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Adil Bhatti, Rami Abo-Shasha, Rejean Munger, Michael O'Connor; A comparison of non-cycloplegic and cycloplegic autorefraction using Spot™ to manual cycloplegic retinoscopy in a pediatric population. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5677. doi: https://doi.org/.
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Cycloplegic manual retinoscopy is the gold standard for determining pediatric refractive error. As an alternative to this labour-intensive technique, there is continued interest in autorefraction, particularly for use in pediatric vision screening programs. This study compares autorefraction using Spot™ (PediaVision LLC, Pompano Beach, FL) to manual retinoscopy in a pediatric population.
Case series (retrospective chart review). Forty-five children underwent autorefraction (non-cycloplegic and cycloplegic) and manual cycloplegic refraction by a staff ophthalmologist in the pediatric ophthalmology clinic. Refractive errors were converted to spherical equivalents. Data from the right eye of each subject were used. Statistical measures of performance (sensitivity, specificity, positive and negative predictive values) were then calculated for both non-cycloplegic and cycloplegic autorefraction conditions: myopia (< -1D), hyperopia (+>2D), cylindrical (>1D), and anisometropia (>1.5D in equivalent sphere), using manual retinoscopy as the gold standard.
The mean differences between non-cycloplegic autorefraction and cycloplegic retinoscopy, non-cycloplegic autorefraction and cycloplegic autorefraction, and cycoplegic autorefraction and cycoplegic retinoscopy were -1.85 +/- 2.20, -2.10 +/- 2.52, and 0.20 +/- 2.16, respectively. Sensitivity and specificity for non-cycloplegic autorefraction were as follows: myopia (sensitivity 40%, sensitivity 90%), hyperopia (sensitivity 18.8%, sensitivity 96.6%), cylinder (sensitivity 75%, sensitivity 79.3%), and anisometropia (sensitivity 21.8%, sensitivity 95.4%). Cycloplegic autorefraction for myopia revealed sensitivity 66.7% and sensitivity 100%; for hyperopia, sensitivity 83.3% and sensitivity 92.9%; for cylinder, sensitivity 50% and sensitivity 71.4%; and for anisometropia, sensitivity 84.2% and sensitivity 90.5%.
These results suggest that the Spot™ autorefractor is fairly effective at detecting clinically significant refractive errors under cycloplegic conditions. Under non-cycloplegic conditions, induced accommodation may limit the instrument’s ability to effectively detect hyperopia and anisometropia in pediatric subjects. This factor should be taken into consideration when using these types of devices for pediatric vision screening.
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