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Estay AM, Plaza-Rosales I, Torres HR, Cerfogli FI. Training in retinoscopy: learning curves using a standardized method. BMC MEDICAL EDUCATION 2023; 23:874. [PMID: 37974128 PMCID: PMC10655477 DOI: 10.1186/s12909-023-04750-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Retinoscopy is one of the most effective objective techniques for evaluating refractive status, especially in non-cooperative patients. However, it presents a slow learning curve that often leads to student frustration. With the current Covid-19 pandemic and the need for social isolation, clinical education based on simulation has become more relevant. Therefore, we implemented retinoscopy laboratories and learning protocols to reduce student stress and learning time. METHODS We conducted a study to evaluate the retinoscopy learning curve using a new training protocol proposal. One hundred trainees were assessed in four stages, corresponding to 08, 12, 16, and 20 hours of training. Six different refractive defects were used trying to reproduce frequent conditions of care. The time spent on the assessment was not considered as additional training time. To analyze the data, we used non-parametric statistics and linear regression to assess the variables associated with training time and performance rate. RESULTS The mean performance score at 08 hrs was 32.49% (±16.69 SD); at 12 hrs was 59.75% (±18.80 SD); at 16 hrs was 70.83% (±18.53 SD) and at 20 hrs was 84.26% (±13.18 SD). Performance at 12 hrs was significative higher than 08 hrs of training, but did not show significant differences with the performance rate at 16 and 20 hrs. We found a strong positive correlation between performance and training time in retinoscopy (R = 0.9773, CI: 0.2678 - 0.9995 p = 0.0227). CONCLUSION This study showed that an increasing number of hours of practice positively correlates with performance in retinoscopy. The elaboration of a protocol and standardization of performance per hour also allowed us to estimate that a minimum of 13.4 hrs of practice is required to achieve 60% performance. Using the resulting formula, it is possible to determine the number of hours of retinoscopy practice are necessary to reach a certain level of performance.
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Affiliation(s)
- Antonio M Estay
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia #1027, 8380492, Santiago, Chile.
| | - Iván Plaza-Rosales
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia #1027, 8380492, Santiago, Chile
- Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Hernán R Torres
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia #1027, 8380492, Santiago, Chile
| | - Fabiola I Cerfogli
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia #1027, 8380492, Santiago, Chile
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Alpins N, Ong JKY, Randleman JB, Stamatelatos G. Quantifying Corneal Topographic Astigmatism (CorT Total) in Keratoconic Eyes. J Refract Surg 2023; 39:206-213. [PMID: 36892237 DOI: 10.3928/1081597x-20230103-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To determine optimal corneal regions from which to derive corneal topographic astigmatism (CorT) in kerato-conic eyes. METHODS In this retrospective study, potential measures of corneal astigmatism are calculated from raw total corneal power data (179 eyes from 124 patients) from a corneal tomographer. The measures are derived from annular corneal regions varying in both extent and center position, and evaluated according to the variability of the ocular residual astigmatism (ORA) in the cohort. This variability is quantified by the ORArms, which is the root-mean-squared distance of the ORAs from their summated vector mean in double angle space. The lower the ORArms, the better the corneal astigmatism measure corresponds to manifest refractive cylinder. RESULTS Corneal astigmatism measures derived from regions centered on corneal vertex had ORArms values (mild: 1.07 diopters [D], moderate: 1.61 D, severe: 2.65 D) as low or lower than other measures derived from regions centered on thinnest point, corneal apex (front or back), or pupil center. Corneal astigmatism measures derived from a region centered 30% of the way toward thinnest point from corneal vertex appeared to have even lower ORArms values (mild: 1.05 D, moderate: 1.45 D, severe: 2.56 D). None of the corneal astigmatism measures corresponded closely with manifest refractive cylinder for severe keratoconus (ORArms > 2.50 D). CONCLUSIONS For keratoconic eyes, the CorT should be derived from an annular region centered 30% of the way toward thinnest point from corneal vertex, although when the keratoconus is mild, a standard corneal-vertex-centered CorT performs just as well. [J Refract Surg. 2023;39(3):206-213.].
