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Plusoptix Vision Screener: the accuracy and repeatability of refractive measurements using a new autorefractor
  1. A H Dahlmann-Noor1,2,
  2. O Comyn1,
  3. V Kostakis1,2,
  4. A Misra1,2,
  5. N Gupta1,
  6. J Heath1,
  7. J Brown1,
  8. A Iron1,
  9. S McGill1,
  10. K Vrotsou3,4,
  11. A J Vivian1,2
  1. 1
    Eye Treatment Centre, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, UK
  2. 2
    Ophthalmology Department, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
  3. 3
    Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Institute of Public Health, Robinson Way, Cambridge, UK
  4. 4
    Research Unit, Galdakao Hospital, Bizkaia, Spain
  1. Dr A J Vivian, Eye Treatment Centre, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds IP33 2QZ, UK; anthony.vivian{at}


Background: The Plusoptix Vision Screener (PVS) is a new non-cycloplegic videoretinoscopy autorefractor. Refractive accuracy may affect its performance as a screening tool.

Aims: Study 1: To determine the intra- and interobserver variability of PVS measurements. Study 2: To compare PVS measurements with gold-standard manual cycloplegic retinoscopy (MCR).

Methods: Study 1: PVS refraction of 103 children with mean (SD) age 5.5 (0.6) years by two observers. Study 2: PVS and MCR refraction of 126 children with mean (SD) age 5.5 (1.5) years, including 43 children with manifest strabismus ⩾5 PD, comparing mean spherical equivalent (MSE) and Jackson cross cylinders J0 and J45.

Results: Study 1: Repeatability coefficients (observer 1): MSE: 0.63 D, J0: 0.24 D, J45: 0.18 D; those of observer 2 were nearly identical. The mean difference (95% limits of agreement) between the two observers for MSE, J0 and J45 were, respectively, 0.03 (−0.62 to 0.68 D), −0.008 (−0.25 to 0.23 D) and 0.013 (−0.18 to 0.20) D. Study 2: MSE tended to be lower on PVS than MCR, with differences of up to 8.00 D. Less than 20% of values were within ±0.50 D of each other. Agreement was better for J0 and J45. Strabismus was associated with an odds ratio of 3.7 (95% CI 1.3 to 10.5) of the PVS failing to obtain a reading.

Conclusions: The PVS may underestimate children’s refractive error.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by Suffolk Local Research Ethics Committee.

  • Patient consent: Obtained from the parents.