraflex n=29) IOL. Autorefraction was repeated 2 months later.

Results The autorefractor prescription was similar (average difference: 0.09±0.53 D; p=0.19) to that found by subjective refraction, with ∼71% within ±0.50 D. The horizontal cylindrical components were similar (difference: 0.00±0.39 D; p=0.96), although the oblique (J45) autorefractor cylindrical vector was slightly more negative (by −0.06±0.25 D; p=0.06) than the subjective refraction. The results were similar for each of the IOL designs except for the spherical IOL, where the mean spherical equivalent difference between autorefraction and subjective was more hypermetropic than the Tetraflex accommodating IOL (F=2.77, p=0.04). The intrasession repeatability was <0.55 D (95% CI) and intersession repeatability <0.50 D in ≥85%.

Conclusions The autorefractor gives valid and repeatable measures of pseudophakic eye refraction and hence objective accommodation.

  • Intraocular lens
  • pseudophakia
  • objective accommodation
  • autorefractor
  • lens and zonules
  • optics and refraction

Statistics from


  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Solihull Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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