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First Author: M.Gobbe UK
Co Author(s): D. Reinstein T. Archer T. Yap G. Carp
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To measure and compare the inter-observer reproducibility of manifest refraction according to a standardized protocol for normal pre-operative subjects in a refractive surgery practice.
London Vision Clinic, London, UK
A retrospective study of patients attending two pre-operative refractions prior to laser vision correction. The first manifest refraction was carried out by one of seven optometrists and the second manifest refraction carried out by one of two surgeons, all trained using a standard manifest refraction protocol. Sphero-cylindrical data was converted into power vectors for analysis. The dioptric power differences between observers were calculated and analyzed.
1,922 consecutive eyes were stratified into either myopic or hyperopic groups and then further stratified by each surgeon/optometrist combination. The average (range) of mean dioptric power difference was 0.21 D (0.15 to 0.32 D) and the mean difference in spherical equivalent refraction was 0.03 D with 95% of all refractions within ḟ0.44 D for all optometrist/surgeon combinations. Severity of ametropia either myopic or hyperopic was not found to affect the inter-observer reproducibility of manifest refraction.
This study demonstrated a concordance in refraction between surgeons and optometrists using a standard manifest refraction protocol of less than 0.25 D. This degree of inter-observer repeatability is similar to intra-observer repeatability studies published to date and may represent the value of training and use of a standard manifest refraction protocol between refraction observers in a refractive surgery practice involving co-management between surgeons and optometrists.