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Musa M, Enaholo E, Bale BI, Salati C, Spadea L, Zeppieri M. Retinoscopes: Past and present. World J Methodol 2024; 14:91497. [PMID: 39310243 PMCID: PMC11230066 DOI: 10.5662/wjm.v14.i3.91497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills. AIM To discuss the history of retinoscopes and examine current literature on the subject. METHODS A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term "Retinoscopy," with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)]. RESULTS This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope. CONCLUSION The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
| | - Ehimare Enaholo
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa, Nkpor 434101, Nigeria
| | | | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Bui A, Mitchell GL, McDaniel C, Morrison A, Toole A, Buckland M, Kulp MT. Detection of significant vision conditions in children using QuickSee wavefront autorefractor. Ophthalmic Physiol Opt 2024; 44:501-513. [PMID: 38504505 DOI: 10.1111/opo.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus). METHODS Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses. RESULTS The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51). CONCLUSIONS QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.
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Affiliation(s)
- Anh Bui
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - G Lynn Mitchell
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | - Ann Morrison
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Andrew Toole
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio, USA
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Morrison AM, Kulp MT, Ciner EB, Mitchell GL, McDaniel CE, Hertle RW, Candy TR, Roberts TL, Peterseim MM, Granet DB, Robbins SL, Srinivasan G, Allison CL, Ying GS, Orel-Bixler D, Block SS, Moore BR. Prescribing patterns for paediatric hyperopia among paediatric eye care providers. Ophthalmic Physiol Opt 2023; 43:972-984. [PMID: 37334937 DOI: 10.1111/opo.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. METHODS Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. RESULTS Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. CONCLUSION Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.
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Affiliation(s)
- Ann M Morrison
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Elise B Ciner
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| | - G Lynn Mitchell
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | | | - T Rowan Candy
- Indiana University Bloomington, Bloomington, Indiana, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - M Millicent Peterseim
- Medical University of South Carolina Albert Florens Storm Eye Institute, Charleston, South Carolina, USA
| | - David B Granet
- Viterbi Family Department of Ophthalmology, Ratner Children's Eye Center, University of California San Diego, La Jolla, California, USA
| | - Shira L Robbins
- Viterbi Family Department of Ophthalmology, Ratner Children's Eye Center, University of California San Diego, La Jolla, California, USA
| | - Gayathri Srinivasan
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | | | - Gui-Shuang Ying
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Deborah Orel-Bixler
- Berkeley School of Optometry, University of California, Berkeley, California, USA
| | | | - Bruce R Moore
- New England College of Optometry, Boston, Massachusetts, USA
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Shah R, Edgar DF, Evans BJW. Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data. Ophthalmic Physiol Opt 2023; 43:454-465. [PMID: 36866712 DOI: 10.1111/opo.13112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age. METHODS Retrospective anonymised data from computerised vision screening at age 4-5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. RESULTS Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2-8.0), 8.5 (8.1-8.9), 7.5 (7.1-7.9), 7.8 (7.4-8.2), 8.7 (8.1-9.2), 8.5 (7.9-9.0) and 9.3 (8.8-9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. CONCLUSIONS For children 4-5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population.
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Affiliation(s)
- Rakhee Shah
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - David F Edgar
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - Bruce J W Evans
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
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Rao DP, Negiloni K, Gurunathan S, Velkumar S, Sivaraman A, Baig AU, B K, Murali K. Validation of a Simple-to-Use, Affordable, Portable Wavefront Aberrometry-Based Auto Refractometer in a Paediatric Population. Clin Ophthalmol 2022; 16:4281-4291. [PMID: 36578668 PMCID: PMC9792114 DOI: 10.2147/opth.s387831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose InstaRef R20 is a handheld, affordable auto refractometer based on Shack Hartmann aberrometry technology. The study's objective was to compare InstaRef R20's performance for identifying refractive error in a paediatric population to that of standard subjective and objective refraction under both pre- and post-cycloplegic conditions. Methods Refraction was performed using 1) standard clinical procedure consisting of retinoscopy followed by subjective refraction (SR) under pre- and post-cycloplegic conditions and 2) InstaRef R20. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 20 children was assessed. Results The refractive error was measured in 132 children (mean age 12.31 ± 3 years). The spherical equivalent (M) and cylindrical components (J0 and J45) of the device had clinically acceptable differences (within ±0.50D) and acceptable agreement compared to standard pre- and post-cycloplegic manual retinoscopy and subjective refraction (SR). The device agreed within ± 0.50D of retinoscopy in 67% of eyes for M, 78% for J0 and 80% for J45 and within ± 0.50D of SR in 70% for M and 77% for cylindrical components. Conclusion InstaRef R20 has an acceptable agreement compared to standard retinoscopy in paediatric population. The measurements from this device can be used as a starting point for subjective acceptance. The device being simple to use, portable, reliable and affordable has the potential for large-scale community-based refractive error detection.