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Venkataraman AP, Brautaset R, Domínguez-Vicent A. Effect of six different autorefractor designs on the precision and accuracy of refractive error measurement. PLoS One 2022; 17:e0278269. [PMID: 36441778 PMCID: PMC9704684 DOI: 10.1371/journal.pone.0278269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the precision of objective refraction measurements with six different autorefractors that have different designs and measurement principles and to compare the objective refraction values with the subjective refraction. METHOD Objective refraction of 55 participants was measured using six autorefractors with different designs. The instrument features mainly varied in terms of measurement principles, inbuilt fogging, open or closed view, and handheld or stationary designs. Two repeated measurements of objective refraction were performed with each autorefractor. The objective refractions from the six autorefractors were compared with the standard subjective refraction. The repeatability limit and Bland-Altman were used to describe the precision and accuracy of each autorefractor, respectively. The analysis was done using the spherical component of the refraction and the power-vector components, spherical equivalent (M), and cylindrical vectors. RESULTS The repeatability of all autorefractors was within 1.00 and 0.35D for measuring the M and both cylindrical components, respectively. Inbuilt fogging was the common feature of the instruments that showed better repeatability. Compared to subjective refraction, the mean difference for sphere and M was below +0.50D, and it was close to zero for the cylindrical components. The instruments that had inbuilt fogging showed narrower limit of agreement. When combined with fogging, the open field refractors showed better precision and accuracy. CONCLUSIONS The inbuilt fogging is the most important feature followed by the open view in determining the precision and accuracy of the autorefractor values.
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Affiliation(s)
- Abinaya Priya Venkataraman
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Rune Brautaset
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Alberto Domínguez-Vicent
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Abstract
CLINICAL RELEVANCE For a correct spectacle prescription, accommodation spasm should not be overlooked in the measurements made using an autorefractometer. Although this can be easily understood with cycloplegia, it is not practical. Therefore, investigating practical methods that can predict excess accommodation will be useful in clinical practice. BACKGROUND To evaluate the performance of a photoscreener in detecting pseudo-myopia due to accommodation spasm and whether it eliminates the need for cycloplegia. METHODS Study was conducted in Van Training and Research Hospital. The manifest refraction of the patients was measured using an by an autorefractometer followed by a photoscreener before cycloplegia. Cycloplegic refraction errors were detected using an autorefractometer. Patients with pseudo-myopia due to accommodation spasm were diagnosed by observing a significant hyperopic shift in cycloplegic autorefractometer values compared to the non-cycloplegic values and were included in study. Cycloplegic autorefractometer and non-cycloplegic photoscreener measurements were compared. RESULTS The mean non-cycloplegic autorefractometer values were as follows: --6.34 ± 1.29D, -0.42 ± 0.58D, and -6.55 ± 1.36D for spherical, cylindrical, and spherical equivalents, respectively. These values were 0.23 ± 0.63D, -0.21 ± 0.41D, and 0.11 ± 0.73D for cycloplegic autorefractometer measurements, respectively. Cycloplegic autorefractometer values showed a significant hyperopic shift of 6.57 ± 1.26D and 6.67 ± 1.34D for spherical and spherical equivalents, respectively, compared to non-cycloplegic values (p < 0.001 for both). There was no significant difference between non-cycloplegic photoscreener and cycloplegic autorefractometer measurements for spherical, cylindrical, and spherical equivalents (p = 0.126, p = 0.078, and p = 0.053, respectively). . There was agreement between the measurements in the Bland-Altman graph. CONCLUSION There was consistency between non-cycloplegic photoscreener and cycloplegic autorefractometer measurements in patients with pseudomyopia due to accommodation spasm. Therefore, photoscreener measurements can be a fast, practical, cost-effective examination method for screening these patients without the need for cycloplegia.
