Dataset Information

Visual acuity testing using autorefraction or pinhole occluder compared with a manual protocol refraction in individuals with diabetes.

ABSTRACT:

Purpose

To compare visual acuity (VA) scores obtained after autorefraction or using a pinhole occluder to scores obtained after refraction according to a standard clinical research protocol.

Design

Prospective, comparative case series.

Participants

One hundred ten study participants (209 eyes) with diabetes mellitus and a broad range of diabetic retinopathy severity and VA.

Methods

We measured VA after autorefraction by a Topcon KR-8000 autorefractor as well as after a Diabetic Retinopathy Clinical Research Network (DRCR.net) protocol manual refraction. The order of testing was randomized and examiners were masked to the source of each refraction. A second VA measurement, utilizing an identical DRCR.net manual refraction, was made in a subset of eyes (n = 144; 69%) to establish test-retest variability for comparison purposes. All eyes underwent VA testing using a pinhole occluder.

Main outcome measures

Best corrected VA as measured by the Electronic Early Treatment Diabetic Retinopathy Study Visual Acuity Test (E-ETDRS).

Results

In all eyes, the median E-ETDRS VA letter score (EVA) obtained after manual refraction (MR-EVA) was 69 (Snellen equivalent 20/40), ranging from 4 to 93 (20/800 to 20/16). The median MR-EVA was slightly better than the median EVA obtained after autorefraction (AR-EVA), with a median difference (AR-EVA - MR-EVA) of -1 letter (25th, 75th percentiles, -4, 2 letters). The absolute difference between AR-EVA and MR-EVA was similar to the test-retest variability of MR-EVA alone. In contrast, MR-EVA was better than EVA obtained using a pinhole occluder (PH-EVA; median PH-EVA - MR-EVA, -4 letters [-9, 0]), and had significantly less test-retest variability (P<0.001). Generally, the spherical equivalent of autorefraction was slightly more hyperopic (or less myopic) than the spherical equivalent of manual refraction (median difference, +0.25 diopters [0, +0.63]).

Conclusions

Given the substantial time and effort required for training and certification of study protocol refractionists, and the similarity between AR-EVA and MR-EVA, further evaluation of autorefraction, but not pinhole occluder testing, as an alternative to the current clinical research gold standard of ETDRS protocol manual refraction in study participants with diabetic retinopathy is warranted.

SUBMITTER: Sun JK

PROVIDER: S-EPMC3057328 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Publications

Visual acuity testing using autorefraction or pinhole occluder compared with a manual protocol refraction in individuals with diabetes.

Sun Jennifer K JK Aiello Lloyd Paul LP Cavallerano Jerry D JD Stockman Margaret M Miller Kellee M KM Qin Haijing H Beck Roy W RW Glassman Adam R AR

Ophthalmology 20101014 3

<h4>Purpose</h4>To compare visual acuity (VA) scores obtained after autorefraction or using a pinhole occluder to scores obtained after refraction according to a standard clinical research protocol.<h4>Design</h4>Prospective, comparative case series.<h4>Participants</h4>One hundred ten study participants (209 eyes) with diabetes mellitus and a broad range of diabetic retinopathy severity and VA.<h4>Methods</h4>We measured VA after autorefraction by a Topcon KR-8000 autorefractor as well as after ...[more]

PMID: 20947171

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Project description:ObjectiveTo compare visual acuity (VA) scores after autorefraction vs manual refraction in eyes of patients with diabetes mellitus and a wide range of VAs.MethodsThe letter score from the Electronic Visual Acuity (EVA) test from the electronic Early Treatment Diabetic Retinopathy Study was measured after autorefraction (AR-EVA score) and after manual refraction (MR-EVA score), which is the research protocol of the Diabetic Retinopathy Clinical Research Network. Testing order was randomized, study participants and VA examiners were masked to refraction source, and a second EVA test using an identical supplemental manual refraction (MR-EVAsuppl score) was performed to determine test-retest variability.ResultsIn 878 eyes of 456 study participants, the median MR-EVA score was 74 (Snellen equivalent, approximately 20/32). The spherical equivalent was often similar for manual refraction and autorefraction (median difference, 0.00; 5th-95th percentile range, -1.75 to 1.13 diopters). However, on average, the MR-EVA scores were slightly better than the AR-EVA scores, across the entire VA range. Furthermore, the variability between the AR-EVA scores and the MR-EVA scores was substantially greater than the test-retest variability of the MR-EVA scores (P < .001). The variability of differences was highly dependent on the autorefractor model.ConclusionsAcross a wide range of VAs at multiple sites using a variety of autorefractors, VA measurements tend to be worse with autorefraction than manual refraction. Differences between individual autorefractor models were identified. However, even among autorefractor models that compare most favorably with manual refraction, VA variability between autorefraction and manual refraction is higher than the test-retest variability of manual refraction. The results suggest that, with current instruments, autorefraction is not an acceptable substitute for manual refraction for most clinical trials with primary outcomes dependent on best-corrected VA.

