Reliability And Acceptability Of Tele-controlled Subjective Refraction Compared With Traditional Subjective Refraction

Purpose:To explore the reliability,efficiency and acceptability of tele-controlled subjective refraction supported by RDx,an optical software designed for remote control phoropter,compared with traditional subjective refraction.Methods:Observational study.Sixty-five participants were recruited from the optometry clinic of Nanchang Aier Eye Hospital.Objective refraction was performed by an optometry assistant using KR800autorefractometer（Topcon,Japan）.Then,Tele-controlled subjective refraction and traditional subjective refraction were performed at least 60minutes intervals by an experienced optometrist randomly.The examination order was determined by drawing lots.A validity usability questionnaire distributed to each participant after the examination was applied to evaluate the receptibility of the tele-controlled subjective refraction.Subjects were further subdivided according to cylinder power（cylinder power≥-1.00D and<-1.00D）and age（age≤18 and age>18）.Differences and degree of correlation between two methods was tested with the Wilcoxon signed-rank test and Spearman correlation test.Bland-Altman analysis was used to assess the agreement between both methods of refraction.Paired samples t-test was carried out to compare the refraction elapsed time.Results:One hundred thirty eyes of 65 participants,aged 9 to 40 years,mean±standard deviation 20.4±5.9 years,28 male（44%）and 37 female（56%）,were included in this study.Overall,there were no significant statistical differences（P>0.05）between tele-controlled subjective refraction and traditional subjective refraction for all parameters.A high correlation between two methods was found for SE,S and C（r_s>0.60,p<0.05）except for J₀ and J₄₅（r_s=0.29,p<0.01;r_s=0.17,p=0.06）.The mean difference（traditional subjective refraction-tele-controlled subjective refraction）and its 95%Limits of Agreement（Lo A）for S,SE,C,J₀ and J₄₅ were-0.03±0.42D,-0.03±0.36D,0.00±0.39D,-0.00±0.57D and-0.01±0.79D respectively.The percentage of SE difference points that fell within 95%Lo A of all eyes was97%,and this value was 93%for S,92%both for J₀ and J₄₅.Besides,no significant differences were noted among all subgroups between 2 methods of subjective refraction for SE,J₀ and J₄₅（p>0.05）.The Bland-Altman analysis showed that all difference points of J45 were fell within 95%Lo A in the group with cylinder power absolute value great than 1.00D,which means higher cylinder power group reached a better agreement of parameter J₄₅ compared with the lower cylinder power group（100%vs93%）.As for elapsed time,the tele-controlled subjective refraction was statistically higher than traditional method（11.1±2.0min vs 10.4±1.7min,p=0.02）and no statistical difference was found between different age groups（11.50±2.30min vs 10.94±1.96min,p=0.36）.The Completed questionnaires were returned by55 participants（85%）.The vast majority of people（98%）showed high satisfaction and acceptance of tele-controlled method.Conclusions:There were no statistical difference between two methods of subjective refraction for sphere,cylinder and spherical equivalent.According to the distribution law of difference points for all refraction parameters within the 95%Limits of Agreement,the tele-controlled subjective refraction showed good agreement with traditional subjective refraction except for the axis of cylinder especially in low cylinder power group.The was no practical significant difference between the examination efficiency of two methods of refraction even though the tele-controlled method took slightly longer.The vast majority of people showed high satisfaction and acceptance of the tele-controlled subjective refraction which means great feasibility in clinical practice.