Comparison of vision performance of spectacles prescribed to 0.05D versus 0.25D steps.

Clinical Relevance: Traditionally, refraction is performed, and spectacles are manufactured in in 0.25D-steps. Trial and spectacle lenses manufactured in smaller increments may allow for a more accurate refraction and prescribed spectacles.

Background: To determine whether refraction in 0.05D-steps improves the proportion of eyes achieving achieve duochrome equality, and whether spectacles prescribed in 0.05D-steps offer any vision benefits, compared to 0.25D-steps.

Methods: Myopic young adults were enrolled into two prospective studies conducted at different sites. Study 1 comprised 66 participants (refracted under cycloplegia) while Study 2 comprised 51 participants (not cyclopleged). A standard refraction was performed in both studies and a trial frame and trial lenses were used to determine the spherical endpoint of duochrome equality (0.25D-steps first then 0.05D-steps). In Study 2, the cylindrical component was refined in 0.05D-steps before the spherical endpoint in 0.05D-steps. Monocular high-contrast-visual-acuity (HCVA) was measured while wearing the final refractions. Participants in Study 2 wore spectacles manufactured in 0.25D and 0.05D-steps for 7 days each in a randomized, double-masked study. Both spectacles appeared identical. Outcome measures assessed on dispensing and after 7 days of wear comprised monocular acuity-based measurements (HCVA, low-contrast-visual-acuity, vanishing-optotype-acuity, contrast-sensitivity) and subjective ratings. The Quality-of-Vision questionnaire and subjective preference were assessed after 7 days.

Results:     Both studies showed a higher proportion of eyes achieved duochrome equality ( < 0.001) and better average monocular HCVA ( ≤ 0.006) in 0.05D-steps. Study 2 showed 0.05D-step spectacles provided better average results for all monocular acuity-based measurements ( < 0.006) and were preferred by 65% ( = 0.04) of participants after 7 days ( = 0.04). There were no differences between spectacles for any other measures ( > 0.1).

Conclusions: Refraction performed, and spectacles manufactured in 0.05D-steps for this study improved average acuity-based outcomes and were preferred by most participants to spectacles in traditional 0.25D-steps.