Open-field and closed-field aberrometry to measure ocular refraction in a prospective semi-randomized crossover study

To assess the agreement and repeatability of closed-field and open-field pyramidal wavefront aberrometers in measuring non-cycloplegic spherocylindrical refraction, compared to subjective refraction and open-field autorefractometry. Fifty healthy adults (27 non-presbyopic, 23 presbyopes) were tested using four methods: closed-field aberrometer (CFA), open-field aberrometer (OFA), open-field autorefractor (OFAUTO), and subjective refraction. Measurements were performed monocularly and binocularly. Significant differences in the M component of the power vector were primarily observed when comparing OFA and subjective refraction, and OFAUTO and subjective refraction, across both age groups and in both eyes, and CFA comparing subjective refraction limited to presbyopic participants. In non-presbyopic participants, CFA showed more negative M values than OFA, consistent with a possible accommodative response or instrument myopia under closed-field non-cycloplegic conditions. No clinically relevant differences were found between monocular and binocular measurements when using the OFA and OFAUTO devices, regardless of age group. All reliability coefficients for the various procedures were relatively high in the Presbyopic group for both eyes. In the Non-presbyopic group, the reliability of M measurements showed a notable decline in the case of CFA in both eyes. OFA demonstrated high reliability comparable to OFAUTO, but a non-negligible clinical difference compared to subjective procedure. The outcomes of CFA in non-presbyopic participants highlights the challenge of accommodation control in non-cycloplegic conditions for closed-field systems. The effect of pupil size warrants further investigation to enhance understanding of objective refraction accuracy compared to the subjective procedure.