{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T14:14:25Z","timestamp":1777990465469,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The purpose of this study was to investigate the variation in subjective manifest refraction measures in a patient cohort screened for myopic refractive surgery. Methods: In this retrospective non-randomised cross-sectional single-centre study, we evaluated a dataset containing sequences of three refraction measurements performed by four experienced optometrists in 175 eyes screened for refractive corneal or lens surgery for myopia or myopic astigmatism. Refraction was converted from sphere (SPH), cylinder (CYL) and axis to power vector components (spherical equivalent SEQ and cylinder projections C0 and C45). The mean power vectors of the three repeat measurements (MEAN) and the deviations (DEV) of the repeat measurements from the MEAN were evaluated. Results: MEAN values for SPH\/CYL\/SEQ\/C0\/C45 were \u22125.93\/0.99\/\u22125.44\/\u22120.47\/0.02 D and the corresponding standard deviations were 0.20\/0.16\/0.17\/0.17\/0.16 D. DEV of both SEQ and CYL correlated significantly with patient age (Spearman R = 0.16 and 0.20). DEV of CYL correlated with mean (myopic) SEQ (R = \u22120.22) and CYL (R = 0.27) whereas DEV of SEQ showed no significant correlation with mean SEQ or CYL. Conclusions: The variation in subjective manifest refraction with repeat measurements is in a range of \u00b10.16 to \u00b10.20 D for SPH, CYL and the power vector components SEQ, C0 and C45. If reliable subjective refraction measurements are mandatory, e.g., for planning refractive surgery procedures or for formula constant optimisation, repeat refractometry measures could help to ensure representative data and to estimate the intraindividual variations.<\/jats:p>","DOI":"10.3390\/diagnostics16091396","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T13:23:37Z","timestamp":1777987417000},"page":"1396","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in Manifest Subjective Refraction in a Population Screened for Refractive Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-6177","authenticated-orcid":false,"given":"Achim","family":"Langenbucher","sequence":"first","affiliation":[{"name":"Department of Experimental Ophthalmology, Saarland University, 66424 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-2559","authenticated-orcid":false,"given":"Jascha","family":"Wendelstein","sequence":"additional","affiliation":[{"name":"Department of Experimental Ophthalmology, Saarland University, 66424 Homburg, Germany"},{"name":"Department of Ophthalmology, Ludwig Maximilian University (LMU), 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N\u00f3ra","family":"Szentm\u00e1ry","sequence":"additional","affiliation":[{"name":"Department of Experimental Ophthalmology, Saarland University, 66424 Homburg, Germany"},{"name":"Department of Ophthalmology, Semmelweis-University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0779-7449","authenticated-orcid":false,"given":"Alan","family":"Cayless","sequence":"additional","affiliation":[{"name":"School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4401-4948","authenticated-orcid":false,"given":"Anika","family":"F\u00f6rster","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Refraktive Chirurgie, Augenzentrum am Franziskus-Hospital, 48145 M\u00fcnster, Germany"},{"name":"Eye-Clinic, Ruhr-University, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Augen- und Laserklinik Castrop-Rauxel, 44575 Castrop-Rauxel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0593-6847","authenticated-orcid":false,"given":"Suphi","family":"Taneri","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Refraktive Chirurgie, Augenzentrum am Franziskus-Hospital, 48145 M\u00fcnster, Germany"},{"name":"Eye-Clinic, Ruhr-University, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1097\/j.jcrs.0000000000000343","article-title":"Repeatability and reproducibility of manifest refraction","volume":"46","author":"Taneri","year":"2020","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/ceo.14449","article-title":"Prediction of refraction error after toric lens implantation with biometric input data uncertainties and power labelling tolerances","volume":"53","author":"Langenbucher","year":"2025","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jcrs.2007.10.031","article-title":"Sources of error in intraocular lens power calculation","volume":"34","author":"Norrby","year":"2009","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e285","DOI":"10.1111\/aos.15726","article-title":"Impact of uncertainties in biometric parameters on intraocular lens power formula predicted refraction using a Monte-Carlo simulation","volume":"102","author":"Langenbucher","year":"2024","journal-title":"Acta Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/aos.17549","article-title":"Tolerance to surgically induced anisometropia-A systematic review","volume":"104","author":"Skov","year":"2025","journal-title":"Acta Ophthalmol."},{"key":"ref_6","first-page":"e122","article-title":"A review of angle kappa and multifocal intraocular lenses and their effect on visual outcomes","volume":"104","author":"Kohnen","year":"2025","journal-title":"Acta Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/aos.17482","article-title":"Prevalence and associated factors of reduced visual acuity and undercorrected refractive error in Finland: Results from a nationwide survey","volume":"103","author":"Purola","year":"2025","journal-title":"Acta Ophthalmol."},{"key":"ref_8","unstructured":"Bennett, A.G., and Rabbetts, R.B. (2007). Bennett & Rabbetts: Clinical Visual Optics, Butterworth Heinemann Ltd.. [4th ed.]."