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Affiliation(s)
- Mehmet Siraç Demir
- Van Training and Research Hospital, Ophthalmology Department, Saglik Bilimleri University, Van, Turkey
| | - Ersin Muhafiz
- Faculty of Medicine, Ophthalmology Department, Kafkas University, Kars, Turkey
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Pei R, Liu Z, Rong H, Zhao L, Du B, Jin N, Zhang H, Wang B, Pang Y, Wei R. A randomized clinical trial using cyclopentolate and tropicamide to compare cycloplegic refraction in Chinese young adults with dark irises. BMC Ophthalmol 2021; 21:256. [PMID: 34112149 PMCID: PMC8194231 DOI: 10.1186/s12886-021-02001-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the necessity of cycloplegia for epidemiological studies of refraction in Chinese young adults (aged 17-22 years) with dark irises, and to compare the cycloplegic effects of 1% cyclopentolate and 0.5% tropicamide in them. METHODS A total of 300 young adults (108 males and 192 females) aged 17 to 22 years (mean 19.03 ± 1.01) were recruited from Tianjin Medical University from November 2019 to January 2020. Participants were randomly divided into two groups. In the cyclopentolate group, two drops of 1% cyclopentolate eye drop were administrated (one drop every 5 min), followed by autorefraction and subjective refraction 30 to 45 min later. In the tropicamide group, four drops of 1% Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) eye drop were given (one drop every 5 min), followed by autorefraction and subjective refraction 20 to 30 min later. The participants and the examiners were masked to the medication. Distance visual acuity, intraocular pressure (IOP), non-cycloplegic and cycloplegic autorefraction (Topcon KR-800, Topcon Co. Tokyo, Japan), non-cycloplegic and cycloplegic subjective refraction and ocular biometry (Lenstar LS-900) were performed. RESULTS The values of spherical equivalent (SE) and sphere component were significantly different before and after cycloplegia in the cyclopentolate group and the tropicamide group (p < 0.05). The mean difference between noncycloplegic and cycloplegic autorefraction SE was 0.39 D (±0.66 D) in the cyclopentolate group and 0.39 D (±0.34 D) in the tropicamide group. There was no significant difference in the change of SE and sphere component after cycloplegia between the cyclopentolate group and the tropicamide group (p > 0.05). In each group, no significant difference was found between autorefraction and subjective refraction after cycloplegia (p > 0.05). We also found that more positive or less negative cycloplegic refraction was associated with the higher difference in SE in each group. CONCLUSIONS Cycloplegic refractions were generally more positive or less negative than non-cycloplegic refractions. It is necessary to perform cycloplegia for Chinese young adults with dark irises to obtain accurate refractive errors. We suggest that cycloplegic autorefraction using tropicamide may be considered as a reliable method for epidemiological studies of refraction in Chinese young adults with dark irises. TRIAL REGISTRATION The study was registered on September 7, 2019 (Registration number: ChiCTR1900025774 ).
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Affiliation(s)
- Ruxia Pei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Zhuzhu Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Hua Rong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Liqiong Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Bei Du
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Na Jin
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Hongmei Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Biying Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China
| | - Yi Pang
- Illinois College of Optometry, 3241 S, Michigan Ave, Chicago, IL, 60616, USA.
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, China.