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Affiliation(s)
- Divya Parthasarathy Rao
- R&D, Remidio Innovative Solutions Inc, Glen Allen, VA, USA,Correspondence: Divya Parthasarathy Rao, R&D, Remidio Innovative Solutions Inc, 11357 Nuckols Road, #102, Glen Allen, VA, 23059, USA, Tel +1 855 513-3335, Email
| | - Kalpa Negiloni
- R&D, Remidio Innovative Solutions Pvt Ltd, Bengaluru, India
| | | | | | | | | | - Kumari B
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Bengaluru, India
| | - Kaushik Murali
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Bengaluru, India
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Hunter SC, Suh DW, Molina I, Espinoza J. Automated screening devices for vision screening in preschool children: A comparison of the PlusoptiX S12C photoscreener and retinomax K+3 autorefractor. FRONTIERS IN OPHTHALMOLOGY 2022; 2:1049622. [PMID: 38983509 PMCID: PMC11182206 DOI: 10.3389/fopht.2022.1049622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/05/2022] [Indexed: 07/11/2024]
Abstract
Introduction Automated vision screening devices such as photoscreeners and autorefractors have been used to accurately identify amblyopia, refractive amblyopia risk factors (ARFs), and refractive error in young children; however, there is conflicting data about the effectiveness of different screening devices. We compared the performance of two commercially available screening devices in preschool children. Methods Children aged 3 to 5 years attending 5 preschools in Anaheim Elementary School District were screened with the PlusoptiX S12C photoscreener using ROC 3 referral criteria and Retinomax K+3 autorefractor in March 2022. Screened children were offered free cycloplegic eye examinations performed by optometrists on the UCI EyeMobile for Children mobile clinic. Children were evaluated for the presence of refractive ARFs using 2021 American Association for Pediatric Ophthalmology and Strabismus age-based referral criteria guidelines for instrument-based screening. Results A total of 158 children were screened and 79 children received cycloplegic examinations. At least one refractive ARF was found in 20% of examined children, corresponding to a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 94%/89%/68%/98% for the PlusoptiX and 100%/65%/42%/100% for the Retinomax. Discussion In detecting refractive ARFs, the PlusoptiX was found to have a higher specificity and PPV while the Retinomax had a higher sensitivity and NPV. While both devices demonstrated a high sensitivity and NPV, we found that the PlusoptiX performed better overall as a screening device for our program as the Retinomax referred too many children.
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Affiliation(s)
- Stephen C Hunter
- University of California Riverside School of Medicine, Riverside, CA, United States
| | - Donny W Suh
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA, United States
| | - Iliana Molina
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA, United States
| | - Jennifer Espinoza
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA, United States
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Maguire MG, Ying GS, Ciner EB, Kulp MT, Candy TR, Moore B. Detection of Significant Hyperopia in Preschool Children Using Two Automated Vision Screeners. Optom Vis Sci 2022; 99:114-120. [PMID: 34889862 PMCID: PMC8816853 DOI: 10.1097/opx.0000000000001837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE Moderate to high uncorrected hyperopia in preschool children is associated with amblyopia, strabismus, reduced visual function, and reduced literacy. Detecting significant hyperopia during screening is important to allow children to be followed for development of amblyopia or strabismus and implementation of any needed ophthalmic or educational interventions. PURPOSE This study aimed to compare the sensitivity and specificity of two automated screening devices to identify preschool children with moderate to high hyperopia. METHODS Children in the Vision in Preschoolers (VIP) study were screened with the Retinomax Autorefractor (Nikon, Inc., Melville, NY) and Plusoptix Power Refractor II (Plusoptix, Nuremberg, Germany) and examined by masked eye care professionals to detect the targeted conditions of amblyopia, strabismus, or significant refractive error, and reduced visual acuity. Significant hyperopia (American Association for Pediatric Ophthalmology and Strabismus definition of hyperopia as an amblyopia risk factor), based on cycloplegic retinoscopy, was >4.00 D for age 36 to 48 months and >3.50 D for age older than 48 months. Referral criteria from VIP for each device and from a distributor (PediaVision) for the Power Refractor II were applied to screening results. RESULTS Among 1430 children, 132 children had significant hyperopia in at least one eye. Using the VIP referral criteria, sensitivities for significant hyperopia were 80.3% for the Retinomax and 69.7% for the Power Refractor II (difference, 10.6%; 95% confidence interval, 7.0 to 20.5%; P = .04); specificities relative to any targeted condition were 89.9 and 89.1%, respectively. Using the PediaVision referral criteria for the Power Refractor, sensitivity for significant hyperopia was 84.9%; however, specificity relative to any targeted condition was 78.3%, 11.6% lower than the specificity for the Retinomax. Analyses using the VIP definition of significant hyperopia yielded results similar to when the American Association for Pediatric Ophthalmology and Strabismus definition was used. DISCUSSION When implementing vision screening programs for preschool children, the potential for automated devices that use eccentric photorefraction to either miss detecting significant hyperopia or increase false-positive referrals must be taken into consideration.
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Affiliation(s)
| | - Gui-Shuang Ying
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise B Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana
| | - Bruce Moore
- New England College of Optometry, Boston, Massachusetts
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Kulp MT, Ciner E, Ying GS, Candy TR, Moore BD, Orel-Bixler D. Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers - Hyperopia in Preschoolers (VIP-HIP) Studies. Asia Pac J Ophthalmol (Phila) 2022; 11:52-58. [PMID: 35044337 PMCID: PMC8813881 DOI: 10.1097/apo.0000000000000483] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This review summarizes clinically relevant outcomes from the Vision in Preschoolers (VIP) and VIP-Hyperopia in Preschoolers (VIP-HIP) studies. In VIP, refraction tests (retinoscopy, Retinomax, SureSight) and Lea Symbols Visual Acuity performed best in identifying children with vision disorders. For lay screeners, Lea Symbols single, crowded visual acuity (VA) testing (VIP, 5-foot) was significantly better than linear, crowded testing (10-foot). Children unable to perform the tests (<2%) were more likely to have vision disorders than children who passed and should be referred for vision evaluation. Among racial/ethnic groups, the prevalence of amblyopia and strabismus was similar while that of hyperopia, astigmatism, and anisometropia varied. The presence of strabismus and significant refractive errors were risk factors for unilateral amblyopia, while bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. A greater risk of astigmatism was associated with Hispanic, African American, and Asian race, and myopic and hyperopic refractive error. The presence and severity of hyperopia were associated with higher rates of amblyopia, strabismus, and other associated refractive error. In the VIP-HIP study, compared to emmetropes, meaningful deficits in early literacy were observed in uncorrected hyperopic 4- and 5-year-olds [≥+4.0 diopter (D) or ≥+3.0 D to ≤+6.0 D associated with reduced near visual function (near VA 20/40 or worse; stereoacuity worse than 240")]. Hyperopia with reduced near visual function also was associated with attention deficits. Compared to emmetropic children, VA (distance, near), accommodative accuracy, and stereoacuity were significantly reduced in moderate hyperopes, with the greatest risk in those with higher hyperopia. Increasing hyperopia was associated with decreasing visual function.
