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Riping Zhang, Mingzhi Zhang, Mingguang He, Graeme MacKenzie, Joshua D. Silver, Leon Ellwein, Bruce Moore, Nathan G. Congdon; The Child Self-refraction Study: Results From Rural Guangdong, China. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3054.
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We sought to compare outcomes between adjustable spectacles and conventional measures of refractive error in children.
Rural Chinese school-children aged 12-18 years with uncorrected visual acuity ≤ 6/12 in either eye underwent self-refraction without cycloplegia, automated refraction without cycloplegia and subjective refraction with cycloplegia. Corrected and uncorrected vision, lines of vision improvement and spherical equivalent refractive error were measured.
Among 648 participants (mean age 14.9 +/- 0.98 years, 59.3% girls, 44.4% wearing glasses, 60.6% with 2.00D or more of myopia in the right eye), 100% completed self-refraction. The proportion with better-eye visual acuity ≥ 6/7.5 with currently-worn spectacles, self-refraction, automated refraction, and subjective refraction were 30.2%, 96.9%, 98.4% and 99.1% respectively (self-refraction versus automated refraction P = 0.065, self-refraction versus subjective refraction P =0.006). Improvement in better-eye vision with self-refraction and subjective refraction was within +/-1 line in 98.0% of children. In logistic models, failure to achieve maximum recorded visual acuity of 6/6 in right eyes with self-refraction was associated with higher absolute value of myopia/hyperopia (P < 0.001) and higher astigmatism (P < 0.001), but not age, gender or previous glasses wear. Significant inaccuracies in power (≥ 1.00 Diopter) were less common in right eyes with self-refraction than automated refraction (4.8% versus 10.8%, P < 0.001).
Visual acuity with self-refraction was excellent in the large majority of these rural children with a significant burden of inadequately-corrected refractive error. Inaccurate power was less common with self-refraction than non-cycloplegic automated refraction.
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