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Reproducibility of manifest refraction between surgeons and optometrists in a clinical refractive surgery practice

2014; Lippincott Williams & Wilkins; Volume: 40; Issue: 3 Linguagem: Inglês

10.1016/j.jcrs.2013.08.053

1873-4502

Dan Z. Reinstein, Timothy E. Yap, Glenn I. Carp, Timothy J. Archer, Marine Gobbé,

Glaucoma and retinal disorders

Purpose To measure and compare the interobserver reproducibility of manifest refraction according to a standardized protocol for normal preoperative patients in a refractive surgery practice. Setting Private clinic, London, United Kingdom. Design Retrospective case series. Methods This retrospective study comprised patients attending 2 preoperative refractions before laser vision correction. The first manifest refraction was performed by 1 of 7 optometrists and the second manifest refraction by 1 of 2 surgeons, all trained using a standard manifest refraction protocol. Spherocylindrical data were converted into power vectors for analysis. The dioptric power differences between observers were calculated and analyzed. Results One thousand nine hundred twenty-two consecutive eyes were stratified into a myopia group and a hyperopia group and then further stratified by each surgeon–optometrist combination. The mean surgeon–optometrist dioptric power difference was 0.21 diopter (D) (range 0.15 to 0.32 D). The mean difference in spherical equivalent refraction was 0.03 D, with 95% of all refractions within ±0.44 D for all optometrist–surgeon combinations. The severity of myopic or hyperopic ametropia did not affect the interobserver reproducibility of the manifest refraction. Conclusions There was close agreement in refraction between surgeons and optometrists using a standard manifest refraction protocol of less than 0.25 D. This degree of interobserver repeatability is similar to that in intraobserver repeatability studies published to date and may represent the value of training and the use of a standard manifest refraction protocol between refraction observers in a refractive surgery practice involving co-management between surgeons and optometrists. Financial Disclosure Dr. Reinstein is a consultant to Carl Zeiss Meditec AG and has a proprietary interest in the Artemis technology, Arcscan, Inc., through patents administered by the Cornell Center for Technology Enterprise and Commercialization. No other author has a financial or proprietary interest in any material or method mentioned.