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Affiliation(s)
| | - Elise Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, US
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, IN, US
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Accuracy of Noncycloplegic Refraction for Detecting Refractive Errors in School-aged African Children. Optom Vis Sci 2021; 98:920-928. [PMID: 34460453 DOI: 10.1097/opx.0000000000001742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
SIGNIFICANCE Cycloplegia is often restricted in screening settings. Previous studies have evaluated noncycloplegic refraction for screening, but their data are not fully applicable to school-aged African children. This article adds to the literature by investigating this in school-aged African children. PURPOSE The purpose of this study was to evaluate the ability of noncycloplegic autorefraction (NCA) and noncycloplegic retinoscopy (NCR) to detect refractive errors in school-aged African children and quantify differences between noncycloplegic and cycloplegic refraction measures. METHODS Autorefraction and retinoscopy were performed on 150 children aged 6 to 15 years before and after cyclopentolate cycloplegia. Subjective refraction was performed by the same examiner after cycloplegia. Noncycloplegic and cycloplegic measurements were compared, and the data were assessed with receiver operating characteristic curves and Bland-Altman plots. RESULTS With the exception of cylindrical vector J0 (P = .17) and J45 (P = .08) obtained with NCR, all mean measures of NCA and NCR significantly differed from mean cycloplegic subjective refraction measurements by -0.71 ± 0.67 (P ≤ .001; 95% confidence interval, -2.02 to +0.60) and -0.75 ± 0.68 (P ≤ .001; 95% confidence interval, -2.08 to +0.58), respectively. Mean spherical power between the two tests did not differ (NCA -NCR, mean bias of -0.037 ± 0.675 and 95% limits of agreement of -1.36 to 1.286; P = .51). The sensitivities for detecting any refractive error for NCR and NCA were 86.8 and 82.9%, respectively, and the specificities were 82.0% for NCR and 82.4% for NCA. Performance of both tests was excellent for myopia (area under the curve, >0.90; sensitivity, ≥90%) and similar (P = .13), but the specificities for detecting hyperopia were 78.0% for NCR and 80.0% for NCA. CONCLUSIONS Noncycloplegic refraction may accurately detect astigmatism and myopia in this population but may elicit higher myopic values and lower hyperopic values than using cycloplegic refraction.
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Li L, Fu J, Chen W, Meng Z, Sun Y, Su H, Yao Y, Dai W. Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study. Jpn J Ophthalmol 2021; 65:526-536. [PMID: 33656708 DOI: 10.1007/s10384-021-00828-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the differences between cycloplegic and noncycloplegic refraction as well as associated factors in grade one students of primary schools, and explore the effectiveness of noncycloplegic refraction for refractive error screening. STUDY DESIGN Cross-sectional study. METHODS A school-based study of 1856 students was conducted in Lhasa, Tibetan Plateau, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P at a 5-min interval. Autorefraction was performed under both cycloplegic and noncycloplegic conditions. Bland-Altman analysis, receiver operating characteristic curve analysis, univariate and multiple linear regression models were used for analysis. RESULTS Of the 1856 children enrolled, 1830 (98.60%) completed all procedures. The average age was 6.83 ± 0.46 years. 965 (52.73%) children were boys and 1737 (94.92%) were Tibetan. Overall, there was a significant difference between cycloplegic and noncycloplegic SE of 0.90 ± 0.76D (P < 0.001). However, the intra-class coefficient correlation (ICC) for cylinder between these two methods was high (ICC = 0.941, 95% CI, 0.935-0.946). Larger differences between cycloplegic and noncycloplegic SE were associated with hyperopic RE and higher cylindrical value (P < 0.001). The prevalence of myopia, emmetropia and hyperopia with and without cycloplegia was (3.93% vs 14.59%), (9.95% vs 45.8%) and (86.21% vs 39.56%), respectively. Myopia, emmetropia and hyperopia based on noncycloplegic refraction was defined as SE ≤ - 0.625D, - 0.625 < SE ≤ 0D, and SE > 0D, respectively. CONCLUSIONS Lack of cycloplegia leads to underestimation of hyperopia, with overestimation of myopia and emmetropia. Larger hyperopic refraction exhibited greater difference between cycloplegic and noncycloplegic refraction.
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Affiliation(s)
- Lei Li
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jing Fu
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Weiwei Chen
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yunyun Sun
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Han Su
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yao Yao
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Wei Dai
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
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Padhy D, Bharadwaj SR, Nayak S, Rath S, Das T. Does the Accuracy and Repeatability of Refractive Error Estimates Depend on the Measurement Principle of Autorefractors? Transl Vis Sci Technol 2021; 10:2. [PMID: 33505769 PMCID: PMC7794271 DOI: 10.1167/tvst.10.1.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to determine the accuracy and repeatability of refractive errors obtained using three autorefractors based on different measurement principles, vis-à-vis, gold-standard retinoscopy. Methodology Accuracy of noncycloplegic, sphero-cylindrical refractive error of 234 eyes was obtained using the rotary prism-based RM-8900 closed-field autorefractor, photorefraction based Spot vision screener, wavefront aberrometry based E-see, and streak retinoscopy by four different examiners, masked to the results of each other. Intersession repeatability of autorefractors was determined by repeat measurements in a subset of 40 subjects. Results Retinoscopy values of M, J0, and J45 power vectors for the cohort ranged from -10.2 to 8 D, -1.4 to 1.8 D, and -0.9 to 1.2 D, respectively. Across autorefractors, the interequipment bias of M and J0 power vectors were statistically insignificant (< ±0.5 D; P > 0.05) but the corresponding limits of agreement were ±2.5 and ±1 D, respectively, without any trend across instruments or the patient's age (P > 0.5). Repeatability of M and J0 power vectors were ±0.75 D and ±0.40 D, respectively, across autorefractors. The range of J45 power vector was too narrow for any meaningful analysis. Conclusions Refractive errors measured using autorefractors operating on different principles show minimal bias and good short-term repeatability but relatively large agreement limits, vis-à-vis, retinoscopy. Among them, the wavefront aberrometry based E-see autorefractor performs relatively better in all measurement parameters evaluated here. Translational Relevance Although autorefractor estimates of noncycloplegic refractive error appears independent of their measurement principle, their relatively poor agreement with gold-standard retinoscopy warrants caution while used for screening and quantification of refractive errors.
