Efficiency and Accuracy of the Welch Allyn SureSight Noncycloplegic Aurorefractor for Assessing School-aged Children

Abstract

Abstract: : Purpose: Detection and correction of refractive errors (RE) during early childhood is critical for optimizing visual development and has obvious practical implications for educational achievement. Recent advances in noncycloplegic autorefractive technology designed to provide rapid, objective measurement of RE make early identification possible. We used the Welch Allyn SureSight to screen school-aged children to see whether (1) it was practical for large-scale screening (2) repeated measures agreed (3) results were comparable to those obtained with traditional cycloplegic techniques. Methods: Both eyes from 147 healthy 5- to 9-year-olds were refracted twice with the SureSight (Welch Allyn, Inc., USA) noncycloplegic autorefractor. Results: (1) All children were compliant and provided data in less than two minutes (M = 103.56 sec). (2) Repeated measures for sphere and cylinder estimates were correlated (p < .01) and test-retest differences small (M = -.16D; M = .01D, respectively). (3) Means and SDs for sphere and cylinder for the right eye were estimated to be: The sudden significant (p < .01) change from hyperopia to myopia between 6- and 7-yr is inconsistent with developmental data obtained with cycloplegic refractive techniques. Moreover, this shift coincides with the age the manufacturer recommends changing the autorefractor setting from child to adult mode to correct for estimated age differences in accommodation. Estimates of cylinder were reasonably consistent with data obtained with cycloplegic methods. Conclusions: The SureSight is a fast, potentially effective device for large-scale screening. However, our results call into question the accuracy of the absolute values of estimated spherical RE provided by this autorefractor, at least with school-aged children. Possibly the calibration for the shift from child to adult modes needs greater sensitivity to real accommodative change with age. Nevertheless, preliminary age norms provided by the SureSight may be useful to identify children with high RE if individual estimates are interpreted relative to the group rather than absolutely.  

Keywords: refractive error development • clinical research methodology • visual development: infancy and childhood