ACCURACY AND DIAGNOSTIC PERFORMANCE OF SMARTPHONE-BASED REFRACTION APPLICATIONS COMPARED TO STANDARD CLINICAL REFRACTION

Abstract

Background: Smartphone-based refraction applications have emerged as accessible and cost-effective tools for estimating refractive errors, but their accuracy and diagnostic performance compared with standard clinical refraction remain uncertain across different patient populations and refractive conditions.

Objective: To evaluate the accuracy and diagnostic performance of smartphone-based refraction applications in comparison with standard clinical refraction methods.

Methods: This prospective comparative clinical study was conducted over six months in the Department of Ophthalmology after IRB approval. Thirty-four patients with refractive complaints were enrolled after written informed consent. Each participant underwent objective refraction using an autorefractometer followed by subjective refinement with a trial lens set, which served as the reference standard. Refraction was then assessed using the PEEK Acuity smartphone application under standardized conditions. Data were analyzed using SPSS v27, with agreement assessed by paired t-tests and Intraclass Correlation Coefficient (ICC); p≤0.05 was considered significant.

Result: A total of 34 participants included 19 (55.9%) females and 15 (44.1%) males. OD visual acuity was 6/12 in 44.1% and 6/9 in 32.4%, while OS was 6/12 in 41.2% and 6/9 in 32.4%. Objective and subjective refraction had a median spherical value of −0.75 D, whereas PEEK Acuity showed a more myopic median of −1.25 D. Significant differences were found among the three methods for both OD (χ²=36.683, df=2, p<0.001) and OS (χ²=38.095, df=2, p<0.001). PEEK Acuity differed significantly from objective and subjective refraction in both eyes (all adjusted p<0.001), while objective and subjective refraction did not differ significantly (OD p=0.86; OS p=1.00).

Conclusion: The findings indicate that objective and subjective refraction showed excellent agreement, while PEEK Acuity consistently produced significantly more myopic refractive estimates than standard clinical refraction.