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Affiliation(s)
- Debananda Padhy
- Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.,Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Shrikant R Bharadwaj
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Suryasmita Nayak
- Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.,Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Suryasnata Rath
- Ophthalmic Plastics, Orbit and Ocular Oncology Services, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
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Agreement and Repeatability of Noncycloplegic and Cycloplegic Wavefront-based Autorefraction in Children. Optom Vis Sci 2020; 96:879-889. [PMID: 31703049 PMCID: PMC6855388 DOI: 10.1097/opx.0000000000001444] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Increasing prevalence of refractive error requires assessment of ametropia as a screening tool in children. If cycloplegia is not an option, knowledge about the increase in uncertainty for wavefront-based autorefraction is needed. The cycloplegic agent as the principal variant presents cross-reference and allows for extraction of the influence of accommodation. PURPOSE The purpose of this study was to determine the repeatability, agreement, and propensity to accommodate of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront-based autorefraction (ZEISS i.Profiler plus; Carl Zeiss Vision, Aalen, Germany) in children aged 2 to 15 years. METHODS In a clinical setting, three consecutive measurements were feasible for 145 eyes (OD) under both conditions. Data are described by spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45). In the case of M, the most positive value of the three measurements was chosen, whereas the mean was applied for astigmatic components. RESULTS Regarding agreement, differences for ARc minus ARnc were statistically significant: for M, 0.55 (0.55 D; mean [SD]; P < .001), that is, more hyperopic in cycloplegia; for J0, −0.03 (0.11 D; P = .002); and for J45, −0.03 D (SD, 0.09 D; P < .001). Regarding repeatability, astigmatic components showed excellent repeatability: SD < 0.11 D (ARnc) and SD < 0.09 D (ARc). The repeatability of M was SD = 0.57 D with a 95% interval of 1.49 D (ARnc). Under cycloplegia, this decreased to SD = 0.17 D (ARc) with a 95% interval of 0.50 D. The mean propensity to accommodate was 0.44 D from repeated measurements; in cycloplegia, this was reduced to 0.19 D. CONCLUSIONS Wavefront-based refraction measurement results are highly repeatable and precise for astigmatic components. Noncycloplegic measurements of M show a systematic bias of 0.55 D. Cycloplegia reduces the propensity to accommodate by a factor of 2.4; for noncycloplegic repeated measurements, accommodation is controlled to a total interval of 1.49 D (95%). Without cycloplegia, results improve drastically when measurements are repeated.
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Kara C, Petriçli İS. Comparison of photoscreening and autorefractive screening for the detection of amblyopia risk factors in children under 3 years of age. J AAPOS 2020; 24:20.e1-20.e8. [PMID: 31926368 DOI: 10.1016/j.jaapos.2019.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the effectiveness of photoscreening and autorefractive screening for the detection of amblyopia risk factors (ARFs) in a cohort of preterm and term-born children <3 years of age. METHODS In this cross-sectional study, the Spot Vision photoscreener and the SureSight autorefractor were used to screen participants. The diagnostic and predictive values of the devices in detecting ARF based on American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 referral criteria was calculated using manufacturer criteria, the VIP 90 (90% specificity) and VIP 94 (94% specificity) criteria from the Vision in Preschool (VIP) study, and criteria recommended by Rowatt and colleagues. Results were evaluated using receiver operating characteristic (ROC) curves. RESULTS A total of 368 patients (mean age, 14.4 ± 10.4 months) were included. The ARF rate was 25% according to the 2013 AAPOS criteria. The highest specificity and positive predictive values (PPV) were obtained with Spot Vision manufacturer criteria (specificity, 0.91; PPV, 0.69). SureSight manufacturer criteria showed very low specificity and PPV values (specificity, 0.43; PPV, 0.35) and a high false positive rate (57%). The highest specificity and PPV values for SureSight were obtained with the Rowatt criteria (specificity, 0.86; PPV, 0.62). CONCLUSIONS In our study cohort, photoscreening with the Spot Vision manufacturer criteria seemed sufficient for vision screening in the 0-3 years age group, with high specificity values. The Rowatt criteria may increase performance of the SureSight in this age group.
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Affiliation(s)
- Caner Kara
- Department of Ophthalmology, Etlik Zübeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey.
| | - İkbal Seza Petriçli
- Department of Ophthalmology, Etlik Zübeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
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Yakar K. Anterior chamber depth and axial length affect clinical performance of Spot Vision Screener. Arq Bras Oftalmol 2020; 83:43-47. [PMID: 31664336 PMCID: PMC11984441 DOI: 10.5935/0004-2749.20200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. METHODS A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. RESULTS Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). CONCLUSION The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.
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Affiliation(s)
- Konuralp Yakar
- Department of Ophthalmology, Ataturk State Hospital, Sinop, Turkey
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15
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Tan QQ, Christiansen SP, Wang J. Development of refractive error in children treated for retinopathy of prematurity with anti-vascular endothelial growth factor (anti-VEGF) agents: A meta-analysis and systematic review. PLoS One 2019; 14:e0225643. [PMID: 31790445 PMCID: PMC6886775 DOI: 10.1371/journal.pone.0225643] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/09/2019] [Indexed: 01/11/2023] Open
Abstract
Objective To investigate refractive error development in preterm children with severe retinopathy of prematurity (ROP) treated with anti-vascular endothelial growth factor (anti-VEGF) agents and laser photocoagulation. Methods Selection criteria were comparative studies that compared the refractive errors in children, birthweights ≤1500 grams and gestational ages ≤30 weeks, and treatments for Type I ROP with intravitreal bevacizumab (IVB) versus laser photocoagulation. Studies were identified using PubMed, Google Scholar, and published reviews. Meta-analyses were performed on the post-treatment outcomes of spherical equivalent (SEQ), cylindrical power, and prevalence of high myopia. Longitudinal development of refractive error in IVB, or in laser-treated children, or in normal full-term children was visually summarized. Results Two randomized controlled trials and 5 non-randomized studies, including a total of 272 eyes treated by IVB and 247 eyes treated by laser, were included in this study. Compared with laser-treated children, IVB-treated children have less myopic refractive error (P<0.001), lower prevalence of high myopia (P<0.05), and less astigmatism (P = 0.02). Conclusions Treatment with IVB is associated with less myopia and astigmatism than laser treatment for infants with severe ROP. Given the complexity of ROP and the variability of dosing, our review supports close monitoring of refractive error outcomes in children treated with IVB.
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Affiliation(s)
- Qing-Qing Tan
- Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, Sichuan, China
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, United States of America
| | - Stephen P. Christiansen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Boston Medical Center, Boston, Massachusetts, United States of America
| | - Jingyun Wang
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, United States of America
- * E-mail:
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Tousignant B, Garceau MC, Bouffard-Saint-Pierre N, Bellemare MM, Hanssens JM. Comparing the Netra smartphone refractor to subjective refraction. Clin Exp Optom 2019; 103:501-506. [PMID: 31773810 DOI: 10.1111/cxo.13003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/30/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Among technologies targeting mobile eye care, EyeNetra is a smartphone-based subjective refraction system. This study compared the results from this system with those of professional subjective refraction. Participant visual comfort and preference of results were also measured. METHODS Thirty-six optometry-naïve participants (n = 36 eyes, aged 18-35 years), were randomly subjected to three refraction methods: professional subjective refraction, unassisted Netra (participants alone) and refined Netra (sphere results refined by a practitioner). Using a randomised, double-blind design, refraction results were mounted in a trial frame and distance logMAR visual acuities were measured. Subjective appreciation and visual comfort were assessed by questionnaire. Overall preference was ranked. RESULTS Unassisted Netra yielded a median myopic overcorrection of 0.60 D (interquartile range [IQR] 0.25 to 0.94) compared to professional subjective refraction. Median equivalent sphere with unassisted Netra (-1.40 D, IQR -3.10 to -0.90) was significantly more myopic than refined Netra (-0.70 D, IQR -1.60 to -0.30) and then subjective refraction (-0.80 D, IQR -1.60 to -0.30) (all p-values < 0.01). Median visual acuity with professional subjective refraction (-0.16, IQR -0.22 to -0.09) was superior than unassisted Netra (-0.08, IQR -0.20 to 0.03) (p < 0.01). Subjective refraction was ranked first in preference of trial framed results by 72 per cent of participants; median preference rank favoured professional subjective refraction to both Netra results (all p < 0.01). For all questionnaire items, visual comfort was higher with subjective refraction than with unassisted Netra (all p < 0.04). CONCLUSION The Netra device - especially when used without professional assistance and compared to subjective refraction - induces significant myopic overcorrection and lower levels of visual acuity, subjective preference and visual comfort.
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Thomas J, Rajashekar B, Kamath A, Gogate P. Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers. Clin Exp Optom 2019; 103:347-352. [PMID: 31566805 DOI: 10.1111/cxo.12962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/15/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Preschool vision screenings are considered to be cost-effective methods to identify children with vision disorders. The children of this age group are poor at communicating their symptoms and hence screening is mandated. This study is aimed at estimating the diagnostic accuracy and agreement of Lea, HOTV and E visual acuity charts for detecting significant refractive errors. METHODS A cross-sectional study was conducted, in which monocular unaided vision assessment of each study participant was performed with Lea, HOTV and E charts. Stereo acuity was measured with the Randot Preschool Test and a comprehensive eye examination including dilatation was performed. Significant refractive error was defined as hyperopia > 3.25 D, myopia > 2.00 D, astigmatism > 1.50 D, anisometropia if interocular difference > 1.00 D for hyperopia, > 3.00 D for myopia or > 1.50 D for astigmatism. Sensitivity, specificity, positive and negative predictive values were estimated. Bland-Altmann plots were generated to help identify the level of agreement between the vision charts. RESULTS A total of 256 eyes were analysed. Lea, HOTV and E had sensitivities of 87.8 per cent, 90.2 per cent and 90.2 per cent, respectively. Specificity and positive predictive values were better for HOTV (77.3 per cent, 65.5 per cent) and Lea (75 per cent, 62.6 per cent), compared to E chart (69.8 per cent, 58.7 per cent). Negative predictive values for Lea, HOTV and E charts were 92.8 per cent, 93.8 per cent and 93.8 per cent, respectively. Bland-Altmann analysis showed good agreement between Lea and HOTV, Lea and E, and HOTV and E visual acuity charts. The acuity difference was least between Lea and HOTV charts (0.1 logMAR). Eighty-five (33.2 per cent) eyes had significant refractive errors. Eighty (94.1 per cent) eyes were astigmatic. CONCLUSION The diagnostic accuracy of the visual acuity charts was high for the identification of significant refractive errors in preschool children. There was very good agreement between the visual acuity charts.
