title: Reproducibility of manifest refraction between surgeons and optometrists in a clinical refractive surgery practice.
abstract: OBJECTIVE
  To measure and compare the interobserver reproducibility of manifest refraction according to a standardized protocol for normal preoperative patients in a refractive surgery practice.
  
  
  METHODS
  Private clinic, London, United Kingdom.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  This retrospective study comprised patients attending 2 preoperative refractions before laser vision correction. The first manifest refraction was performed by 1 of 7 optometrists and the second manifest refraction by 1 of 2 surgeons, all trained using a standard manifest refraction protocol. Spherocylindrical data were converted into power vectors for analysis. The dioptric power differences between observers were calculated and analyzed.
  
  
  RESULTS
  One thousand nine hundred twenty-two consecutive eyes were stratified into a myopia group and a hyperopia group and then further stratified by each surgeon-optometrist combination. The mean surgeon-optometrist dioptric power difference was 0.21 diopter (D) (range 0.15 to 0.32 D). The mean difference in spherical equivalent refraction was 0.03 D, with 95% of all refractions within ±0.44 D for all optometrist-surgeon combinations. The severity of myopic or hyperopic ametropia did not affect the interobserver reproducibility of the manifest refraction.
  
  
  CONCLUSIONS
  There was close agreement in refraction between surgeons and optometrists using a standard manifest refraction protocol of less than 0.25 D. This degree of interobserver repeatability is similar to that in intraobserver repeatability studies published to date and may represent the value of training and the use of a standard manifest refraction protocol between refraction observers in a refractive surgery practice involving co-management between surgeons and optometrists.
authors.affiliation: From the London Vision Clinic (Reinstein, Yap, Carp, Archer, Gobbe), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (Reinstein), Paris, France. Electronic address: dzr@londonvisionclinic.com.
authors.forename: Dan Z
authors.initials: DZ
authors.lastname: Reinstein
authors.affiliation: From the London Vision Clinic (Reinstein, Yap, Carp, Archer, Gobbe), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (Reinstein), Paris, France.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Yap
authors.affiliation: From the London Vision Clinic (Reinstein, Yap, Carp, Archer, Gobbe), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (Reinstein), Paris, France.
authors.forename: Glenn I
authors.initials: GI
authors.lastname: Carp
authors.affiliation: From the London Vision Clinic (Reinstein, Yap, Carp, Archer, Gobbe), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (Reinstein), Paris, France.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Archer
authors.affiliation: From the London Vision Clinic (Reinstein, Yap, Carp, Archer, Gobbe), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (Reinstein), Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Gobbe
mesh_terms: D000293:Adolescent; D000328:Adult; D048988:Corneal Surgery, Laser; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000175:diagnosis*; D015588:Observer Variation; D009885:Ophthalmology / Q000592:standards*; D009907:Optometry / Q000592:standards*; D011331:Private Practice; D012029:Refraction, Ocular / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014787:Vision Tests / Q000592:standards*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult