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PubMed2000

Refractive Error Study in Children: results from La Florida, Chile.

PURPOSE: To assess the prevalence of refractive errors and vision impairment in school-age children in a suburban area (La Florida) of Santiago, Chile. METHODS: Random selection of geographically defined clusters was used to identify a representative sample of children 5 to 15 years of age. Children in the 26 selected clusters were enumerated through a door-to-door survey and invited to report to a community health clinic for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus were done from April through August 1998. Independent replicate examinations of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in six clusters. RESULTS: A total of 6,998 children from 3,830 households were enumerated, and 5,303 children (75.8%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.50 (20/40) or worse in at least one eye was 15.8%, 14.7%, and 7.4%, respectively; 3.3% had best visual acuity 0.50 or worse in both eyes. Refractive error was the cause in 56.3% of the 1,285 eyes with reduced vision, amblyopia in 6.5%, other causes in 4.3%, with unexplained causes in the remaining 32.9%. Myopia -0.50 diopter or less in either eye was present in 3.4% of 5-year-old children, increasing to 19.4% in males and 14.7% in females by age 15. Over this same age range, hyperopia 2.00 diopters or greater decreased from 22.7% to 7.1% in males and from 26.3% to 8.9% in females. Females had a significantly higher risk of hyperopia than males. CONCLUSIONS: Refractive error, associated primarily with myopia, is a major cause of reduced vision in school-age children in La Florida. More than 7% of children could benefit from the provision of proper spectacles. Efforts are needed to make existing programs that provide free spectacles for school children more effective. Further studies are needed to determine whether the upward trend in myopia continues far beyond 15 years of age.

Adolescent↗
PubMed2003

Age, gender, biometry, refractive error, and the anterior chamber angle among Alaskan Eskimos.

BACKGROUND: The prevalence of angle-closure glaucoma (ACG) is greater for Eskimos/Inuit than it is for any other ethnic group in the world. Although it has been suggested that this prevalence may be due to a population tendency toward shallower anterior chamber angles, available evidence for other populations such as Chinese with high rates of ACG has not consistently demonstrated such a tendency. METHODS: A reticule, slit-lamp, and standard Goldmann one-mirror goniolens were used to make measurements in the anterior chamber (AC) angle according to a previously reported protocol for biometric gonioscopy (BG) (Ophthalmology 1999;106:2161-7). Measurements were made in all four quadrants of one eye among 133 phakic Alaskan Eskimos aged 40 years and older. Automatic refraction, dilated examination of the anterior segment and optic nerve, and A-scan measurements of AC depth, lens thickness, and axial length were also carried out for all subjects. RESULTS: Both central and peripheral AC measurements for the Eskimo subjects were significantly lower than those previously reported by us for Chinese, blacks, and whites under the identical protocol. Eskimos also seemed to have somewhat more hyperopia. There were no differences in biometric measurements between men and women in this Eskimo population. Angle measurements by BG seemed to decline more rapidly over life among Eskimos and Chinese than blacks or whites. Although there was a significant apparent decrease in AC depth, increase in lens thickness, and increase in hyperopia with age among Eskimos, all of these trends seemed to reverse in the seventh decade and beyond. CONCLUSIONS: Eskimos do seem to have shallower ACs than do other racial groups. Measurements of the AC angle seem to decline more rapidly over life among Eskimos than among blacks or whites, a phenomenon also observed by us among Chinese, another group with high ACG prevalence. This apparent more rapid decline may be due to a cohort effect with higher prevalence of myopia and resulting wider angles among younger Eskimos and Chinese.

Adult↗
PubMed1992

Clinical follow-up of 193-nm ArF excimer laser photokeratectomy.

The excimer laser has been undergoing rapid development for clinical use since the early 1980s. The authors report 2-year follow-up results from studies in 31 eyes (15 women and 14 men) to evaluate the excimer laser in performing photokeratectomy. Patients were divided into two groups: 27 eyes (group 1) underwent phototherapeutic keratectomy, and 4 eyes (group 2) underwent photorefractive keratectomy. Visual function improved in 21 of 27 eyes in group 1 and in 2 of 4 eyes in group 2. Complications were minimal and manageable. The authors describe a procedure to minimize induced hyperopia in phototherapeutic keratectomy patients, and, although not statistically significant, less induced hyperopia was noted in these patients. Photokeratectomy may be an alternative to penetrating or lamellar keratoplasty and more invasive refractive procedures, but the long-term effects must be carefully observed.

Adult↗
PubMed1993

A prototype erodible mask delivery system for the excimer laser.

PURPOSE: The authors developed an erodible mask delivery system for the argon-fluoride 193-nm excimer laser, which offers the possibility of correcting hyperopia and astigmatism as well as myopia. METHOD: Masks were made of polymethylmethacrylate on a quartz window, with intended corrections for myopia and hyperopia of 2.5 and 5 diopters (D). Ablations using the mask and control ablations using an expanding diaphragm were performed in 30 eyes of 15 pigmented rabbits with an Excimed UV200 laser (Summit Technology, Inc, Waltham, MA). The rabbits were followed for 134 days with regular biomicroscopy and retinoscopic examination by two observers. RESULTS: Ablations with the mask to correct myopia were successful and produced stable corrections, although the higher-power mask produced undercorrections. Hyperopic masks produced paradoxic myopic corrections, possibly due to the lack of a transition zone at the edge of the mask. Corneas ablated with the mask had less sub-epithelial haze than those ablated with the diaphragm at all examinations. Results of histopathologic examination showed epithelial hyperplasia over the ablation zone in all eyes. Dichlorotriazinyl aminofluorescein collagen staining showed subepithelial new collagen in all eyes, but there was no relation between the depth of ablation at any point on the cornea and the amount of new collagen deposited there. CONCLUSIONS: Myopic ablations are feasible with the erodible mask, although additional calibration is needed. Hyperopic ablations were unsuccessful with the current design. Corneas ablated with the mask may be clearer than corneas ablated with the diaphragm, possibly due to a smoother ablated surface. Regression of effect after laser ablation in the rabbit model is likely due more to epithelial hyperplasia than to stromal remodeling.

Animals↗
PubMed1999

Refractive errors in an older population: the Blue Mountains Eye Study.

OBJECTIVE: To determine prevalence and associations with refractive errors in a defined older population. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 3654 residents, aged 49-97, of the Blue Mountains, west of Sydney, Australia. METHODS: Comprehensive questionnaire and detailed eye examination, including refraction. MAIN OUTCOME MEASURES: Refractive error of phakic eyes, age, gender, and education. RESULTS: Prevalence rates were determined for myopia (15%), hyperopia (57%), and emmetropia (28%). Hyperopia prevalence was age-related, increasing from 36% in persons aged <60 years to 71 % of persons aged > or = 80 (P < 0.0001), whereas myopia prevalence decreased with age, from 21 % in persons aged <60 years to 10% of persons aged > or = 80 years (P < 0.0001). Younger myopic subjects in this population reported first wearing distance correction at a significantly younger age than older subjects, P < 0.0001. After adjustment for age, women were slightly more hyperopic (mean +0.75 diopters [D]) than men (mean +0.59 D, P = 0.0012. The gender-adjusted mean spherical error increased with age from +0.03 D in persons aged <60 years to +1.2 D in persons aged > or = 80 years (P < 0.0001). The gender-adjusted mean cylinder power also increased with age, from -0.6 D in persons aged <60 years to -1.2 D in persons aged > or = 80 years (P < 0.0001). The mean axis of astigmatism was "against the rule" in all age groups. Anisometropia increased with age, from a mean of 0.4 D in persons aged <60 to 0.9 D in persons aged > or = 80 years (P < 0.0001). Higher education was associated with myopia in men (P = 0.009) but not in women (P = 0.21) after adjustment for age. CONCLUSION: This report has documented the detailed refractive status of an older population, confirming previously described trends but also finding an apparent higher prevalence of myopia among younger members of this community.

Aged↗
PubMed1997

Off-axis photorefractive eye screening in children.

PURPOSE: To determine the utility of mass photoscreening for detecting visual anomalies in young, school-age children. SETTING: Seventy elementary schools in Alabama, Florida, Georgia, North Carolina, and Virginia, USA. METHODS: An off-axis photorefractive technique was used to screen 14,591 children in kindergarten, first, and fourth grades in 70 schools in 5 southeastern states in the United States. RESULTS: A total of 14,075 (96.5%) of the screenings yielded analyzable photographs. Overall, 647 (4.6%) children had significant ocular findings; significant was defined as hyperopia 2.50 diopters (D) or more, myopia 1.00 D or more, anisometropia 1.00 D or more, astigmatism 2.00 D or more, media opacity 1.0 mm or more in diameter, or 5 degrees or more or 10.00 prism diopters or more of ocular misalignment. Another 950 (6.7%) had possibly significant findings, defined as the sign being present but in an amount less than that considered significant. The most common refractive error was myopia (4.5%), followed by anisometropia (3.1%), hyperopia (2.9%), and astigmatism (1.0%). Alignment problems were found in 1.7% and media opacities in 0.1%. Among the 1.0% with other ocular anomalies were cases of anisocoria greater than 2.0 mm or irregular pupils, ptosis greater than 2.0 mm, and subconjunctival hemorrhages. In all, 202 children had significant anomalies thought to predispose to amblyopia, including 196 with significant anisometropia and 6 with significant lens opacities. At a screening cost of $5 per child for the whole study, the cost of identifying these children with potentially blinding eye disease was $361 each. CONCLUSION: Mass photoscreening may be used to detect amblyogenic conditions in children early enough to prevent blindness with timely and appropriate treatment.

Amblyopia↗
PubMed1999

Visual acuity after cycloplegia in children: implications for atropine penalization.

BACKGROUND: Atropinization of the sound eye is an alternative to patching in the treatment of amblyopia. Whether atropine treatment can induce a switch in fixation depends on the refractive error of the sound eye, visual acuity of the amblyopic eye, distance from the fixation target, and presence of any optical correction or penalization. General guidelines are needed on the basis of refractive error and visual acuity in the amblyopic eye to predict which patients may potentially benefit from atropine penalization. METHODS: Refractive error and visual acuity at distance (6 m) and/or at near (33 cm) were recorded in a normal eye of 126 consecutive children (mean age, 8.2 years), 30 to 60 minutes after receiving cyclopentolate 1%. Visual acuity was plotted versus refractive error at distance and at near, and best-fit curves were calculated. RESULTS: There was a consistent, reproducible relationship between refractive error and visual acuity after cycloplegia at both distance and near in healthy children. CONCLUSIONS: The results of this study can be used to quickly determine whether atropine penalization has the potential for success on the basis of a patient's visual acuity in the amblyopic eye and refractive error in the sound eye. When adequate hyperopia is present in the sound eye, one should consider testing for fixation preference or initiating a therapeutic trial of atropine. Those children with insufficient hyperopia in the sound eye relative to visual acuity in the amblyopic eye can be spared the time, expense, and potential side effects of atropine penalization.

Adolescent↗
PubMed2000

Distribution of refractive errors in Spain.

The aim of this work was to characterise the refractive state of a Spanish population. Special attention to myopia prevalence was carried out. At this stage 7621 subjects, 3692 males and 3929 females, between 3 and 93 years were examined by means of static retinoscopy and subjective refraction. The most prevalent was emmetropia with a mean percentage of 43.2% and ranging from 60.6% (3-8 years) to 29.0% (66-93 years). The prevalence of hyperopia (35.6%) increased with age, from 36.9% (3-8 years) to 55.8% (66-93 years). Myopia appeared to be more prevalent in the 30-35 age group (30.1%), agreeing with the more near-work demanding age range. Mean refractive error obtained was +0.19 +/- 3.42 D, ranging from +0.05 +/- 3.18 D (20-35 years) to +0.96 +/- 2.42 (66-93 years). Reading addition value obtained was similar to respective values of age of other populations. The whole Spanish population evaluated was emmetrop. No differences in prevalence from other populations were found, obtaining greater values of myopia in groups with more near work and a greater percentage of hyperopia versus age.

Adolescent↗
PubMed2000

Refractive results of radial keratotomy: a ten-year retrospective study.

PURPOSE: To investigate the long-term effects and stability of refraction after radial keratotomy procedure. METHODS: Radial keratotomy was performed on 123 persons to reduce myopia (range: -1 to -13 diopters) in 1986 to 1989. A mean of 11.5 years later (range 10 to 13), 61 of these patients with 102 eyes underwent a standardised refractive examination where subjective spherical equivalent refraction was measured and compared to the preoperative and the one month postoperative refractive measurement collected from the patients records. RESULTS: There was a reduction in spherical equivalent from an average of -5.46 diopters (SD 2.38) preoperatively to -2.32 diopters (SD 1.96) 11.5 years postoperatively. The mean change in direction of myopia between 1 month and 11.5 years postoperatively was 0.17 diopters (SD 1.18). This change was not statistically significant. From 1 month to 11.5 years, 10 of the eyes had developed more than 1 diopter hyperopia, and 20% more than 1 diopter myopia. When asked directly, all patients were satisfied with the result of their operation in general; 2 patients still complained of glare. CONCLUSION: No significant changes in refraction were found between 1 month and 11.5 years after radial keratotomy. Previously reported long-term studies on this field have found a trend toward progressive hyperopia. No evidence of such change can be supported by this study.

Adolescent↗
PubMed1999

A longitudinal study of cycloplegic refraction in a cohort of 350 Japanese schoolchildren. Cycloplegic refraction.

We performed a 5 year longitudinal study of cycloplegic refraction in a cohort of 350 Japanese schoolchildren from 6 to 11 years of age in a rural area of southwestern Japan. The spherical refraction was measured under cycloplegia with an infrared autorefractometer. The grouped data from 350 right eyes showed leptokurtic frequency distributions, and the median was +0.91 D at age 6 yrs, shifted towards emmetropia with increasing age and reached +0.34 D at age 11 years. The prevalence of myopia of -1.0 D or more was 0.3%, 0.6%, 2.0%, 2.6%, 2.9%, and 4.9% from age 6 to 11 years, and the prevalence of myopia of more than -2.0 D was less than 1% at age 6-9 years and thereafter increased up to 6.0% at age 11 years. Linear regression analysis for the longitudinal refractive data revealed that 247 (70.6%) of the 350 eyes exhibited first-order linear decrease in hyperopia or increase in myopia with an average annual change of -0.15 D/year, 14 (4%) showed second-order curvilinear change, and 89 (25.4%) remained unchanged. In the eyes with linear change, there was a significant relationship between the refraction at age 6 years and the rate of subsequent change such that the less hyperopic or emmetropic at age 6 years, the larger the change. The refraction at birth was estimated by extrapolation of the linear regression analysis results, implying that 88% of newborns have hyperopia of +1.0 D or greater and myopia is rare. These results indicate the current state of refraction in Japanese schoolchildren of a rural area.

Child↗
PubMed2002

[Congenital ptosis: amblyogenic refractive errors, amblyopia, manifest strabismus and stereopsis related to the types of ptosis. Data on 77 patients and review of the literature].

BACKGROUND: Former reports on amblyogenic refractive errors, amblyopia and binocular vision in congenital ptosis usually comprise all forms of ptosis without any differentiation. This study is an analysis of different kinds of ptosis. PATIENTS AND METHODS: 154 eyes (98 ptotic eyes) of 77 patients with congenital ptosis aged > or = 1 year (56 unilateral ptoses: 45 simple, 1 with rectus superior paresis, 7 with Marcus Gunn's syndrome, 2 congenital oculomotor palsies, 1 unilateral fibrosis syndrome; 21 bilateral ptoses: 10 simple, 2 with bilateral double elevator paresis, 7 blepharophimosis syndromes and 2 bilateral fibrosis syndromes) were investigated concerning visual acuity, refractive error (94 % in cycloplegy), strabismus and stereo acuity. As amblyogenic refractive errors were defined: astigmatism > or = ldpt, anisometropia > or = 1 dpt (spherical equivalent) and hyperopia > or = 3 dpt; amblyopia was defined as visual acuity less than 1.0 or a difference between both eyes of at least 0.2. RESULTS: Altogether were found: Hyperopia > or = 3 dpt in 28.6 % (n = 28); astigmatism > or = 1 dpt in 63.3 % (n = 62), anisometropia in 27.3 % (n = 21), amblyopia in 65.3 % (n = 64), strabismus in 29.9 % (n = 23) and stereopsis in 76.6 % (n = 59). In unilateral simple ptosis, astigmatism of the fellow eye was found in 26.8 % (n = 14). In unilateral ptosis, esotropia was 21.4 % (n = 12), in bilateral ptosis, exotropia 19 % (n = 4), as well as astigmatism > or = 3 dpt 26.2 % (n = 11). As was to be expected, ptosis groups with motility disorders were associated with higher rates of strabismus and amblyopia. The blepharophimosis syndrome could be differentiated by the typical lid anomalies. CONCLUSION: The subgroups of congenital ptosis differ in frequency of amblyogenic factors. In unilateral ptosis these are also frequent in the fellow eye.

Adolescent↗
PubMed2006

Evanescent white linear flecks and posterior microphthalmos: new features of a recently established disease.

BACKGROUND: Posterior microphthalmos is a rare autosomal recessive condition with normal anterior segment and small posterior segment resulting in axial hyperopia and retinal folding. HISTORY AND SIGNS: The proband from a consanguineous Turkish family was clinically investigated at 5 months of age and followed for the next 8 years. At five months of age, refraction revealed a severe hyperopia of + 10 diopters in both eyes (OU) with a mean axial length of 16.5 mm. Fundus examination showed a dystrophic maculo-papillar bundle. Multiple whitish deep intraretinal linear lesions sparing the macula were present in the mid-periphery with no preferential orientation. THERAPY AND OUTCOME: By 8 years of age, visual acuity was 20/25 in the right eye (OD) and 20/30 in the left eye (OS) with S + 14 OU. The whitish linear lesions had disappeared and were replaced by retinal pigment epithelium alterations. Optical coherence tomography (OCT) revealed a thickened retina with normal appearance at the site of the linear lesions. CONCLUSIONS: This is the first report of long-term follow-up and OCT findings in this rare ocular developmental abnormality.

Child↗
PubMed1995

[Phototherapeutic keratectomy in recurrences of granular corneal dystrophy after keratoplasty].

BACKGROUND: Recurrences of granular corneal dystrophy (Groenouw type I dystrophy) after penetrating keratoplasty have been often reported in the literature. Up to now the therapy of these recurrences consists in performing a lamellar or penetrating re-keratoplasty. As those recurrent opacities at first are located in the area of Bowman's membrane and the superficial corneal stroma, a phototherapeutic keratectomy (PTK) with an excimer laser offers a therapeutic alternative to re-keratoplasty. PATIENTS AND METHODS: We describe three eyes of two patients with recurrent opacities on the transplant after successful keratoplasty because of granular corneal dystrophy. In all eyes we performed an excimer-laser PTK (Keratom of Schwind Company, Kleinostheim/Germany, wave length 193 nm) after abrasion of the epithelium with a hockey-knife. The depth of ablation depended on the location of the opacities and was between 7 microns and 35 microns. During the excimer-laser treatment several biomicroscopical slit-lamp controls were performed to make sure whether a sufficient depth of ablation was obtained. RESULTS: The opacities could be totally removed in all eyes by excimer-laser PTK. Postoperatively the visual acuity increased and the patient's photophobia decreased. At the same time a slight progression of hyperopia developed depending on the depth of ablation. During the follow-up period of 5 to 12 months no recurrent opacities could be found until now. CONCLUSIONS: Phototherapeutic keratectomy with the excimer laser seems to be a good alternative to re-keratoplasty in superficially located recurrences of granular corneal dystrophy in a graft after keratoplasty. A slight progression of hyperopia depending on the depth of ablation has to be accepted. The future will show whether there will develops recurrent opacities of the dystrophy after an excimer laser treatment.

Aged↗
PubMed2006

Identification of apolipoprotein A-I as a "STOP" signal for myopia.

Good visual acuity requires that the axial length of the ocular globe is matched to the refractive power of the cornea and lens to focus the images of distant objects onto the retina. During the growth of the juvenile eye, this is achieved through the emmetropization process that adjusts the ocular axial length to compensate for the refractive changes that occur in the anterior segment. A failure of the emmetropization process can result in either excessive or insufficient axial growth, leading to myopia or hyperopia, respectively. Emmetropization is mainly regulated by the retina, which generates two opposite signals: "GO/GROW" signals to increase axial growth and "STOP" signals to block it. The presence of GO/GROW and STOP signals was investigated by a proteomics analysis of the retinas from chicken with experimental myopia and hyperopia. Of 18 differentially expressed proteins that were identified, five displayed an expression profile corresponding to GO/GROW signals, and two corresponded to STOP signals. Western blotting confirmed that apolipoprotein A-I (apoA-I) has the characteristics of a STOP signal both in the retina as well as in the fibrous sclera. In accordance with this, intraocular application of the peroxisome proliferator-activated receptor alpha agonist GW7647 resulted in up-regulation of apoA-I levels and in a significant reduction of experimental myopia. In conclusion, using a comprehensive functional proteomics analysis of chicken ocular growth models we identified targets for ocular growth control. The correlation of elevated apoA-I levels with reduced ocular axial growth points toward a functional relationship with the observed morphological changes of the eye.

Animals↗
PubMed2003

Myopic refractive shift caused by incident cataract: the Blue Mountains Eye Study.

PURPOSE: To assess the myopic shift in refraction caused by incident cataract in the Blue Mountains Eye Study (BMES) population. METHODS: Five-year prospective follow-up of the BMES, initially performed in 1992. After 5 years, 2335 survivors (75.1%) of 3654 baseline BMES participants were re-examined. Refractive change was assessed by age, sex, incident cataract type and baseline refraction. Slit-lamp and retroillumination lens photographs were graded for presence of incident cataract and signs of previous cataract surgery. Objective and subjective refractions were performed. RESULTS: In a multivariate model, age (p < 0.0001), incident nuclear cataract (p < 0.0003), hyperopia (p < 0.0009), incident posterior subcapsular cataract (p < 0.0027) and incident cortical cataract (p < 0.025) were factors associated with a relatively modest myopic refractive shift (0.34 diopters). Baseline myopia and gender were not associated with refractive change over the follow-up period. A myopic shift in refraction occurred most frequently in older (> or = 70 years) than younger (< 70 years) participants. CONCLUSIONS: Older age, baseline hyperopia and all types of incident cataract were principal factors found associated with myopic refractive shift over 5 years in an older population.

Aged↗
PubMed2003

Wave-front analysis as screening technique for amblyogenic ametropia with and without cycloplegia.

INTRODUCTION: For many years, attempts have been made to find an easy, efficient and inexpensive method to screen children for amblyogenic ametropia. Wave-front analysis is a new way to determine the refractive state of the eye from a distance. This technique could be a useful tool for infant screening. PURPOSE: The purpose of the study was the evaluation of the efficacy of a commercially available wave-front analyzing autorefractometer (SureSight, software version 2.0, Welch Allyn, Skaneateles Falls, NY 13153, U.S.A.) in detecting amblyogenic ametropia in patients with and without cycloplegia. METHODS: 256 eyes (-28.25 D to +7.88 D spherical equivalent) of 128 patients (1-81 years) were examined with the wave-front autorefractometer under cycloplegia. Prior to this investigation, 108 eyes (-21.38 D to 75 D) of 54 of these patients (1-76 years) were refracted without cycloplegia. The readings of the wave-front autorefractometer were compared with the results of retinoscopy under cycloplegia. RESULTS: Without cycloplegia, the sensitivity in detecting any amblyogenic ametropia such as anisometropia, astigmatism, myopia or hyperopia was 94%, while the specificity was 63%. Following cycloplegia, the sensitivity decreased to 87% and the specificity increased to 80%. CONCLUSION: Wave-front analyzing refractometry is highly applicable for infant screening. At the present state of development, the efficacy in detecting amblyogenic ametropia is similar to that of other screening techniques and instruments that operate from distance. Cycloplegia enhances the sensitivity in detecting hyperopia and decreases the sensitivity in detecting astigmatism.