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Affiliation(s)
- Jyothi Thomas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Bellur Rajashekar
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Parikshit Gogate
- Department of Ophthalmology, DY Patil Medical College Hospital, Pune, India
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Srinivasan G, Russo D, Taylor C, Guarino A, Tattersall P, Moore B. Validity of the Spot Vision Screener in detecting vision disorders in children 6 months to 36 months of age. J AAPOS 2019; 23:278.e1-278.e6. [PMID: 31521849 DOI: 10.1016/j.jaapos.2019.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the Spot Vision Screener in detecting targeted vision disorders compared to cycloplegic retinoscopy in children <3 years of age. METHODS Children, ages 6 months to 36 months underwent vision screening using the Spot Vision Screener. Results were compared to results of comprehensive eye examinations. Validity of the Spot was evaluated by calculating the area under the curve (AUC); the receiver operating characteristics (ROC) were used to determine optimal sensitivity and specificity for detection of targeted vision disorders. RESULTS A total of 249 children were included. The AUC for detecting targeted vision disorders as defined by the study specific criteria using the Spot was 0.790. Compared to cycloplegic retinoscopy, the Spot underestimated hyperopia by 1.02 D (95% CI, 0.86-1.17 D). For hyperopia ≥4.5 D spherical equivalent (n = 10), the mean difference between the Spot and cycloplegic retinoscopy was 3.46 D (95% CI, 1.95-4.98 D). In contrast, the Spot overestimated astigmatism compared to cycloplegic retinoscopy (-1.00 D vs -0.48 D; P < 0.001) by -0.52 D (95% CI, 0.43-0.62 D). CONCLUSIONS The Spot Vision Screener showed good overall validity in detecting targeted vision disorders. It was within 0.5 D and 1 D of cycloplegic retinoscopy with regard to low hyperopia and astigmatism. Higher hyperopic spherical equivalent refractive errors showed larger differences in mean values between the Spot and cycloplegic retinoscopy.
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Affiliation(s)
| | - Diane Russo
- New England College of Optometry, Boston, Massachusetts
| | | | | | | | - Bruce Moore
- New England College of Optometry, Boston, Massachusetts
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Zimmerman DR, Ben-Eli H, Moore B, Toledano M, Stein-Zamir C, Gordon-Shaag A. Evidence-based preschool-age vision screening: health policy considerations. Isr J Health Policy Res 2019; 8:70. [PMID: 31514739 PMCID: PMC6739935 DOI: 10.1186/s13584-019-0339-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background There are many causes of visual impairment, and even blindness, which are treatable or at least preventable. Two such conditions are strabismus (crossed-eye, squint) and refractive error (visual image not focused on the most sensitive part of the retina). If these are not detected and corrected at an early age, they can lead to an irreversible impairment known as amblyopia (lazy eye). Pediatric vision screening and subsequent treatment for amblyopia and amblyogenic risk factors are thus key to preventing vision loss. Furthermore, vision screening can detect moderate to high hyperopia, which has been found to be associated with poor school readiness. Evidence-based recommendations call for screening children at 3–5 years of age; they are old enough to cooperate, but still within the window of effective intervention. However, these recommendations have yet to be universally implemented as the standard of care. Methods This paper integrates a review of the literature and the international experience of preschool vision screening with the findings from a preliminary feasibility study of expanded screening in Israel to formulate a discussion of the current health policy challenge in Israel and the options for addressing it. The advantages and disadvantages of various venues for vision screening are discussed. Findings Screening by optometrists in Mother and Child Health Centers, as implemented in a recent pilot project in the Jerusalem District, would allow the most comprehensive testing. Photo-screening in preschools would reach the most children, but at the cost of missing hyperopia (farsightedness). Either approach would probably constitute improvements over the current situation. The relative strengths of the two approaches depends in part on the ability to purchase automatic screening equipment (and the efficacy of that equipment) vs. the ongoing cost of paying trained personnel. Conclusions Further research should be conducted in Israel to determine the prevalence of refractive errors, so that best practices can be established for Israel’s population and social needs. In the interim, the Ministry of Health should promptly implement the inclusion of preschool visions screening for children in the approved “basket of services” covered by the National Health Insurance Laws, using photo-screening, including collection of the clinical data. Electronic supplementary material The online version of this article (10.1186/s13584-019-0339-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Hadas Ben-Eli
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel.,Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bruce Moore
- New England College of Optometry, Boston, MA, USA
| | - Monique Toledano
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel.,The Hebrew University of Jerusalem, Faculty of Medicine, The Hebrew University and Hadassah Braun School of Public and Community Medicine, Jerusalem, Israel
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Doherty SE, Doyle LA, McCullough SJ, Saunders KJ. Comparison of retinoscopy results with and without 1% cyclopentolate in school‐aged children. Ophthalmic Physiol Opt 2019; 39:272-281. [DOI: 10.1111/opo.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sue E Doherty
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Lesley A Doyle
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Sara J McCullough
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Kathryn J Saunders
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
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Han S, Zhang X, Zhao X, Wang Y, Hao Q, Li R, Huang D, Zhu H, Sun Q, Chen J, Gao Y, Li M, Chen X, Liu H. Stereoacuity and Related Factors in Healthy Preschool Children: The Nanjing Eye Study. Ophthalmic Epidemiol 2019; 26:336-344. [PMID: 31167630 DOI: 10.1080/09286586.2019.1624782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To assess the distribution of stereoacuity and related factors in healthy preschool children aged 48-60 months in eastern China. Methods: This cross-sectional study was part of the Nanjing Eye Study, a longitudinal population-based cohort study. In 2016, preschool children without any neurological problems or ophthalmological abnormalities completed comprehensive eye examinations, including visual acuity, ocular alignment and movements, cycloplegic refraction, axial length, interpupillary distance, Titmus stereotest, anterior segment, and fundus examination. Multivariate linear regression model was used to determine the factors associated with stereoacuity score, and logistic regression model was used to determine the factors associated with subnormal stereoacuity (worse than 40 arc-seconds). Results: Among 942 healthy preschool children (mean age = 55 months), the mean (SD) stereoacuity was 81 (2.3) arc-seconds with majority (76.5%) worse than 40 arc-seconds. In the multivariate analysis, older age (p = 0.001) and better presenting visual acuity (PVA) (p = 0.01) were independently associated with better stereoacuity score. Older age was also associated with low risk of subnormal stereoacuity (odds ratio = 0.37,p < 0.001 for age 57-60 months compared to age 48-51 months). Conclusions: The maturation of stereopsis has not completed by the age of 48-60 months. Age and PVA should be taken into account when evaluating stereopsis in healthy preschoolers. The significant associations of age and PVA with stereoacuity provide valuable insights into possible intervention for healthy preschool children with poor stereoacuity.
