Cycloplegia Improves the Inter-Optometrist Repeatability of Subjective Refraction

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Dr. Pablo Perez-Merino,

 

I have read the manuscript "Cycloplegia Improves the Inter-Optometrist Repeatability of Subjective Refraction" with great interest. This study addresses an important topic regarding the potential of cycloplegia to enhance repeatability in objetive refraction measurements, particularly relevant in pediatric optometry. The authors provide a thorough introduction, effectively contextualizing the role of cycloplegic refraction in children. I also appreciate their use of Fourier analysis to assess the evolution of refraction, which adds depth to their methodology. The study objective is clearly stated, providing a solid foundation for the research.

 

The results are well-presented, utilizing Bland-Altman plots that facilitate accurate comparisons among the studied groups. Additionally, the discussion is comprehensive, effectively situating the findings within the current state of the art and offering meaningful insights.

 

I fully support the publication of this article in its current form.

Author Response

Thank you very much for the positive feedback on our work. We appreciate your time reviewing the manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript evaluated the inter-optometrist repeatability of subjective refraction (non- cycloplegic) and cycloplegic refraction, by looking at spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45), measured in two different sessions by two different optometrists. The methodology is solid, the analysis is relatively complete, and the figures and tables are clearly presented. The paper might be suitable for publication if the authors will attend several issues and revise the text.

1.        The authors state in the manuscript that this study is the only one that used cycloplegia to evaluate the inter-optometrist repeatability (line 189), but there were articles, for example, McCullough, S. J., Doyle, L., & Saunders, K. J. (2017). Intra‐and inter‐examiner repeatability of cycloplegic retinoscopy among young children. Ophthalmic and Physiological Optics, 37(1), 16-23. that studied inter-optometrist repeatability.

2.        Line 93: this equation is incorrect, it should be “M=S+C/2”. If the authors did not use the correct function for computing the M values, please correct them.

3.        Line 175: The authors seem to use repeatability and the corresponding 95%CI interchangeably. Please make this clear whether it’s Sr or r that’s being discussed.

4.        Line 180: it seems like the two participants that are outside of the dashed lines had differences of 0.50 D and 0.625 D, not 0.50 D and 0.75 D.

Author Response

Thank you very much for your comments. We greatly appreciate your constructive feedback, which helps to make the work easier to understand. We have incorporated the suggested changes into the manuscript (in Red):

Comment 1: The authors state in the manuscript that this study is the only one that used cycloplegia to evaluate the inter-optometrist repeatability (line 189), but there were articles, for example, McCullough, S. J., Doyle, L., & Saunders, K. J. (2017). Intra‐and inter‐examiner repeatability of cycloplegic retinoscopy among young children. Ophthalmic and Physiological Optics, 37(1), 16-23. that studied inter-optometrist repeatability.

Response 1: Thank you for your comment. Indeed, this is not the first study to evaluate inter-optometrist repeatability using cycloplegia. However, it is important to note that the study you referenced focuses exclusively on retinoscopy, whereas our discussion refers to subjective refraction. This is why we have not incorporated your suggestion into the discussion.

Comments 2, 3, and 4: 

2. Line 93: this equation is incorrect, it should be “M=S+C/2”. If the authors did not use the correct function for computing the M values, please correct them.
3. Line 175: The authors seem to use repeatability and the corresponding 95%CI interchangeably. Please make this clear whether it’s Sr or r that’s being discussed.
4. Line 180: it seems like the two participants that are outside of the dashed lines had differences of 0.50 D and 0.625 D, not 0.50 D and 0.75 D.
   
   Response: Thank you for your comments. We have corrected all of these points in the new version of the manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

In this manuscript, the authors show that cycloplegia improves the inter-optometrist repeatability of subjective refraction in young hyperopes showing that the accommodation is likely the primary source of error that could explain the differences in subjective refraction among optometrists.

 My main impression is that the manuscript is novel and interesting, has a sufficient impact and adds to the knowledge base. The manuscript conforms to the journal-specific instructions and fits into the scope of journal.

The manuscript is clear, relevant for the field and presented in a well-structured manner.

The cited references are mostly recent publications and there is no excessive number of self-citations in the manuscript.

The manuscript is scientifically sound and the experimental design is appropriate to test the hypothesis. The results are reproducible based on the details given in the methods section.

The figures are appropriate and they show properly the data. They are easy to interpret and understand. The data is interpreted appropriately and consistently throughout the manuscript; the statistical analyses are of high standard.

The conclusions are consistent with the evidence and arguments presented, coherent and supported by the listed citations. The manuscript will attract a wide readership.

Ethic statements are adequate.

There is an overall merit to publish this work.

Author Response

Thank you for your comments, interest in our work, and positive evaluation of its publication.