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Mukash SN, Kayembe DL, Mwanza JC. Agreement Between Retinoscopy, Autorefractometry and Subjective Refraction for Determining Refractive Errors in Congolese Children. CLINICAL OPTOMETRY 2021; 13:129-136. [PMID: 33907484 PMCID: PMC8071214 DOI: 10.2147/opto.s303286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the agreement between retinoscopy and autorefractometry and between subjective refraction and both retinoscopy and autorefractometry in Congolese children. PATIENTS AND METHODS Fifty-four children (6-17 years old) were enrolled consecutively in this cross-sectional study. Refraction was evaluated before and after cycloplegia (1% cyclopentolate) with retinoscopy and autorefractometry. Readings were compared (paired t-test) and agreement assessed with Bland-Altman plots. Subjective refraction was compared with the two methods to determine which one provides better reference estimates for subjective refraction. RESULTS Under cycloplegia, the spherical power was comparable between retinoscopy and autorefractometry (1.12 ± 1.37 D vs 1.22 ± 1.06D, P = 0.70), cylinder power was significantly more myopic on retinoscopy than autorefractometry (0.80 ± 1.10D vs -0.62 ± 0.66, P = 0.019), and SE was greater on autorefractometry than retinoscopy (0.91 ± 1.10D vs 0.72 ± 1.00D, P = 0.014). Retinoscopy and autorefractometry overestimated the power of spherical (P = 0.022 and 0.002, respectively) and cylindrical components (all P < 0.001). There was an agreement between retinoscopy and autorefractometry in measuring spherical (bias: 0.09 ± 0.16D; limit of agreement, LoA: -0.40 to 0.22D) and cylindrical power (bias: -0.18 ± 0.20D; LoA: -0.57 to 0.21D). Subjective refraction agreed with cycloplegic retinoscopy for determining SE power (bias: 0.11D; LoA: -0.51 to 0.73D). CONCLUSION Retinoscopy and autorefractometry can be used interchangeably in children for determining the power of spherical and cylindrical components. Cycloplegic retinoscopy is better than autorefractometry to obtain SE reference values for subjective refraction in children.
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Affiliation(s)
- Sabrina N Mukash
- Department of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo
| | - David L Kayembe
- Department of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude Mwanza
- Department of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sheppard AL, Bashir A, Wolffsohn JS, Davies LN. Accommodating intraocular lenses: a review of design concepts, usage and assessment methods. Clin Exp Optom 2021; 93:441-52. [DOI: 10.1111/j.1444-0938.2010.00532.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Abar Bashir
- Aston University, Birmingham, United Kingdom
E‐mail:
| | | | - Leon N Davies
- Aston University, Birmingham, United Kingdom
E‐mail:
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Cycloplegic Effects on the Cylindrical Components of the Refraction. J Ophthalmol 2021; 2021:8810782. [PMID: 33884203 PMCID: PMC8041553 DOI: 10.1155/2021/8810782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
It is important to predict which astigmatic patients require separate refraction for near vision. This study compared cylindrical components changes by cyclopentolate 1% for the low and high amount of astigmatism. The right eyes of 1014 healthy individuals (307 males and 707 females) with cylindrical refractive power more than -0.5 diopter on autorefractometer were selected. Both male and female patients in the age range of 17-45 years were refracted before and after cycloplegia, using 1% cyclopentolate. All volunteers were classified into 2 subgroups including the lower astigmatism group (-2.25 to -0.50) and the higher astigmatic group (-2.50 to over). Alpines' method was used to compare the effect of cycloplegic drop on cylindrical power. The mean age in the lower astigmatism group (29.58; 95% CI: 29.18 to 29.99 years) was not significantly different from the higher astigmatic group (29.85; 95% CI: 29.07 to 30.62) and there were no significant differences in gender between these two groups (P=0.54). Differences between wet and dry refraction in J0 (-0.03; 95% CI:-0.06 to -0.008) and J45 (-0.03; 95% CI:-0.06 to -0.01) were significant only in the higher astigmatic group. Axis changes by the cycloplegic drop in the lower astigmatism group were 3.51 (CI: 3.22 to 3.81) and axis changes by the cycloplegic drop in the higher astigmatism group were 2.21 (CI: 1.73 to 2.49). In patients with a lower amount of astigmatism (-2.25 to -0.50), additional near subjective refraction could be done for precise determination of axis and in patients with a higher amount of astigmatism (-2.50 to over), near subjective refraction might be done for precise determination of power.