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Affiliation(s)
- Shu Han
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China.,Department of Ophthalmology, The Second Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Xiaohan Zhang
- Department of Ophthalmology, Wuxi Children's Hospital , Wuxi , China
| | - Xiaoyan Zhao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Yue Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Qingfeng Hao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Rui Li
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Dan Huang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Qigang Sun
- Maternal and Child Healthcare Hospital of Yuhuatai District , Nanjing , China
| | - Ji Chen
- Maternal and Child Healthcare Hospital of Yuhuatai District , Nanjing , China
| | - Yan Gao
- The Fourth School of Clinical Medicine of Nanjing Medical University , Nanjing , China
| | - Meng Li
- The Fourth School of Clinical Medicine of Nanjing Medical University , Nanjing , China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , China
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Hopkins S, Black AA, White SL, Wood JM. Validity of the +1.50 plus lens screening test as a predictor of uncorrected moderate hyperopia. Ophthalmic Physiol Opt 2019; 39:141-147. [PMID: 30994200 DOI: 10.1111/opo.12617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Screening for uncorrected hyperopia in school children is important given its association with poorer visual function and academic performance. However, standard distance visual acuity screening may not detect low to moderate hyperopia. The plus lens test is used to screen for hyperopia in many school screening protocols, but has not been well validated. The current study investigated the effectiveness of the plus lens test to identify hyperopia in school children. METHODS Participants included Grade 2 school children. Monocular distance visual acuity (logMAR letter chart) was measured unaided, and then through a +1.50D lens, known as the plus lens test. Cycloplegic refraction was undertaken to classify moderate hyperopia (≥+2.00D). Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for commonly used cut-offs for the plus lens test: 6/6, 6/9 and less than two lines difference between unaided acuity and acuity through the plus lens test. RESULTS The sample included 59 children (mean age 7.2 ± 0.4 years). Fourteen (24%) children were classified as having uncorrected hyperopia. The sensitivity and specificity of the +1.50 plus lens test for identifying hyperopia were 0% and 98% respectively for a 6/6 cut-off, 29% and 91% for 6/9 cut-off, and 50% and 76% for a <2 line reduction between unaided acuity and acuity through the plus lens test. Receiver Operating Curve (ROC) analysis revealed area under curves of 0.69 based on acuity through the plus lens test, and 0.65 for a reduction in acuity through the plus lens test. CONCLUSIONS The plus lens test has low sensitivity for detecting uncorrected hyperopia using traditional cut-offs of 6/9 or better. This raises questions about the role of the plus lens test in school screening batteries.
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Affiliation(s)
- Shelley Hopkins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alex A Black
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Sonia L White
- School of Early Childhood and Inclusive Education, Faculty of Education, Queensland University of Technology, Brisbane, Australia
| | - Joanne M Wood
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Silverstein E, Donahue SP. Preschool Vision Screening: Where We Have Been and Where We Are Going. Am J Ophthalmol 2018; 194:xviii-xxiii. [PMID: 30059651 DOI: 10.1016/j.ajo.2018.07.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To discuss the evolution of instrument-based screening to detect amblyopia and its risk factors, and to summarize the importance of preschool vision screening. DESIGN Expert commentary. METHODS Author experiences were supplemented by a review and interpretation of pertinent medical literature. RESULTS Amblyopia remains a public health problem, as it is a common cause of monocular visual impairment. As a disease, amblyopia detection is best obtained by appropriate vision screening rather than by yearly mandated comprehensive eye examinations for all children; the US Preventative Services Task Force (USPSTF) recently reaffirmed their recommendations for vision screening in preschool children. Vision screening devices have evolved over the past 4 decades ranging from photoscreeners that use instantaneously developing film, to autorefractors that detect amblyopia risk factors, to nerve fiber layer scanners that detect the microtropia that nearly always accompanies amblyopia. When it is detected early, effective treatment for amblyopia can be initiated. CONCLUSIONS Amblyopia is a reversible cause of vision loss in children. Vision screening devices and screening programs have been extensively studied-experts and literature agree: vision screening devices and programs are cost-effective, are efficient, and are effective methods for amblyopia detection. The authors support the regular use of instrument-based vision screening in the medical home for all children until they reach a developmental stage where they can participate reliably in optotype-based vision screening.
