Subjective refraction using power vectors by updating a conventional phoropter with a Stokes lens for continuous astigmatic power generation.

PURPOSE: To implement a pure power vector method for monocular subjective refraction using a regular phoropter with the only modification being the inclusion of a Stokes lens. The proposed methodology was tested with three different Stokes lenses, and the results were compared with conventional clinical refraction procedures.

METHODS

Power vector subjective refraction was performed by attaching a Stokes lens to the Risley prism holder. Stokes lenses allow for pure astigmatic compensation in the form of the J0 , J45 components while the spherical lenses in the phoropter allow determination of the spherical component in the form of M (spherical equivalent). The proposed routine is presented step-by-step using three Stokes lenses having different astigmatic powers.

RESULTS

Monocular subjective refraction was performed on 26 healthy subjects with a mean age of 44 ± 16 years, mean spherical equivalent of -0.56 D (range -5.50 to +2.38 D) and refractive astigmatism ≤1.50 D. No differences were found between the results obtained with the conventional technique versus the vector-based procedure for the spherical equivalent (p = 0.28) or astigmatic components (p = 0.34). In addition, visual acuity (VA) was equivalent through the refractions measured with the conventional and vector procedures (p = 0.12). Repeatability coefficients for J0 and J45 with the new vector methodology were <0.38 D.

CONCLUSIONS

The proposed routine could be helpful for cases where it is difficult to get a valid starting point for conventional refraction (e.g., irregular corneas and media opacities), for testing facilities with limited resources/equipment and/or for motivated clinicians who wish to know about alternative methods of refractive error determination.