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Rakhshandadi T, Sedaghat MR, Askarizadeh F, Momeni-Moghaddam H, Khabazkhoob M, Yekta A, Narooie-Noori F. Refractive characteristics of keratoconus eyes with corneal Vogt's striae: A contralateral eye study. JOURNAL OF OPTOMETRY 2021; 14:183-188. [PMID: 32507616 PMCID: PMC8093541 DOI: 10.1016/j.optom.2020.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The aim of this study was to assess and compare clinical characteristics of bilateral keratoconus patients with unilateral Vogt's striae. METHODS In this contralateral eye study, refractive status were evaluated in patients with bilateral keratoconus whose corneas had definite slit-lamp biomicroscopic evidence of unilateral Vogt's striae. All cases underwent a comprehensive ophthalmic examination. Some refractive errors components provided by autorefraction were converted to vectorial notation for power vector analysis. Finally, the outcomes were compared between keratoconus eyes with and without Vogt's striae. RESULTS Fifty patients aged 20 to 38 years (27.43±5.5) were recruited in this study. The results showed a significant difference in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), non-cycloplegic and cycloplegic autorefraction including sphere, cylinder, spherical equivalent, and J0, between keratoconus eyes with and without Vogt's striae (all P<0.05), except for J45 (P=0.518 in non-cycloplegic autorefraction and P=0.574 in cycloplegic autorefraction). Comparison of cycloplegic and non-cycloplegic autorefraction in both study groups showed significant differences in the sphere and spherical equivalent (all P<0.001), but no significant difference was found in cylinder, J0, and J45 between the study groups (all P>0.05). CONCLUSIONS Comparison of the cycloplegic and non-cycloplegic autorefraction in keratoconus eyes with and without Vogt's striae showed significant differences in UDVA, CDVA, and some refractive errors components provided by autorefraction between the two groups, with a worse condition in KCN eyes with Vogt's striae.
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Affiliation(s)
- Tahereh Rakhshandadi
- Department of Optometry, School of Rehabilitation Sciences, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohamad-Reza Sedaghat
- Cornea Research Center, Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshad Askarizadeh
- Department of Optometry, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Momeni-Moghaddam
- Department of Optometry, School of Rehabilitation Sciences, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Abbasali Yekta
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Foroozan Narooie-Noori
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Gopalakrishnan A, Hussaindeen JR, Sivaraman V, Swaminathan M, Wong YL, Armitage JA, Gentle A, Backhouse S. The Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study-Defining a Threshold for Non-Cycloplegic Myopia Prevalence in Children. J Clin Med 2021; 10:jcm10061215. [PMID: 33804031 PMCID: PMC8001787 DOI: 10.3390/jcm10061215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to −0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to −0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ −0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ −0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤−0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ −0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ −0.50 D.
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Affiliation(s)
- Aparna Gopalakrishnan
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai 600 006, India; (J.R.H.); (V.S.); (M.S.)
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (J.A.A.); (A.G.); (S.B.)
- Correspondence:
| | - Jameel Rizwana Hussaindeen
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai 600 006, India; (J.R.H.); (V.S.); (M.S.)
| | - Viswanathan Sivaraman
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai 600 006, India; (J.R.H.); (V.S.); (M.S.)
| | - Meenakshi Swaminathan
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai 600 006, India; (J.R.H.); (V.S.); (M.S.)
| | - Yee Ling Wong
- R&D AMERA, Essilor International Singapore, Singapore 339346, Singapore;
| | - James Andrew Armitage
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (J.A.A.); (A.G.); (S.B.)
| | - Alex Gentle
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (J.A.A.); (A.G.); (S.B.)
| | - Simon Backhouse
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (J.A.A.); (A.G.); (S.B.)
