Accuracy of WASCA Aberrometer Refraction Compared to Manifest Refraction and Cycloplegic Refraction in Hyperopia Measurement

PURPOSE: To explore the agreement between the wavefront supported custom ablation (WASCA) aberrometer and manifest refraction (MR) and cycloplegic refraction (CR) in hyperopia testing. METHODS: Ninety eyes of 90 hyperopic patients (spherical equivalent ≥ +0.5 D) were evaluated; MR, CR, and WASCA refraction (WR) were performed consecutively. Analysis pupil size was 6.0 mm in WASCA measurement using the Seidel method. The conventional notation was transferred into vector components for analysis, i.e., spherical equivalent (M) and two cross-cylinders at axis 0° (J(0)) and axis 45° (J(45)). Bland-Altman plots were used to test the agreement between the two measurements. RESULTS: The mean Ms obtained with MR and CR were 3.23 ± 1.74 D and 4.04 ± 2.04 D, respectively (P < 0.001), and the correlation was high (r = 0.90, P < 0.001). The WR was highly correlated with MR and CR in terms of M (r = 0.89, 0.87), but not significantly correlated in J(0) and J(45). The total dioptric power vector error was 0.18 ± 1.00 D between WR and MR and −0.64 ± 1.03 D between WR and CR. The limits of agreement of all vector components were beyond ± 1.0 D. With hyperopia level increase, WR tended to overestimate MR (P = 0.04), whereas WR always underestimated CR. CONCLUSIONS: WASCA could act as a reference of subjective refraction in hyperopia measurement, the exchangeability is not fully applicable. TRANSLATIONAL RELEVANCE: WASCA can provide an alternative for objective refraction in hyperopia measurement.