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1097\/OPX.0000000000001781","article-title":"Reliability of Refraction, Keratometry, and Intraocular Pressure Measurements with an Automated All-in-one Device","volume":"98","author":"Tzamalis","year":"2021","journal-title":"Optom. Vis. Sci."},{"key":"ref_10","first-page":"619","article-title":"Reliability of refraction\u2014A literature review","volume":"67","author":"Goss","year":"1996","journal-title":"J. Am. Optom. Assoc."},{"key":"ref_11","first-page":"434","article-title":"Repeatability and accuracy of automated refraction: A comparison of the Nikon NRK-8000, the Nidek AR-1000, and subjective refraction","volume":"74","author":"Elliott","year":"1997","journal-title":"Optom. Vis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1136\/bjo-2023-323921","article-title":"Prediction of spectacle refraction uncertainties with discrete IOL power steps and manufacturing tolerances according to ISO using a Monte Carlo model","volume":"108","author":"Langenbucher","year":"2024","journal-title":"Br. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0886-3350(00)00816-6","article-title":"Multivariate analysis of refractive data: Mathematics and statistics of spherocylinders","volume":"27","author":"Naeser","year":"2001","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/S0886-3350(00)00797-5","article-title":"Power vector analysis of the optical outcome of refractive surgery","volume":"27","author":"Thibos","year":"2001","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/j.1538-9235.1997.tb04707.x","article-title":"Power vectors: An application of Fourier analysis to the description and statistical analysis of refractive error","volume":"74","author":"Thibos","year":"1997","journal-title":"Optom. Vis. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Langenbucher, A., Szentm\u00e1ry, N., Cayless, A., Wendelstein, J., and Hoffmann, P. (2023). Prediction of corneal power vectors after cataract surgery with toric lens implantation-A vector analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0288316"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1111\/aos.16742","article-title":"The Homburg-Adelaide toric IOL nomogram: How to predict corneal power vectors from preoperative IOLMaster 700 keratometry and total corneal power in toric IOL implantation","volume":"103","author":"Langenbucher","year":"2025","journal-title":"Acta Ophthalmol."},{"key":"ref_18","unstructured":"(2020). Ophthalmic Optics\u2014Visual Acuity Testing\u2014Standard and Clinical Optotypes and Their Presentation (Standard No. ISO Standard No. 8596:2017\/Amd 1:2019)."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1046\/j.1475-1313.2001.00596.x","article-title":"Collaborative Longitudinal Evaluation of Keratoconus Study. Repeatability of subjective refraction in myopic and keratoconic subjects: Results of vector analysis","volume":"21","author":"Raasch","year":"2001","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_20","first-page":"245","article-title":"Repeatability and validity of the PowerRefractor and the Nidek AR600-A in an adult population with healthy eyes","volume":"80","author":"Allen","year":"2003","journal-title":"Optom. Vis. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1002\/j.1538-9235.1998.tb05112.x","article-title":"The repeatability of automated and clinician refraction","volume":"75","author":"Bullimore","year":"1998","journal-title":"Optom. Vis. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4831298","DOI":"10.1155\/2020\/4831298","article-title":"Repeatability of Aberrometry-Based Automated Subjective Refraction in Healthy and Keratoconus Subjects","volume":"2020","author":"Carracedo","year":"2020","journal-title":"J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.ophtha.2005.12.021","article-title":"Accuracy, repeatability, and clinical application of spherocylindrical automated refraction using time-based wavefront aberrometry measurements","volume":"113","author":"Nissman","year":"2006","journal-title":"Ophthalmology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/OPX.0b013e31819fa590","article-title":"Standardized patient methodology to assess refractive error reproducibility","volume":"86","author":"Shah","year":"2009","journal-title":"Optom. Vis. Sci."},{"key":"ref_25","first-page":"618","article-title":"Non-cycloplegic spherical equivalent refraction in adults: Comparison of the double-pass system, retinoscopy, subjective refraction and a table-mounted autorefractor","volume":"6","author":"Vilaseca","year":"2013","journal-title":"Int. J. Ophthalmol."},{"key":"ref_26","first-page":"23","article-title":"Repeatability and validity of astigmatism measurements","volume":"15","author":"Walline","year":"1999","journal-title":"J. Refract. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s00347-014-3064-6","article-title":"Reproducibility of subjective refraction measurement","volume":"111","author":"Grein","year":"2014","journal-title":"Ophthalmologe"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1097\/OPX.0000000000000923","article-title":"Repeatability and Reproducibility of Virtual Subjective Refraction","volume":"93","author":"Perches","year":"2016","journal-title":"Optom. Vis. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1002\/j.1538-9235.1995.tb03938.x","article-title":"Repeatability of subjective and objective refraction","volume":"72","author":"Rosenfield","year":"1995","journal-title":"Optom. Vis. Sci."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1396\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T13:39:42Z","timestamp":1777988382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091396"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091396","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]}}}