Lions Aravind Institute of Community Ophthalmology, Madurai, India.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
PLoS One. 2022 Aug 3;17(8):e0272451. doi: 10.1371/journal.pone.0272451. eCollection 2022.
To assess the accuracy of refraction measurements by ClickCheckTM compared with the standard practice of subjective refraction at a tertiary level eye hospital.
Diagnostic accuracy trial.
All participants, recruited consecutively, underwent auto-refraction (AR) and subjective refraction (SR) followed by refraction measurement using ClickCheckTM (CR) by a trained research assistant. Eyeglass prescriptions generated using ClickCheckTM and the resulting visual acuity (VA) was compared to SR for accuracy. Inter-rater reliability and agreement were determined using Intra-class correlation and Bland Altman analysis respectively.
The 1,079 participants enrolled had a mean (SD) age of 39.02 (17.94) years and 56% were women. Overall, 45.3% of the participants had refractive error greater than ±0.5D. The mean (SD) spherical corrections were -0.66D (1.85) and -0.89D (2.20) in SR and CR respectively. There was high level of agreement between the spherical power measured using SR and CR (ICC: 0.940 (95% CI: 0.933 to 0.947). For the assessment of cylindrical correction, there was moderate level of agreement between SR and CR (ICC: 0.493 (0.100 to 0.715). There was moderate level of agreement between the VA measurements performed by using corrections from SR and CR (ICC: 0.577 (95% CI: 0.521-0.628). The subgroup analysis based on the age categories also showed high level of agreement for spherical corrections between the two approaches (ICC: 0.900). Bland Altman analysis showed good agreement for spherical corrections between SR and CR (Mean difference: 0.224D; 95% LoA: -1.647 D to 2.096 D) without evidence of measurement bias.
There was a high level of agreement for spherical power measurement between CR and SR. However, improvements are needed in order to accurately assess the cylindrical power. Being a portable, low-cost and easy-to-use refraction device, ClickCheckTM can be used for first level assessment of refractive errors, thereby enhancing the efficiency of refractive services, especially in low- and-middle-income countries.
评估 ClickCheckTM 与三级眼科医院主观验光标准方法相比的验光准确性。
诊断准确性试验。
所有连续招募的参与者均接受自动验光（AR）和主观验光（SR），然后由经过培训的研究助理使用 ClickCheckTM（CR）进行验光测量。使用 ClickCheckTM 生成的眼镜处方和由此产生的视力（VA）与 SR 进行准确性比较。使用组内相关系数和 Bland-Altman 分析分别确定观察者间可靠性和一致性。
共纳入 1079 名参与者，平均（标准差）年龄为 39.02（17.94）岁，56%为女性。总体而言，45.3%的参与者有大于±0.5D 的屈光不正。SR 和 CR 中平均（标准差）球镜矫正分别为-0.66D（1.85）和-0.89D（2.20）。SR 和 CR 测量的球镜力之间具有高度一致性（ICC：0.940（95%置信区间：0.933 至 0.947））。对于柱镜矫正的评估，SR 和 CR 之间具有中度一致性（ICC：0.493（0.100 至 0.715））。使用 SR 和 CR 的矫正值进行 VA 测量之间具有中度一致性（ICC：0.577（95%置信区间：0.521 至 0.628））。基于年龄类别进行的亚组分析也显示，两种方法之间的球镜矫正具有高度一致性（ICC：0.900）。Bland-Altman 分析显示 SR 和 CR 之间的球镜矫正具有良好的一致性（平均差异：0.224D；95%置信区间：-1.647 D 至 2.096 D），没有测量偏差的证据。
CR 和 SR 之间的球镜力测量具有高度一致性。然而，需要改进以准确评估柱镜力。作为一种便携式、低成本且易于使用的验光设备，ClickCheckTM 可用于评估屈光不正的初步评估，从而提高屈光服务的效率，特别是在中低收入国家。
