title: Clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM-5500.
abstract: OBJECTIVE
  A clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM-5500 (Japan) was performed to evaluate validity and repeatability compared with non-cycloplegic subjective refraction and Javal-Schiotz keratometry. An investigation into the dynamic recording capabilities of the instrument was also conducted.
  
  
  METHODS
  Refractive error measurements were obtained from 150 eyes of 75 subjects (aged 25.12 +/- 9.03 years), subjectively by a masked optometrist, and objectively with the WAM-5500 at a second session. Keratometry measurements from the WAM-5500 were compared to Javal-Schiotz readings. Intratest variability was examined on all subjects, whilst intertest variability was assessed on a subgroup of 44 eyes 7-14 days after the initial objective measures. The accuracy of the dynamic recording mode of the instrument and its tolerance to longitudinal movement was evaluated using a model eye. An additional evaluation of the dynamic mode was performed using a human eye in relaxed and accommodated states.
  
  
  RESULTS
  Refractive error determined by the WAM-5500 was found to be very similar (p = 0.77) to subjective refraction (difference, -0.01 +/- 0.38 D). The instrument was accurate and reliable over a wide range of refractive errors (-6.38 to +4.88 D). WAM-5500 keratometry values were steeper by approximately 0.05 mm in both the vertical and horizontal meridians. High intertest repeatability was demonstrated for all parameters measured: for sphere, cylinder power and MSE, over 90% of retest values fell within +/-0.50 D of initial testing. In dynamic (high-speed) mode, the root-mean-square of the fluctuations was 0.005 +/- 0.0005 D and a high level of recording accuracy was maintained when the measurement ring was significantly blurred by longitudinal movement of the instrument head.
  
  
  CONCLUSIONS
  The WAM-5500 Auto Ref/Keratometer represents a reliable and valid objective refraction tool for general optometric practice, with important additional features allowing pupil size determination and easy conversion into high-speed mode, increasing its usefulness post-surgically following accommodating intra-ocular lens implantation, and as a research tool in the study of accommodation.
authors.affiliation: Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Sheppard
authors.forename: Leon N
authors.initials: LN
authors.lastname: Davies
mesh_terms: D000065:Accommodation, Ocular; D000328:Adult; D006801:Humans; D009907:Optometry / Q000295:instrumentation*; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000175:diagnosis*; D015203:Reproducibility of Results; D015351:Vision Screening / Q000295:instrumentation* / Q000592:standards; D055815:Young Adult