Subjective versus objective refraction in healthy young adults

Yuval Kozlov, Michael Kinori, Sharon Armarnik, Tal Yahalomi, Aya Ekshtein, Leora Levian, Daphna Mezad-Koursh, Joseph Pikkel, Oded Ben-Ari

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate objective and subjective refraction differences in healthy young adults. Methods: Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. Results: This study included 1,395 young adult participants. The average age was 22.17 years (range, 17–39, 84.8% males). The average SE was − 0.65 ± 1.19 diopter (D) compared with − 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p < 0.001). This difference was more common in older participants (p < 0.001). J0 and J45 value differences were not significant. The absolute SE value of subjective refraction was lower in the myopic (p < 0.001) and hyperopic (p < 0.001) patients. Conclusions: Young hyperopic participants tended to prefer “less plus” in subjective refraction compared with autorefraction. Young myopic participants tended to prefer “less minus” in subjective refraction compared with autorefraction. All participants, but mainly older participants, preferred slightly “less Cp” than that measured using autorefraction; The astigmatic axis did not differ significantly between the methods.

Original languageEnglish
Article number79
JournalBMC Ophthalmology
Issue number1
StatePublished - 20 Feb 2024
Externally publishedYes

Bibliographical note

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  • Astigmatism
  • Autorefraction
  • Hyperopia
  • Myopia
  • Subjective refraction
  • Visual acuity


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