Ellipsoid Spectacle Comparison of Plusoptix, Retinomax and 2WIN Autorefractors

Abstract

Background

Handheld devices can automatically give an estimate of refraction. The established method for refraction comparison using spherical equivalent (M) and J0, J45 vector transformations by Bland–Altman analysis is too complex for non-eye doctors involved with vision screening and remote vision clinics. Therefore, a simpler comparison technique was developed.

Methods

Based on the spectacle limit to resolve grade A 1 logMAR, B 3 logMAR and C 6 logMAR blur, J0, J45, and M are combined into the Alaska Blind Child Discovery (ABCD) composite ellipsoid GRADE system. Pediatric eye patients had confirmatory examination after dry refraction with three portable autorefractors: Plusoptix, 2WIN and Retinomax. The refractions were then compared using both Bland–Altman and ABCD composite. Performance to detect AAPOS amblyopia risk factors was also assessed.

Results

A total of 202 children, mean age seven years, 28% high spectacle need and 43% AAPOS 2013 amblyopia risk factors showed high correlation with cycloplegic refraction (intraclass correlation 0.49 to 0.90) for sphere, J0 and J45 spectacle components. Plusoptix had more (10%) inconclusives due to patients out-of-range. The Retinomax was unable to screen some younger children and was less reliable for sphere but gave more precise astigmatism estimates. The proportion of autorefractions expected to give GRADE A/B high-need patients acuity improvement to 20/40 would be 41% for Plusoptix, 39% for 2WIN and 65% for Retinomax. Sensitivity/specificity for amblyopia risk factor detection was 80%/83% for Plusoptix, 72%/88% for 2WIN and 84%/73% for Retinomax.

Conclusion

The simplified spectacle comparison resembled Bland–Altman and could assist lay vision screeners and non-eye doctors attempting remote spectacle donation worldwide.

Graphical abstract

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Keywords:

• spectacles
• remote dispensing
• autorefractors
• validation

Disclosure

Robert Arnold is board member of Glacier Medical Software that makes cloud-based ROP Check, is board member of PDI Check that makes vision screening games for Nintendo 3DS autostereoscopic screen, is coordinator of the Alaska Blind Child Discovery that has received discounted vision screening technology from several vendors, and is investigator and protocol developer for NIH-supported Pediatric Eye Disease Investigator Group (PEDIG). In addition, he is a member of the non-paid advisory boards for Plusoptix, GoCheck Kids, Adaptica, and iScreen. Kyle Smith is board member of PDI Check. The authors report no other conflicts of interest in this work.

Additional information

Funding

There is no funding to report.