Repeatability of a Combined Adaptive Optics Visual Simulator and Hartman-Shack Aberrometer in Pseudophakic Eyes With and Without Previous Corneal Refractive Surgery

Purpose: To evaluate the intrasession repeatability of wavefront aberrations obtained by a combined adaptive optics visual simulator and Hartman-Shack aberrometer in pseudophakic eyes with and without previous corneal refractive surgery. Methods: Three consecutive measurements were performed in one eye of each individual. Total ocular aberrations were recorded up to the 5th Zernike order for a 4.5-mm pupil. Repeatability was assessed by calculating the within-subject standard deviation (S w ), the repeatability limit (R), and the intraclass correlation coefficient (ICC). Vector analysis was performed to assess astigmatism variability between scans. Results: The study enrolled 32 normal individuals and 24 individuals with a history of refractive surgery. In normal and eyes that had previous refractive surgery, respectively, the S w values were 0.155 and 0.176 diopters (D) for sphere and 0.184 and 0.265 D for cylinder. The S w values for all 3rd order terms ranged from 0.037 to 0.047 µm in normal eyes and 0.044 to 0.063 µm in eyes that had previous refractive surgery. The S w for primary spherical aberration was 0.020 µm in normal eyes and 0.026 µm in eyes that had previous refractive surgery. ICC values for measurements of astigmatism yielded larger variability (ICC = 0.751 and 0.879). However, both groups demonstrated excellent repeatability (ICC > 0.9) for root mean square higher order aberrations (RMS-HOA) and total RMS values. Conclusions: In pseudophakic eyes, the adaptive optics Hartmann-Shack device demonstrated acceptable repeatability for measurement of sphere and 3rd and 4th order HOAs with higher variability for astigmatism measurements, especially in eyes with a prior history of corneal refractive surgery. [ J Refract Surg . 2024;40(9):e645–e653.]