Mechanisms of Neuroperceptual Differences Between Subjective and Objective Refraction Based on Multimodal Imaging and Neurovisual Features.

PURPOSE: To quantify individual variations between subjective and objective refraction, explore correlations between multimodal imaging features, clinical parameters and refraction discrepancies, screen independent influencing factors, and construct a predictive model to provide technical support for personalized refractive surgery.

METHODS

A total of 264 myopic patients (264 eyes) were enrolled. Paired t-test and Bland-Altman analysis were used to quantify refraction differences. Correlation analysis, multivariate regression, and machine learning algorithms were applied to explore influencing mechanisms and build a prediction model.

RESULTS

There were significant individual differences between subjective and objective refraction, and the difference distribution was consistent with the normal distribution. The difference between subjective and objective refraction was moderately correlated with long-term daily maintained refraction (r=0.47, P<0.001), weakly correlated with subjective refraction, objective refraction, corneal morphological features, and OCT optic nerve imaging features (r=0.17~0.25, P<0.05), and extremely weakly correlated or uncorrelated with OCT macular imaging features and fundus color photography imaging features (r<0.10, P>0.05). Multivariate regression analysis showed that long-term daily maintained refraction, corneal higher-order aberrations, and OCT optic nerve imaging features were independent risk factors affecting the difference (P<0.05). The prediction model constructed based on 126-dimensional radiomics key features, long-term daily maintained refraction, and core clinical parameters had a prediction accuracy of 87.2% and an area under the ROC curve (AUC) of 0.89.

CONCLUSION

Long-term daily maintained refraction is the core factor affecting the neuroperceptual difference between subjective and objective refraction. Among multimodal imaging features, only OCT optic nerve-related features have a weak correlation with the difference, and corneal higher-order aberrations are independent influencing factors. The results of this study can provide a theoretical basis and technical support for the precise diagnosis and treatment of refractive correction.