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Li L, Fu J, Chen W, Meng Z, Sun Y, Su H, Yao Y, Dai W. Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study. Jpn J Ophthalmol 2021; 65:526-536. [PMID: 33656708 DOI: 10.1007/s10384-021-00828-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the differences between cycloplegic and noncycloplegic refraction as well as associated factors in grade one students of primary schools, and explore the effectiveness of noncycloplegic refraction for refractive error screening. STUDY DESIGN Cross-sectional study. METHODS A school-based study of 1856 students was conducted in Lhasa, Tibetan Plateau, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P at a 5-min interval. Autorefraction was performed under both cycloplegic and noncycloplegic conditions. Bland-Altman analysis, receiver operating characteristic curve analysis, univariate and multiple linear regression models were used for analysis. RESULTS Of the 1856 children enrolled, 1830 (98.60%) completed all procedures. The average age was 6.83 ± 0.46 years. 965 (52.73%) children were boys and 1737 (94.92%) were Tibetan. Overall, there was a significant difference between cycloplegic and noncycloplegic SE of 0.90 ± 0.76D (P < 0.001). However, the intra-class coefficient correlation (ICC) for cylinder between these two methods was high (ICC = 0.941, 95% CI, 0.935-0.946). Larger differences between cycloplegic and noncycloplegic SE were associated with hyperopic RE and higher cylindrical value (P < 0.001). The prevalence of myopia, emmetropia and hyperopia with and without cycloplegia was (3.93% vs 14.59%), (9.95% vs 45.8%) and (86.21% vs 39.56%), respectively. Myopia, emmetropia and hyperopia based on noncycloplegic refraction was defined as SE ≤ - 0.625D, - 0.625 < SE ≤ 0D, and SE > 0D, respectively. CONCLUSIONS Lack of cycloplegia leads to underestimation of hyperopia, with overestimation of myopia and emmetropia. Larger hyperopic refraction exhibited greater difference between cycloplegic and noncycloplegic refraction.
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Affiliation(s)
- Lei Li
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jing Fu
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Weiwei Chen
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yunyun Sun
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Han Su
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yao Yao
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Wei Dai
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
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12
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Effect of Instrument Design and Technique on the Precision and Accuracy of Objective Refraction Measurement. J Clin Med 2020; 9:jcm9103061. [PMID: 32977411 PMCID: PMC7597959 DOI: 10.3390/jcm9103061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To evaluate the precision and accuracy of objective refraction measurement obtained with combinations of instrument design and technique. We also compared the performance of the instruments with subjective refraction measurements. Method and analysis: The objective refraction was measured in 71 subjects with three autorefractometers that have different designs and measurement principles (binocular with fogging, binocular without fogging, and monocular with fogging). Repeatability and reproducibility metrics were calculated for the objective refraction measurements. The agreement of the objective refraction measurements between the three instruments and the agreement with the subjective refraction measurements were evaluated. RESULTS All three autorefractometers had repeatability and reproducibility limits smaller than 0.70D. The smallest difference (0.10D) in the spherical equivalent was seen between the two binocular instruments. Compared with the subjective refraction, the binocular without fogging technique had the smallest mean difference in spherical equivalent (<0.20D) whereas the binocular fogging technique had the smallest limit of agreement interval (1.00D). For all comparisons, the mean difference and limit of agreement interval for the cylindrical components were lower than 0.10D and 0.75D, respectively. CONCLUSION All three instruments evaluated had good repeatability and reproducibility. The binocular fogging technique provided the best agreement with subjective refraction.
