Abstract: Objective To compare the clinical agreement of subjective refraction results obtained with “monocular fogging” versus “binocular simultaneous fogging”, thereby providing evidence for selecting the fogging method in clinical practice. Methods In this diagnostic test study, 62 volunteers aged 17-23 years from North Sichuan Medical College were enrolled in November 2023 and randomly assigned to two groups. Each participant underwent both “monocular fogging” and “binocular simultaneous fogging” subjective refraction, with a baseline non-fogging subjective refraction performed on the right eye before testing as control. Differences in spherical power, cylindrical power, and astigmatic vector components J0 and J45 between the two fogging methods were compared. Agreement was assessed using the intraclass correlation coefficient(ICC)and Bland-Altman plots. Results No statistically significant differences were found in spherical power, cylindrical power, J0, or J45 between the two fogging methods(P>0.05). Compared with non-fogging refraction, both fogging methods yielded lower spherical powers(P<0.01). The ICCs for spherical power and cylindrical power between the two fogging methods were 0.99 and 0.95, indicating excellent agreement, while those for J0 and J45 were 0.36 and 0.15, indicating poor agreement. Conclusion “Monocular fogging” and “binocular simultaneous fogging” show excellent agreement and interchangeability for spherical and cylindrical power measurements in subjective refraction. Given the higher efficiency, “binocular simultaneous fogging” is recommended for clinical priority.

Key words: Monocular fogging, Binocular simultaneous fogging, Subjective refraction