Adolescent↗
PubMed1998

How accurate is the hand-held refractor Retinomax(R) in measuring cycloplegic refraction: a further evaluation.

AIMS To assess the agreement between the hand-held autorefractor Retinomax(R) and three different on-table autorefractors when measuring cycloplegic refraction in subjects with small and high ametropia. To assess the agreement between the cycloplegic refraction using the Retinomax(R) and by retinoscopy in children with small and high ametropia. METHODS Part A.276 subjects were refracted under cycloplegia using both the Retinomax(R) and an on-table infrared automated refractor (Topcon RM-A 6000, Nidek AR 800 or Nikon NR 5000). They were separated into subjects withsmall ametropia (mean sphere </= 3.5 D hyperopia, </= 3 D myopia) and high ametropia (mean sphere > 3.5 D hyperopia, > 3 D myopia). The agreement between both types of refractors regarding the different refractive components was assessed for the whole group and for the two subgroups of small and high ametropia. Part B. 48 infants were refracted under cycloplegia by retinoscopy and by the Retinomax(R). The agreement between both methods of refraction was analyzed in the same manner as in part A. RESULTS Part A. No significant bias was found between the two types of refractors with regard to the spherical equivalent. The 95% limits of agreement were +/- 1 D. Although no clinically significant bias was found with regard to the cylinder power in the 276 subjects, it was found that the 95% limits of agreement were much better (+/- 0.75 D) in small ametropia subjects than in high ametropia subjects (-2.1 to +1.3 D). No significant bias was found with regard to the axis determination. Part B. No significant bias was found between the Retinomax(R) and retinoscopic measurements with regard to the spherical equivalent. The 95% limits of agreement were -1.36 to +1.76 D. However, the mean difference for spheres and cylinders showed a positive bias and a negative bias, respectively, suggesting more positive spheres and larger cylinders when measured by the Retinomax(R) compared to retinoscopy. This was particularly obvious in cases of high ametropia. CONCLUSION Compared to retinoscopy and on-table autorefraction, the hand-held refractor Retinomax(R) is accurate in any ametropia with respect to the spherical equivalent. In small ametropia, there is a good accuracy when measuring the three refractive components (sphere, cylinder and axis). The accuracy decreases in high ametropia, especially with regard to the cylinder power.

Journal Article↗
PubMed2004

Examination of preschool children for ametropia: first experiences using a new hand-held autorefractor.

INTRODUCTION: Over the last decades, various methods have been investigated for preschool screening for amblyogenic ametropia. The SureSight is a new hand-held wavefront-analyzing autorefractor designed for screening. METHODS: A total of 338 children (3 1/2 - 4 1/2 years-old) were examined in their kindergartens without cycloplegia using the new instrument. Of these, 56 had a cycloplegic retinoscopy as a reference measurement. Hyperopia > or =3 dpt, myopia > or =1 dpt, astigmatism > or =1 dpt and anisometropia > or =1 dpt were considered amblyogenic ametropia. RESULTS: Testability was 99.4%. Accuracy was high for cylinder power and axis but poor for the spherical equivalent. Sensitivity was 41% for the detection of amblyogenic hyperopia, 95% for astigmatism and 75% for anisometropia, with specificity values of 92, 79 and 73%. CONCLUSION: The high testability and accuracy for cylinder power and axis are the strong points. The poor accuracy for the spherical equivalent is probably caused by the lack of cycloplegia. At present, non-cycloplegic autorefractor screening cannot be recommended due to the low specificity. Our findings support the advice that objective refraction in childhood must be performed with cycloplegia.

Child, Preschool↗