一款新型主客观验光一体化设备的临床评估

拟对新型验光设备自适应光学视觉模拟器（VAO）的主观与客观验光的可靠性以及检查效率进行评估。方法：系列病例研究。收集2017年10─11月长沙爱尔眼科医院视光门诊患者。先由资深验光师采用传统方法为受检者分别进行双眼客观验光和主觉验光,其中客观验光采用尼德克电脑验光仪（ARK-1）、主觉验光采用综合验光仪;然后再由一名技术员利用VAO设备对所有受检者再次进行客观和主觉验光。最后用组内相关系数（ICC）和配对t检验比较2种检查方式结果的一致性以及检查耗时。结果：受检者共计70例（140眼）,年龄（13.2±2.2）岁,其中男38例（54%）。2种检查方式在客观验光球镜度、J0、J45的ICC分别为0.897、0.907、0.732;在主觉验光球镜度、J0、J45的ICC分别为 0.937,0.891,0.543。2种检查方式客观验光的平均球镜度差异为0.4695%可信区间（CI）：0.36, 0.55]D （t=9.663,P<0.001）,主觉验光的平均球镜度差异为0.32（95%CI：0.25,0.39）D （t=9.087, P<0.001）,均随着近视度数的增加而下降（r=-0.261,P<0.001）,当受检者为中高度近视时（球镜度<-3.00 D）,球镜度差异95%CI]则降低为0.22（95%CI：0.14,0.32）D （t=4.987,P<0.001）; 2 种检查方式主觉验光的柱镜度差异无统计学意义。就检查耗时而言,VAO方式优于传统方法 （5.9±1.9）min vs. （7.2±0.7）min,t=6.100,P<0.001]。结论：作为一个集合了客观验光与主觉验光功能的新仪器,VAO与传统验光方法的临床差异不大,而且差异随着被检者的近视度数增加而减少,其检查效率高于传统验光方法。

Accuracy and Efficiency of Refraction for Myopes Based on the Visual Adaptive Optics Simulator

This study aimed to evaluate the accuracy and efficiency of the Visual Adaptive Optics Simulator (VAO, Spain) which is able to measure objective and subjective refraction. Methods: Therefractor VAO was an instrument based on the principle of adaptive optics. This was a series case study that included patients in Changsha Aier Eye Hospital from October to November 2017. Subjects with myopia were first measured by experienced optometrists for objective and subjective refraction using an autorefractor (Nidek ARK-1) and phoropter, respectively (designated as the "traditional approach"). Then, these subjects were again measured by a fresh technician with the VAO-based approach. The agreement of the results by these two approaches was compared with an intraclass correlation coefficient (ICC) and a paired-t test analysis. The efficiency of the VAO-based approach was also compared to the traditional approach with a paired-t test. Results: Seventy subjects (140 eyes, 38 males) with a mean age of 13.2±2.2 years participated in the study. The ICC of the objective refraction between the two approaches was 0.897, 0.907, 0.732 for spherical power, J0 and J45, respectively. The ICC of subjective refraction between the two approaches was 0.937, 0.891, 0.543, respectively. Specifically, the mean difference in objective and subjective refraction for spherical power with the two approaches was 0.46 D (95%CI: 0.36, 0.55 D) (t=9.663, P<0.001), and 0.32 D (95%CI: 0.25, 0.39 D) (t=9.087, P<0.001). However, the difference was found to diminish with an increase in the degree of myopia (r=-0.261, P<0.001) and the difference inspherical power dropped by 0.22 D 0.14 D, 0.32 D] for moderate-high myopia (spherical power <-3.00 D; t=4.987, P<0.001). For cylindrical power, there was no significant difference between the two approaches. Never the less, the average measurement time for the VAO-based approach was found to be significantly shorter than the traditional approach (5.9±1.9 min vs. 7.2±0.7 min, t=6.100, P<0.001). Conclusions: VAO produces clinically similar results compared to the traditional approach and the difference between the two approaches tends to be reduced with a greater degree of myopia. In addition, the efficiency of VAO is significantly better than the traditional approach.