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13
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Kuo YC, Wang JH, Chiu CJ. Comparison of open-field autorefraction, closed-field autorefraction, and retinoscopy for refractive measurements of children and adolescents in Taiwan. J Formos Med Assoc 2020; 119:1251-1258. [PMID: 32354691 DOI: 10.1016/j.jfma.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the accuracy and effectiveness of noncycloplegic and cycloplegic autorefraction using two types of autorefractors (ARs) compared with retinoscopy in children and adolescents. METHODS This cross-sectional study included 308 students (6-17 years old) from eastern Taiwan. Noncycloplegic and cycloplegic refractive measurements were obtained using open-field AR (Shin-Nippon NVision-K 5001), closed-field AR (Topcon KR-800), and cycloplegic retinoscopy. Three optical components emerged from the measurements: spherical equivalent (M) and two Jackson cross-cylinder values (J0 and J45). Agreement between both ARs and retinoscopy was evaluated using intraclass correlation coefficient. Measurement discrepancies from retinoscopy among different ARs and cycloplegic status were compared using repeated measures ANOVA and receiver operating characteristic curve analysis. RESULTS Compared with retinoscopy, measurements obtained before and after cycloplegia with both ARs showed excellent reliability for evaluating M and J0 and fair to good results for J45. More myopic results were obtained using KR-800 before cycloplegia; more hyperopic results were obtained using KR-800 and NVision-K 5001 after cycloplegia(all p < 0.05). J45 data obtained using NVision-K 5001 were closest to those obtained by retinoscopy; J0 data obtained using both ARs were comparable with retinoscopy after cycloplegia. NVision-K 5001 outperformed KR-800 in refractive measurements, particularly in hyperopia diagnosis among younger children. CONCLUSIONS Both autorefractors showed great agreement with retinoscopy. Results obtained using NVision-K 5001 without cycloplegia were most similar to those by retinoscopy, especially for oblique astigmatism and hyperopia detection in younger children. For large vision screening in elementary school, Shin-Nippon NVision-K 5001 might be a more suitable autorefractor.
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Affiliation(s)
- Yi-Chun Kuo
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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14
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Kim SH, Lee YC. Availability of Cycloplegic Refraction in Children and Adolescents. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.3.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- So Hee Kim
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young Chun Lee
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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15
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Doherty SE, Doyle LA, McCullough SJ, Saunders KJ. Comparison of retinoscopy results with and without 1% cyclopentolate in school‐aged children. Ophthalmic Physiol Opt 2019; 39:272-281. [DOI: 10.1111/opo.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sue E Doherty
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Lesley A Doyle
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Sara J McCullough
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Kathryn J Saunders
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
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16
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Otero C, Aldaba M, Pujol J. Clinical evaluation of an automated subjective refraction method implemented in a computer-controlled motorized phoropter. JOURNAL OF OPTOMETRY 2019; 12:74-83. [PMID: 30389250 PMCID: PMC6449872 DOI: 10.1016/j.optom.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/30/2018] [Accepted: 09/17/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To investigate a new algorithm to perform an automated non-cycloplegic refraction in adults. METHODS Fifty healthy subjects were measured twice (test-retest) with the new automated subjective refraction method and with the conventional clinician subjective refraction procedure. Objective refraction was also measured with the Grand Seiko WAM-5500 autorefractor. The new automated method was inspired on the root finding bisection algorithm and on the Euclidean distances in the power vector domain. The algorithm was implemented in a computer that was synchronized with a customized motorized phoropter. Repeatability was mainly assessed with the within-subject standard deviation (Sw) and accuracy was mainly assessed with the limits of agreement. RESULTS The within-subject standard deviations of the power vector components (M, J0, J45) obtained for the right eye are (±0.13, ±0.04, ±0.05)D and (±0.17, ±0.03, ±0.07)D, respectively, for the clinical and the automated subjective refraction methods. The limits of agreement (with the clinical method) for the automated and the objective methods are, respectively (±0.56, ±0.18, ±0.31)D and (±0.77, ±0.15, ±0.18)D. Similar results are obtained for the left eye. CONCLUSIONS The proposed automated method is repeatable and more accurate than objective techniques in healthy adults. However, it is not accurate enough to replace the clinical subjective refraction yet and it should be tested in a wider population in terms of age, refraction and different ocular conditions. Despite these important limitations, this method has been shown to be a potentially valuable method to improve the access to primary eye care services in developing countries.
