Non-Cycloplegic and Cycloplegic Autorefraction with Retinomax: An Agreement Study in Preschoolers in Los Angeles, California

ABSTRACT

Purpose

To evaluate the agreement between non-cycloplegic autorefraction (NCAR) and cycloplegic autorefraction (CAR) in an ethnically diverse population of preschool-aged children and the validity of the screening criteria used to refer for further evaluation.

Methods

This study included data from 7,073 preschoolers who underwent NCAR and CAR, which enabled refractive error classification based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 criteria. Right eye data of sphere and cylinder were used to compare NCAR to CAR via paired t-testing and vector analyses, and left eye data for an analysis on anisometropia. The sensitivity and specificity of screening referral criteria for refractive error were calculated.

Results

Mean values of sphere differed between NCAR and CAR by 1.95 ± 1.45 D (p < .05) with 95% limits of agreement (LoA) of −0.94 to 4.85 D, with less discrepancy found in myopic eyes. The mean values of cylinder differed by −0.08 ± 0.43 D (p < .05) with 95% LoA of −0.93 to 0.77 D. Power vector results reflected a similar lack of agreement. The sensitivity and specificity of our screening referral criteria were, respectively, 66% and 84% for myopia, 66% and 98% for hyperopia, and 98% and 58% for astigmatism.

Conclusion

NCAR is insufficient in preschoolers for spherical refractive error referrals. Level of agreements was lower for spherical (15.5% within 0.5D) and higher for cylindrical refractive errors (89.6%) compared to CAR. In the absence of cycloplegic examination, screening programs using NCAR should utilize low referral thresholds for spherical refractive error.

KEYWORDS:

• Pediatric
• refraction
• measurement
• agreement
• amblyopia

Acknowledgments

The authors would like to acknowledge the contributions of Kara Mondino, Pamela Duarte, and Ellie Kalatzi.

Disclosure statement

None of the following authors have any proprietary interests or conflicts of interest related to this submission: Margines, Yu, Mehravaran, Coleman

Additional information

Funding

The UPVP is funded by an unrestricted grant fromResearch to Prevent Blindness (USA) to the UCLA Stein Eye Institute and a grant from First 5 LA. Funding for this investigation originated from the Short-Term Training Program at the David Geffen School of Medicine at UCLA. The investigators have no other relevant financial disclosures related to this subject.