The Use of Digital Integrated Manifest Refraction in Pseudophakic Eyes

Purpose: To evaluate the accuracy and efficiency of a digital integrated manifest refraction system compared with standard manifest refraction in pseudophakic eyes. Methods: This prospective, double-blind study analyzed 100 eyes from 100 pseudophakic patients; 35 eyes received monofocal intraocular lenses MA60AC (AcrySof three-piece IOL; Alcon Laboratories, Inc], MX60 (enVista; Bausch & Lomb, Inc), CNA00 (Clareon Monofocal, Alcon Laboratories, Inc), and SN60AT (AcrySof IQ Monofocal; Alcon Laboratories, Inc) and 65 eyes received trifocal IOLs TFNT00 (AcrySof IQ PanOptix; Alcon Laboratories, Inc) and ZFR00V (Synergy; Johnson & Johnson Surgical Vision, Inc). All patients underwent objective refraction with the Nidek ARK-530A autorefractor, followed by manifest refraction performed with the Topcon VT-100 (Std-MR group) and the digital integrated manifest refraction unit TS-610 (Nidek Co, Ltd) (DI-MR group). Outcomes assessed included manifest spherical equivalent, refractive cylinder, time, correlation, and agreement between methods. Results: The mean manifest spherical equivalent was −0.15 ± 0.38 diopters (D) with the TS-610 and −0.14 ± 0.38 D with standard refraction ( P = .31). Linear regression demonstrated a strong correlation between methods ( R = 0.914, R 2 = 0.835, P < .001). The mean cylinder was −0.66 ± 0.52 D (TS-610) versus −0.62 ± 0.57 D (Std-MR), with a mean difference of −0.11 ± 0.17 D and a centroid of 0.01 ± 0.20 D in vector analysis. DI-MR significantly reduced testing time (3.1 ± 1.8 minutes) compared with Std-MR (7.1 ± 7.4 minutes, P = .001). Conclusions: The automated TS-610 manifest refraction system demonstrated excellent agreement with Std-MR refraction in pseudophakic eyes, while significantly reducing testing time. DI-MR provides a reliable and efficient alternative for postoperative evaluation and may enhance workflow efficiency in cataract and refractive practices.