Quality of eyeglass prescriptions from a low-cost wavefront autorefractor evaluated in rural India: results of a 708-participant field study

AUTHORS
Nicholas J Durr
Shivang R Dave
Daryl Lim
Sanil Joseph
Thulasiraj D Ravilla
Eduardo Lage
JOURNAL BMJ open Ophthalmology 2019;4: e000225
ABSTRACT Objective: To assess the quality of eyeglass prescriptions
provided by an affordable wavefront autorefractor operated
by a minimally trained technician in a low-resource setting.
Methods and Analysis 708 participants were recruited
from consecutive patients registered for routine eye
examinations at Aravind Eye Hospital in Madurai, India,
or an affiliated rural satellite vision centre. Visual acuity
(VA) and patient preference were compared between trial
lenses set to two eyeglass prescriptions from (1) a novel
wavefront autorefractor and (2) subjective refraction by an
experienced refractionist.
Results The mean±SD VA was 0.30±0.37, –0.02±0.14
and −0.04±0.11 logarithm of the minimum angle of
resolution units before correction, with autorefractor
correction and with subjective refraction correction,
respectively (all differences p<0.01). Overall, 25% of
participants had no preference, 33% preferred eyeglass
prescriptions from autorefraction, and 42 % preferred
eyeglass prescriptions from subjective refraction (p<0.01).
Of the 438 patients 40 years old and younger, 96 had
no preference and the remainder had no statistically
significant difference in preference for subjective refraction
prescriptions (51%) versus autorefractor prescriptions
(49%) (p=0.52).
Conclusion Average VAs from autorefractor-prescribed
eyeglasses were one letter worse than those from
subjective refraction. More than half of all participants
either had no preference or preferred eyeglasses
prescribed by the autorefractor. This marginal difference
in quality may warrant autorefractor-based prescriptions,
given the portable form factor, short measurement
time, low cost and minimal training required to use the
autorefractor evaluated here.
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