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Smitha Inaganti, Nisha Krishan-Dave; Comparison of Cycloplegic Handheld Autorefraction with Conventional Cycloplegic Retinoscopy in a Pediatric Population. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2341.
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Several studies have found that autorefraction under cycloplegic conditions is accurate enough to substitute for cycloplegic retinoscopy in children. The purpose of this study is to analyze whether cycloplegic handheld autorefraction is accurate and consistent with cycloplegic retinoscopy performed by ophthalmology residents in a pediatric population.
A retrospective chart review was performed of pediatric patients in an inner-city, resident eye clinic between November 2011 and November 2012. We identified 200 eyes of 100 patients between the ages of 3 and 17 who underwent post cycloplegic handheld autorefraction with the Righton Retinomax 3, followed by streak retinoscopy and subjective manifest refraction, all performed by second year ophthalmology residents. Spherical equivalence, spherical power, cylindrical power and axis measurements were compared.
Spherical equivalence measured by autorefractor was significantly different from both retinoscopy (p<0.0001) and final subjective manifest refraction (p<0.0001). There was no significant difference in spherical equivalence between retinoscopy and manifest refraction (p= 0.41). Similar differences were found in spherical power, with autorefractor measurements significantly different from retinoscopy (p<0.0001) and manifest (p<0.0001) and no significant difference between retinoscopy and manifest refraction (p=0.98). The spherical power measured by autorefractor was within +/- 0.5 diopter range of the manifest refraction in 26% of eyes compared to 84% by retinoscopy. No significant difference was found between the autorefractor and retinoscopy for cylindrical power (p=0.79) with 78% of autorefraction cylindrical power measurements within +/- 0.5 D of manifest. Measurement of axis, in 99 of 200 eyes, was significantly different (p<0.0001), with retinoscopy measuring more consistent with manifest. Only 63% of autorefractor measurements were within ten degrees of manifest axis, compared with 98% of retinoscopy measurements.
Under cycloplegic conditions, there remained a significant difference between handheld autorefraction and standard flash retinoscopy. The autorefractor had a tendency toward overcorrecting spherical power for minus by a mean of 1.1 diopters. The autorefractor was more consistent with retinoscopy when measuring cylindrical power, although measurement of axis was inconsistent.
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