{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:30:11Z","timestamp":1767796211423,"version":"3.49.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["NIH EY024590"],"award-info":[{"award-number":["NIH EY024590"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["P30 EY007551"],"award-info":[{"award-number":["P30 EY007551"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmic Physiologic Optic"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Refractions based on the optimisation of single\u2010value wavefront\u2010derived metrics may help determine appropriate corrections for individuals with Down syndrome where clinical techniques fall short. This study compared dioptric differences between refractions obtained using standard clinical techniques and two metric\u2010optimised methods: visual Strehl ratio (VSX) and pupil fraction tessellated (PFSt), and investigated characteristics that may contribute to the differences between refraction types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Thirty adults with Down syndrome (age\u2009=\u200929\u2009\u00b1\u200910\u2009years) participated. Three refractive corrections (VSX, PFSt and clinical) were determined and converted to vector notation (M, J\n                      <jats:sub>0<\/jats:sub>\n                      , J\n                      <jats:sub>45<\/jats:sub>\n                      ) to calculate the dioptric difference between pairings of each type using a mixed model repeated measures approach. Linear correlations and multivariable regression were performed to examine the relationship between dioptric differences and the following participant characteristics: higher order root mean square (RMS) for a 4\u2009mm pupil diameter, spherical equivalent refractive error and Vineland Adaptive Behavior Scales (a measure of developmental ability).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The least squares mean estimates (standard error) of the dioptric differences for each pairing were as follows: VSX versus PFSt\u2009=\u20090.51\u2009D (0.11); VSX versus clinical\u2009=\u20091.19\u2009D (0.11) and PFSt versus clinical\u2009=\u20091.04\u2009D (0.11). There was a statistically significant difference in the dioptric differences between the clinical refraction and each of the metric\u2010optimised refractions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Increased dioptric differences in refraction were correlated with increased higher order RMS (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 [VSX vs. clinical] and\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 [PFSt vs. clinical]) as well as increased myopic spherical equivalent refractive error (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004 [VSX vs. clinical] and\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 [PFSt vs. clinical]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The observed differences in refraction demonstrate that a significant portion of the refractive uncertainty is related to increased higher order aberrations and myopic refractive error. Methodology surrounding clinical techniques and metric\u2010optimisation based on wavefront aberrometry may explain the difference in refractive endpoints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/opo.13165","type":"journal-article","created":{"date-parts":[[2023,5,20]],"date-time":"2023-05-20T01:30:08Z","timestamp":1684546208000},"page":"1016-1028","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dioptric differences between clinically determined and metric\u2010optimised refractions for adults with Down syndrome"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8226-8032","authenticated-orcid":false,"given":"Maureen D.","family":"Plaumann","sequence":"first","affiliation":[{"name":"University of Houston College of Optometry Houston Texas 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