Purpose: To determine level of agreement, and factors associated with poor agreement between refractive error measurements obtained by autorefraction at a screening center and subjective refraction obtained in the clinic among older individuals screened in Baltimore.

Methods: All subjects underwent autorefraction using Topcon KR800S as part of community-based screenings in Baltimore MD. Participants with presenting vision worse than 20/40 who could be improved with autorefraction (AR) results were referred to the Wilmer Eye Institute for subjective refraction (SR). AR values obtained at screening were compared with SR values obtained during the follow up visit. Data analysis of sphere, cylinder, axis and spherical equivalent (SE) were performed. Pearson’s correlation coefficient was used to compare agreement between AR and SR. Factors associated with large SE differences (> 0.75 D) were assessed.

Results: As of November 2015, 35 patients presented to the Wilmer Eye Institute for SR. 1 patient underwent refraction in one eye only; 35 right eyes and 34 left eyes were included in the analysis. The mean SE by SR was 0.18 D (SD: 3.99, range:-19.13,+ 4.44), while the mean SE by AR was 0.16 D (SD: 4.02, range:-19.56,+ 4.56). The mean astigmatic error by SR was+ 0.98 D (SD: 0.64, range:+ 0.13,+ 3.5). The overall mean difference in SE was 0.06 (SD: 0.61, range:-1.38,+ 2.38); the difference in SE by each eye is shown in the graphs below. 2/35 (6%) subjects had an absolute difference in right eye SE between SR and AR that was greater than 0.75 D, and 6/34 (18%) had an absolute difference in the left eye greater than 0.75 D. The main reason for disagreement was nuclear sclerosis or cortical cataract. Pearson’s correlation coefficient for mean SE by AR compared to SR was 0.989 (p< 0.001).

Conclusions: We found excellent agreement between subjective refraction and autorefraction carried out in the field. On the basis of these results, the study team is piloting an initiative to dispense glasses to seniors in the community based on autorefractor measurements alone without subsequent subjective refraction in order to improve overall delivery of glasses. To date, less than 35% of those needing glasses have followed up for refraction. With this initiative, we hope to provide glasses to more of those who are in need. Results of this pilot effort will also be presented.