Impact of Viewing Conditions and Vision Anomalies on Accuracy and Dynamics of Noncycloplegic Autorefraction

Kiermasz J., Sobol M., Pniewski J.

Optometry and Vision Science

99(12), 2022, 844-852, 10.1097/OPX.0000000000001962


This study was conducted to analyze the influence of binocular vision and accommodation anomalies on refraction dynamics. Our results may help to design more accurate autorefractors and to better understand the difficulties in prescribing an optical correction or adaptation to a correction.


This study aimed to verify whether viewing conditions (open- or closed-field) or vision anomalies, such as ocular surface diseases, accommodative dysfunctions, and binocular vision anomalies, influence (1) the differences between subjective refraction and autorefraction and (2) the characteristics of the short-term refractive state variation.


The subjective refraction of 64 subjects aged 23 to 60 years was measured during a comprehensive optometric examination, and the Ocular Surface Disease Index questionnaire was collected. Twenty successive measurements of automated refraction of each eye were obtained using a conventional autorefractor Nidek ARK-510A and an open-field autorefractor Shin-Nippon NVision-K 5001. Conventional notation of refractive error (sphere, cylinder, axis) was transformed to h-vectors, presented in scatterplots, and analyzed statistically.


The three-way analysis of variance tests showed that there is no influence of accommodation dysfunctions (P = .22 for ARK-510A), binocular vision anomalies (P = .97 for ARK-510A), and ocular surface diseases (P = .20 for ARK-510A) on differences between autorefraction and subjective refraction. The binocular vision anomalies affected the results from open-field autorefractor, whereas the accommodation impacted closed-field refraction measurements. Changes in short-term refractive state variation occurred in sphere power, indicating accommodative state changes; however, 30 subjects demonstrated at least one outlier and/or polymodality of refractive state distributions.


The study showed that the presence of accommodative dysfunctions or binocular vision anomalies might increase the range of short-term refractive state variation. The impact of vision anomalies differs between viewing conditions. The polymodal distribution of refractive state variation and the presence of outliers imply that automatic modes used typically in autorefractors with three to five readings may not accurately represent the refractive state of the eye.