title: Evaluation of image quality metrics for the prediction of subjective best focus.
abstract: OBJECTIVE
  Seven existing and three new image quality metrics were evaluated in terms of their effectiveness in predicting subjective cycloplegic refraction.
  
  
  METHODS
  Monochromatic wavefront aberrations (WA) were measured in 70 eyes using a Shack-Hartmann based device (Complete Ophthalmic Analysis System; Wavefront Sciences). Subjective cycloplegic spherocylindrical correction was obtained using a standard manifest refraction procedure. The dioptric amount required to optimize each metric was calculated and compared with the subjective refraction result. Metrics included monochromatic and polychromatic variants, as well as variants taking into consideration the Stiles and Crawford effect (SCE). WA measurements were performed using infrared light and converted to visible before all calculations.
  
  
  RESULTS
  The mean difference between subjective cycloplegic and WA-derived spherical refraction ranged from 0.17 to 0.36 diopters (D), while paraxial curvature resulted in a difference of 0.68 D. Monochromatic metrics exhibited smaller mean differences between subjective cycloplegic and objective refraction. Consideration of the SCE reduced the standard deviation (SD) of the difference between subjective and objective refraction.
  
  
  CONCLUSIONS
  All metrics exhibited similar performance in terms of accuracy and precision. We hypothesize that errors pertaining to the conversion between infrared and visible wavelengths rather than calculation method may be the limiting factor in determining objective best focus from near infrared WA measurements.
authors.affiliation: *MSc †PhD, MD ‡PhD Institute of Vision and Optics, University of Crete, Heraklion, Crete, Greece.
authors.forename: Marina
authors.initials: M
authors.lastname: Kilintari
authors.forename: Aristophanis
authors.initials: A
authors.lastname: Pallikaris
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsiklis
authors.forename: Harilaos S
authors.initials: HS
authors.lastname: Ginis
mesh_terms: D057128:Aberrometry; D000328:Adult; D057108:Corneal Wavefront Aberration / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D009799:Ocular Physiological Phenomena; D011680:Pupil / Q000187:drug effects; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000175:diagnosis* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D009184:Mydriatics