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Evidence for the need for vision screening of school children in Turkey. BMC Ophthalmol 2017; 17:230. [PMID: 29197362 PMCID: PMC5712108 DOI: 10.1186/s12886-017-0618-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/20/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In many countries, access to general health and eye care is related to an individual's socioeconomic status (SES). We aimed to examine the prevalence of oculo-visual disorders in children in Istanbul Turkey, drawn from schools at SES extremes but geographically nearby. METHODS Three school-based vision screenings (presenting distance visual acuity, cover test, eye assessment history, colour vision, gross stereopsis and non-cycloplegic autorefraction) were conducted on 81% of a potential 1014 primary-school children aged 4-10 years from two private (high SES) schools and a nearby government (low SES) school in central Istanbul. Prevalence of refractive errors and school-based differences were analysed using parametric statistics (ANOVA). The remaining oculo-visual aspects were compared using non-parametric tests. RESULTS Of the 823 children with mean age 6.7 ± 2.2 years, approximately 10% were referred for a full eye examination (8.2% and 16.3% of private/government schools respectively). Vision had not been previously examined in nearly 22% of private school children and 65% of government school children. Of all children, 94.5% were able to accurately identify the 6/9.5 [LogMAR 0.2] line of letters/shapes with each eye and 86.6% the 6/6 line [LogMAR 0], while 7.9% presented wearing spectacles, 3.8% had impaired colour vision, 1.5% had grossly impaired stereo-vision, 1.5% exhibited strabismus, 1.8% were suspected to have amblyopia and 0.5% had reduced acuity of likely organic origin. Of the 804 without strabismus, amblyopia or organic conditions, 6.0% were myopic ≤ - 0.50DS, 0.6% hyperopic ≥ + 2.00DS, 7.7% astigmatic ≥1.00 DC and 6.2% anisometropic ≥1.00DS. CONCLUSIONS The results highlight the need for general vision screenings for all children prior to school entry given the varied and different pattern of visual problems associated with lifestyle differences in two populations raised in the same urban locale but drawn from different socioeconomic backgrounds.
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Hendler K, Mehravaran S, Lu X, Brown SI, Mondino BJ, Coleman AL. Refractive Errors and Amblyopia in the UCLA Preschool Vision Program; First Year Results. Am J Ophthalmol 2016; 172:80-86. [PMID: 27640004 DOI: 10.1016/j.ajo.2016.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the outcomes of full ophthalmic examination for preschool children in LA County who failed screening with the Retinomax Autorefractor. DESIGN Retrospective, cross-sectional study. METHODS Between August 2012 and May 2013, the University of California Los Angeles (UCLA) preschool vision program screened 11 260 preschool children aged 3-5 years in Los Angeles County using the Retinomax Autorefractor only. Of those, 1007 children who failed the screening were examined by an ophthalmologist on the UCLA Mobile Eye Clinic. Data from the eye examination were recorded for all children. Amblyopia was defined as unilateral if there was ≥2 line interocular difference in the best-corrected visual acuity (BCVA) and as bilateral if BCVA was <20/50 for children <4 years old and <20/40 for children ≥4 years old. RESULTS Glasses were prescribed for 740 (74%) of those examined. Uncorrected visual acuity for all examined children was 0.4 ± 0.2 (logMAR mean ± SD), and BCVA was 0.2 ± 0.1. Of the 88% who underwent cycloplegia, 58% had hyperopia (spherical equivalent [SE] ≥+0.50 diopter [D]), mean of +2.50 D, and 21% had myopia (SE ≤-0.50 D), mean of -1.40 D. A total of 69% had astigmatism ≥1.50 D, mean of 1.97 D (range 0-5.75). Spherical and cylindrical anisometropia ≥1.00 D were each found in 26% of those examined. Refractive amblyopia was found in 9% of those examined, or 0.8% of the original population. Of the amblyopic subjects, 77% were unilateral. CONCLUSIONS Screening of preschoolers with the Retinomax led to diagnosis and early treatment of uncorrected refractive errors and amblyopia. By treating children early, amblyopia may be prevented, quality of life improved, and academic achievements enhanced.
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Guha S, Shah S, Shah K, Hurakadli P, Majee D, Gandhi S. A comparison of cycloplegic autorefraction and retinoscopy in Indian children. Clin Exp Optom 2016; 100:73-78. [PMID: 27426488 DOI: 10.1111/cxo.12375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 09/16/2015] [Accepted: 10/06/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Correction of significant refractive errors in childhood helps in preventing amblyopia and strabismus. India has a huge demand for eye-care services related to uncorrected refractive errors with limited manpower resources. This can be overcome by autorefractors, which are free of operator bias, do not need skilled eye-care professionals and can be operated with ease. Hence, the purpose of this study, the first in the Indian population, was to determine the accuracy of autorefraction compared to traditional retinoscopy under cycloplegia. METHOD A cross-sectional study of all children meeting our inclusion criteria was conducted from July till October 2011 in a tertiary eye care centre. Children underwent cycloplegic (cyclopentolate plus tropicamide) refraction with an auto-refractometer (Topcon KR-8900) and traditional retinoscopy and the results were compared. Patients were divided into three groups: Group 1: Myopia and myopic astigmatism, Group 2: Hyperopia and hyperopic astigmatism and Group 3: Mixed astigmatism. Clinically significant difference was defined as either of more than 0.50 D difference in sphere, more than 0.5 D difference in cylinder or more than 20 degrees difference in axis. RESULTS The left eyes of 294 children (148 male) were included in the study. Mean age was 8.22 ± 3.47 years. Clinically significant differences were noted in 13.22 per cent of eyes in Group 1, 15.09 per cent of eyes in Group 2 and 20.90 per cent of eyes in Group 3. Clinically significant differences were more common in children aged less than six years (25 per cent) compared to older children (9.19 per cent). Comparing the sphere, cylinder, spherical equivalent and length of power vector values gained by autorefraction and retinoscopy, no statistically significant differences were found in any group. CONCLUSION Autorefraction with Topcon KR-8900 can be used reliably in Indian children older than six years, if conducted under cycloplegia. In mixed astigmatism and children less than six years, it should be corroborated with retinoscopy.
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Affiliation(s)
- Sujata Guha
- Sankara Nethralaya, Kolkata, West Bengal, India
| | - Sanil Shah
- Sankara Nethralaya, Kolkata, West Bengal, India
| | - Khyati Shah
- Sankara Nethralaya, Chennai, Tamil Nadu, India
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