现场和远程主觉验光的一致性比较

目的 比较现场和远程主觉验光检查屈光度的一致性。设计 诊断试验。研究对象 屈光不正志愿者49例（98眼）。方法 现场和远程主觉验光在国家眼科诊断与治疗工程技术研究中心不同楼层的实验室内完成。同一受试者现场和远程主觉验光由同一专业验光师在不同日期（7天内）完成。用全自动综合验光仪做现场主觉验光，通过宽带网络远程操控全自动综合验光仪做远程主觉验光，由一名非医学背景的助手做电脑自动验光仪验光，结果通过蓝牙传送到平板电脑，再传至验光师电脑端，验光师通过宽带网络远程操控综合验光仪，并远程与受试者语音交流。根据屈光度不同分为近视组（等效球镜度≤-0.50 D)和远视组（等效球镜度≥+0.50 D），分别进行分析。利用MedCalc12.7软件进行Bland-Altman一致性分析，比较现场和远程主觉验光测得屈光度的一致性。主要指标 现场和远程主觉验光的球镜度数、柱镜度数、柱镜轴位、等效球镜度的95%一致性界限及95%一致性界限外点的比率。结果 所有眼现场和远程主觉验光的球镜度数、柱镜度数、柱镜轴位、等效球镜度的95%一致性界限分别为（0.00±0.54）D、（-0.02±0.34）D、（0.70±24.30）°、（0.00±0.52）D。所有眼球镜度数、柱镜度数、柱镜轴位、等效球镜度在95%一致性界限外点的比率分别为1.02%、4.84%、4.84%、2.04%。近视组和远视组球镜度数、柱镜度数、柱镜轴位及等效球镜的95%一致性界限分别为（-0.01±0.52）D、（-0.01±0.32）D、（1.10±18.40）°、（-0.01±0.51）D和（0.20±0.54）D、（-0.05±0.22）D、（-8.00±40.80）°、（0.18±0.53）D；95%一致性界限外点的比率分别为1.08%、3.51%、5.26%、2.15%、和0.00%、0.00%、0.00%、0.00%。结论 现场和远程主觉验光所有眼、近视组及远视组的球镜度数、柱镜度数和等效球镜度一致性高，但柱镜轴位一致性较差。

Agreement between traditional and telecontrolled subjective refraction

Objective To evaluate the agreement of refractive error detected by the traditional and telecontrolled subjective refraction. Design Diagnosis test. Participants 49 volunteers with refractive error. Method Traditional and telecontrolled subjective refraction were processed the laboratory of different floors in National Ophthalmology Diagnosis and Treatment Engineering Research Center. The same volunteers were checked with traditional and telecontrolled subjective refraction by the same professional optometrist on different dates (within 7 days). Integrated automated phoropter was used to process traditional subjective refraction. Telecontrolled subjective refraction was operated with integrated automated phoropter via internet. A non-professional assistant operated the autorefraction. The results were transmitted to the tablet computer via Bluetooth, then conveyed to the optometrist's computer via internet. Optometrist remotely operated the integrated automated refractor through the internet and communicated with volunteers online. According to refractive power, all eyes were divided into myopia group [spherical equivalent (SE)≤-0.50 D] and hyperopia group (SE≥+0.50 D). The MedCalc12.7 software was used for statistical analysis. Agreement of refractive error among traditional and telecontrolled subjective refraction was analyzed by Bland-Altman plots. Main Outcome Measures The 95% agreement of limit (LoA) for spherical power (S), cylindrical power (C), cylindrical axis (A) and SE measured by traditional and telecontrolled subjective refraction. The ratio of S, C, A, and SE points outside 95% LoA. Results The 95% LoA of S, C, A, SE of all eyes was (0.00±0.54) D, (-0.02±0.34) D, (0.70±24.30) ° and (0.00±0.52) D respectively. The ratio of S, C, A, and SE points outside 95% LoA of all eyes was 1.02%, 4.84%, 4.84%, 2.04% respectively. The 95% LoA of S, C, A, SE of myopia and hyperopia group was (-0.01±0.52)D, (-0.01±0.32)D,  （1.10±18.40）°, （-0.01±0.51）D respectively, and (0.20±0.54）D, （-0.05±0.22）D, （-8.00±40.80）°, (0.18±0.53）D respectively; the ratio of points outside 95% LoA was 1.08%, 3.51%, 5.26%, 2.15% respectively and 0.00%、0.00%、0.00%、0.00% respectively. Conclusion The agreement is good for S, C, SE, but poor for A among traditional and telecontrolled subjective refraction.