{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:02:05Z","timestamp":1788242525196,"version":"build-2803163510"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmic Physiologic Optic"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To develop and validate a low\u2010cost, portable automated refraction system (Tongren Digital Sight, TRDS) using deep learning and infrared eccentric photorefraction to improve refractive error correction in resource\u2010constrained settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This randomised controlled crossover trial enrolled 282 participants (18\u201360\u2009years of age) at Beijing Tongren Hospital. TRDS utilised low\u2010cost components (complementary metal\u2010oxide semiconductor (CMOS) detector, infrared light emitting diodes) and an end\u2010to\u2010end deep learning model trained on 362,000 images to analyse fundus reflection signals. Primary outcomes included agreement between TRDS and subjective refraction (gold standard) via Pearson correlation, Bland\u2013Altman plots and intraclass correlation coefficients (ICC) for spherical equivalent (\n                      <jats:italic>M<\/jats:italic>\n                      ), horizontal (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ) and oblique (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      ) cylinder parameters. Secondary outcomes included corrected visual acuity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TRDS showed strong correlations with subjective refraction:\n                      <jats:italic>M<\/jats:italic>\n                      (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.96, ICC\u2009=\u20090.96),\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.74, ICC\u2009=\u20090.71) and\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.76, ICC\u2009=\u20090.75). Mean differences were 0.07 D (\n                      <jats:italic>M<\/jats:italic>\n                      ), \u22120.06 D (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ) and 0.00 D (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      ), with 95% limits of agreement within clinical tolerance. Corrected visual acuity was non\u2010inferior to that of subjective refraction (mean difference\u2009=\u20090.03 logMAR,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Subgroup analysis showed consistent performance across myopia and hyperopia, except for moderate agreement in high myopia (\n                      <jats:italic>M<\/jats:italic>\n                      :\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.62). Subjective and TRDS refraction showed corrected visual acuity of 0.01 (SD\u2009=\u20090.13) and \u22120.02 (SD\u2009=\u20090.08) logMAR, respectively, with a significant mean difference of 0.03 logMAR (95% LoA: 0.01\u20130.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Corrected visual acuity &gt;0.18 logMAR occurred in 13 (4.6%) and 14 (5.0%) participants for subjective and TRDS refraction, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The deep learning\u2010empowered TRDS system demonstrated high accuracy and portability. It offers a scalable solution to improve refractive error correction rates, aligning with WHO goals to enhance global eye health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/opo.70027","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T12:37:13Z","timestamp":1761309433000},"page":"1676-1688","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Deep learning\u2013empowered low\u2010cost portable automated refraction system: A solution to the inadequate effective correction rate of refractive errors in resource\u2010limited areas"],"prefix":"10.1007","volume":"45","author":[{"given":"Huang","family":"Yan","sequence":"first","affiliation":[{"name":"National Engineering Research Centre for Ophthalmology, Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Engineering Research Centre of the Ministry of Education for Ophthalmic Diagnosis and Treatment Equipment and Materials, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9031-1245","authenticated-orcid":false,"given":"Zhen","family":"Yi","sequence":"additional","affiliation":[{"name":"National Engineering Research Centre for Ophthalmology, Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Engineering Research Centre of the Ministry of Education for Ophthalmic Diagnosis and Treatment Equipment and Materials, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun","family":"Qilin","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Multimodal Artificial Intelligence Systems Institute of Automation, Chinese Academy of Sciences (CASIA)  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Hong","sequence":"additional","affiliation":[{"name":"Beijing, He Eye Specialist Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huang","family":"Yan","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Multimodal Artificial Intelligence Systems Institute of Automation, Chinese Academy of Sciences (CASIA)  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tang","family":"Wei","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Multimodal Artificial Intelligence Systems Institute of Automation, Chinese Academy of Sciences (CASIA)  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.14.04100"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-024-03106-0"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/09286586.2022.2127784"},{"key":"e_1_2_11_5_1","first-page":"157","article-title":"Global ophthalmology","volume":"121","author":"Philippin H","year":"2024","journal-title":"Aktueller Stand"},{"key":"e_1_2_11_6_1","unstructured":"World Health Organization 2019[cited 2022 Sep 6]. Available from:https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/328717\/9789241516570\u2010eng.pdf."},{"key":"e_1_2_11_7_1","volume-title":"Seventy\u2010Third World Health Assembly","author":"Resolution WHA73.4","year":"2020"},{"key":"e_1_2_11_8_1","volume-title":"Seventy\u2010Fourth World Health Assembly","author":"Resolution WHA74(12)","year":"2021"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2023.6781"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/APO.0000000000000470"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/opo.13348"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oftal.2023.07.001"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S326680"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjophth\u20102022\u2010001202"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2023.3508"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.2196\/55270"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.05.030"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-1313.2004.00198.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1117\/1.OE.52.6.063002"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjophth\u20102021\u2010000851"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/cxo.13003"},{"key":"e_1_2_11_22_1","unstructured":"BottouL.Large\u2010scale machine learning with stochastic gradient descent[C]\/\/Proceedings of COMPSTAT'2010: 19th International Conference on Computational Statistics Paris France August 22\u201027 2010 Keynote Invited and Contributed Papers.Heidelberg:Physica\u2013Verlag HD;2010:177\u2013186."},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare4030041"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12820"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010024\u201010618\u20108"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010024\u201068993\u20105"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0299491"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2015.1468"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30244-4"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.2196\/16345"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.optom.2018.09.001"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9103144"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X20960628"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1167\/tvst.7.4.11"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-bioeng-071813-105216"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000000726"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12886\u2010022\u201002684\u20105"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000000732"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0272451"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.3341\/kjo.2019.0132"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijo.IJO_1465_18"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000001308"},{"key":"e_1_2_11_43_1","first-page":"6","article-title":"Validation of Near Eye Tool for Refractive Assessment (NETRA)","volume":"1","author":"Kumar BV","year":"2012","journal-title":"Pilot Study Journal MTM"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000000561"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.2196\/14808"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000001382"}],"container-title":["Ophthalmic and Physiological Optics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/opo.70027","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:24:39Z","timestamp":1767785079000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/opo.70027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":45,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/opo.70027"],"URL":"https:\/\/doi.org\/10.1111\/opo.70027","archive":["Portico"],"relation":{},"ISSN":["0275-5408","1475-1313"],"issn-type":[{"value":"0275-5408","type":"print"},{"value":"1475-1313","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]},"assertion":[{"value":"2025-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}