Project description:BackgroundThe accuracy of open-field autorefractors is important for vision screening, clinical care, and vision research, especially in patients with childhood myopia. TOPCON KR3000 autorefractor was conventional autorefractor and subjective refraction after cycloplegia was gold criteria for assessing the refraction. Results of refractive error in Chinese school-aged children obtained by three methods were evaluated and compared.MethodsA cross-sectional study was conducted. A total of 89 patients (with a total of 177 eyes) diagnosed as refractive error in the Affiliated Hospital of Nanjing University of Chinese Medicine from July 2020 to September 2020 were sequentially enrolled in this study. All subjects underwent routine ophthalmic examination to exclude other ocular diseases and had a best corrected visual acuity no less than 0.1 The spherical diopter (SD), spherical equivalence (SE), and astigmatism (J0 and J45) were determined in patients before cycloplegia using two autorefractors, and again after cycloplegia. Subjective refraction results were obtained simultaneously after cycloplegia as gold criteria for comparison. A comparison of data between three methods was performed using paired t-tests and presented graphically using Bland-Altman plots.ResultsBefore cycloplegia, the SD and SE results from WAM were 0.14 D and 0.12 D more positive than the reading from TOPCON (P=0.011 and P=0.021, respectively). The SD measured by WAM and TOPCON was 0.31 D and 0.45 D more negative than the values obtained by subjective refraction after cycloplegia, respectively (P<0.001 and P<0.001, respectively). The SE readings also showed a similar trend (P<0.001, P<0.001). After cycloplegia, the SD and SE measurement obtained with WAM were 0.13 D and 0.12 D more positive than those measured by TOPCON (P<0.001 and P<0.001, respectively), and this was not significantly different to the results obtained using subjective refraction. However, the results of SD, SE, and J0 measured by the TOPCON were significantly different from the results obtained using subjective refraction (P<0.001, P<0.001, and P=0.002, respectively).ConclusionsIn clinical application, the measurements obtained with the WAM-5500 autorefractor were more reliable than those of the TOPCON KR3000 autorefractor in patients with or without cycloplegia. The WAM-5500 Autorefractor represents a reliable and valid objective refraction tool for optometric practice.

Project description:BackgroundEndotracheal intubation by direct laryngoscopy is a mainstay of advanced airway management performed both in the prehospital environment and in the Emergency Department. Many factors may affect the quality of view during direct laryngoscopy, one of them being the visual acuity (VA) of the intubator under these demanding conditions. While some individual variation in VA is to be expected in younger populations, VA naturally deteriorates in older populations particularly beyond the age of 40 years. This study aimed to describe VA in a younger (n=19) and an older (≥40 years of age, n=20) cohort of intubators at baseline and during simulated adult laryngoscopy, and to compare VA between these two age cohorts.MethodsA baseline near VA test was done using a Sloan Early Treatment Diabetic Retinopathy Study (EDTRS) near vision chart at 40 cm under ambient indoor light. Participants in both age cohorts were then requested to perform laryngoscopy using an airway simulator at 40 cm viewing distance and again at a viewing distance of their choice. Both binocular and monocular VA were tested using a near VA chart placed anterior to the vocal cords of the airway trainer. VA was quantified using the logarithm of the minimum angle of resolution (logMAR). Differences in VA between age cohorts were assessed using independent samples t-tests and differences within age cohorts were assessed using paired samples t-tests.ResultsBinocular and monocular near VA was significantly reduced in the older cohort compared to the younger cohort at baseline (both eyes -0.129 logMAR; p = 0.04, right eye -0.147 logMAR; p = 0.005, left eye -0.197 logMAR; p = 0.002). Within each age cohort VA was significantly reduced during laryngoscopy at a fixed viewing distance (younger; both eyes -0.111 logMAR; p < 0.001, right eye -0.095 logMAR; p < 0.001, left eye -0.105 logMAR; p < 0.001; older; both eyes -0,08 logMAR; p < 0.001, right eye -0.110 logMAR; p < 0.001, left eye -0.065 logMAR; p = 0.01) but this was improved by reducing viewing distance.ConclusionIncreased age was associated with a significant reduction in VA at baseline and during laryngoscopy, which can be partially compensated for by adjusting viewing distance. Although it is currently unknown to what extent this age-related reduction of VA might negatively affect time to place an endotracheal tube or success of placement under direct vision, older intubators should be aware of this effect and consider specialized corrective eyewear in order to maintain an adequate level of VA.

Dataset Information

Visual acuity testing using autorefraction or pinhole occluder compared with a manual protocol refraction in individuals with diabetes.

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Publications

Visual acuity testing using autorefraction or pinhole occluder compared with a manual protocol refraction in individuals with diabetes.

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