Subjective and Objective Refraction Using Autorefraction and Two Wavefront-based Aberrometers in Extended-Depth-of-Focus and Simultaneous Vision Intraocular Lenses

PURPOSE: To evaluate the agreement between subjective refraction (SR) and objective refraction (OR) obtained by an autorefractor (AR), Hartmann-Shack aberrometer, and ray-tracing aberrometer after implantation of a wavefront-shaping extended-depth-of-focus (EDOF) or diffractive simultaneous vision intraocular lens (SVIOL) and to assess the potential influences of biometric parameters. DESIGN: Prospective, comparative assessment agreement analysis. SUBJECTS: Patients with healthy eyes, without previous surgeries, implanted with an EDOF (group A) or SVIOL (group B). METHODS: SR performed by experienced opticians and OR with the 3 devices were compared for spherical and cylindrical refractive error, spherical equivalent (SE), and vector components. Axial length, pupil size, intraocular lens (IOL) power, and torus were analyzed as influential factors. MAIN OUTCOME MEASURES: Agreement of SE and spherical and cylindrical refractive error including vector analysis obtained by SR and OR with different devices. RESULTS: Group A comprised 42 eyes, and group B comprised 56 eyes. Mean SE was -0.11 diopters (D) (SR), -0.42 D (AR), -0.40 D (Hartmann-Shack), and -0.29 D (ray-tracing) for group A, and +0.18 D, +0.08 D, -0.03 D, and +0.23 D, respectively, for group B. Significant differences between SR and OR were found for most parameters, whereas none were found between vector components. Intraclass correlation coefficients between SR and OR were mostly poor-maximal moderate and poor for vector analysis. The highest proportion of eyes with an absolute difference ≤0.50 D between SR and OR was achieved with ray-tracing aberrometry in group A (79.5%) and with AR in group B (96.4%). Pupil size significantly affected SE differences between SR and Hartmann-Shack aberrometry in groups A and B, with the latter also being influenced by IOL toricity. CONCLUSIONS: OR with modern devices is not interchangeable with SR after implantation of the studied IOLs; agreement was greater for group B. Pupil size and partially IOL toricity had an impact on SE difference between SR and OR obtained by Hartmann-Shack aberrometry.