Major article
A comparison of photorefraction and retinoscopy in children

This study was partially presented as a poster in the 39th Turkish Ophthalmology Congress, September 17-21, 2005, Antalya, Turkey.
https://doi.org/10.1016/j.jaapos.2007.04.006Get rights and content

Purpose

To compare the results of photorefraction measurement obtained with a Plusoptix CR03 to those of cycloplegic retinoscopy as a standard refraction method in children.

Methods

We assessed the refractive status of 204 eyes in 204 healthy children. The values acquired via photorefraction (noncycloplegic refraction) with a Plusoptix CR03 device were compared with those obtained via cycloplegic retinoscopy. Both methods were used in the same eyes and in all children. The paired tt-test and Pearson’s correlation analysis were used for statistical analysis.

Results

The mean age was 7.1 ± 2.4 years (range, 9 months to 14 years). The average spherical refractive error was +0.05 ± 0.65 D for photorefraction versus +0.75 ± 0.77 D for cycloplegic retinoscopy (average difference, −0.70 D; p < 0.001), with moderate correlation between measures (r = 0.63). The average cylinder power was +0.43 ± 0.38 D for photorefraction versus +0.29 ± 0.38 D for cycloplegic retinoscopy (average difference, +0.14 D; p < 0.001), with moderate correlation between measures (r = 0.70). The average spherical equivalent was +0.26 ± 0.63 D for photorefraction versus +0.90 ± 0.76 D for cycloplegic retinoscopy (average difference, −0.64 D; p < 0.001), with moderate correlation between measures (r = 0.63).

Conclusions

The Plusoptix CR03 device tends toward minus overcorrection in children, resulting in overdiagnosis of myopia. Studies of a population of subjects with a larger range of ametropia will be required to validate this instrument as a screening tool.

Section snippets

Materials and Methods

Because a photorefraction machine is particularly convenient for vision screening, and because screening is often conducted in daycare centers and elementary schools, the current study specifically compared the performance of a photorefraction device with gold-standard cycloplegic retinoscopy in children in this age range.

Refraction was measured with the Plusoptix CR03 and with cycloplegic retinoscopy in 204 eyes in 204 consecutive healthy children (92 boys and 112 girls), who were seen in the

Results

With photorefraction, average S and SE values were +0.05 ± 0.65 D (range, −3.75 to +1.50 D) and +0.26 ± 0.63 D (range, −2.38 to +2.00 D), respectively. With cycloplegic retinoscopy, average S and SE values were +0.75 ± 0.77 D (range, −1.50 to +3.50 D) and +0.90 ± 0.76 D (range, −1.50 to 3.88 D), respectively. We found moderate correlation between the two methods for measurements of S (r = 0.63, p < 0.001) and SE (r = 0.63, p < 0.001). The average cylinder power was +0.43 ± 0.38 D for

Discussion

Photorefraction allows the remote measurement of refractive error by analyzing the vergence of light reflected from the fundus.7 Commercially available photorefractive devices have been used for a number of years. For example, the MTI photoscreener (Medical Technology & Innovations, Inc., Cedar Falls, IA) is used in preschool screening in the United States.17, 18, 19, 20, 21 The first commercial videorefractor using eccentric photorefraction was the TOMEY ViVA (Fortune Optical, Padova, Italy),

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    The authors have no financial interest in any of the products mentioned in the article and received no financial support or sponsorships.

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