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Affiliation(s)
- Carles Otero
- Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge, UK; Center for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa, Spain.
| | - Mikel Aldaba
- Center for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Jaume Pujol
- Center for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa, Spain
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17
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Hsi E, Wang YS, Huang CW, Yu ML, Juo SHH, Liang CL. Genome-wide DNA hypermethylation and homocysteine increase a risk for myopia. Int J Ophthalmol 2019; 12:38-45. [PMID: 30662838 DOI: 10.18240/ijo.2019.01.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/27/2018] [Indexed: 01/04/2023] Open
Abstract
AIM To test for the association between genome-wide methylation and myopia in human and mice. METHODS Long interspersed nucleotide element 1 (LINE-1) methylation levels were used to surrogate genome-wide methylation level. We first tested for the association between high myopia (<-6 D) and LINE-1 methylation in leukocytes in 220 cases and 220 control subjects. Secondly, we validated the results of LINE-1 methylation in eyes from the form deprivation myopia (FDM) mice. Furthermore, we calculated the correlation of LINE-1 methylation levels between leukocyte DNA and ocular DNA in the mice. We also tested whether dopamine can alter LINE-1 methylation levels. RESULTS The LINE-1 methylation level was significantly higher in the myopic human subjects than controls. The upper and middle tertiles of the methylation levels increased an approximately 2-fold (P≤0.002) risk for myopia than the lower tertile. Similarly, FDM mice had high LINE-1 methylation levels in the leukocyte, retina and sclera, and furthermore the methylation levels detected from these three tissues were significantly correlated. Immunohistochemical staining revealed higher levels of homocysteine and methionine in the rodent myopic eyes than normal eyes. Dopamine treatment to the cells reduced both LINE-1 methylation and DNA methyltransferase levels. CONCLUSION LINE-1 hypermethylation may be associated with high myopia in human and mice. Homocysteine and methionine are accumulated in myopic eyes, which may provide excess methyl group for genome-wide methylation.
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Affiliation(s)
- Edward Hsi
- Centre for Myopia and Eye Disease, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan.,Department of Genome Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yung-Song Wang
- Department of Genome Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.,Institute of Fisheries Science, National Taiwan University, Taipei 106, Taiwan
| | - Chia-Wei Huang
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Suh-Hang Hank Juo
- Centre for Myopia and Eye Disease, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan.,Institute of New Drug Development, China Medical University, 91 Hsueh-Shih Road, Taichung 404, Taiwan.,Drug Development Center, China Medical University 404, Taiwan
| | - Chung-Ling Liang
- Department of Ophthalmology, Asia University Hospital, Taichung 413, Taiwan.,Department of Optometry, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
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18
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Li T, Zhou X, Zhu J, Tang X, Gu X. Effect of cycloplegia on the measurement of refractive error in Chinese children. Clin Exp Optom 2018; 102:160-165. [PMID: 30136309 PMCID: PMC6585953 DOI: 10.1111/cxo.12829] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022] Open
Abstract
Background To compare the results of cycloplegic and non‐cycloplegic refractive error measurement in Chinese children, and to assess the relationship between age and the difference in refractive error measured with and without cycloplegia. Methods This was a prospective study that recruited 224 healthy Chinese children at an ophthalmology clinic from November 2016 to February 2017. Refraction before and after cycloplegia were measured using an auto‐refractor. Then spherical equivalent M, J0, and J45 were calculated. The enrolled children were allocated into three groups according to M: myopia, emmetropia, and hyperopia. The distribution of the refraction was further analysed by stratifying by age: four to six years, seven to 11 years, and 12 to 16 years. Results Mean non‐cycloplegic M, J0, and J45 were −1.68 ± 2.00 D, 0.05 ± 0.40 D, and 0.01 ± 0.35 D, while mean cycloplegic M, J0, and J45 were −1.16 ± 2.17 D, 0.02 ± 0.40 D, and −0.01 ± 0.35 D. Significant differences were found between cycloplegic and non‐cycloplegic M (p = 0.009), whereas there were no significant differences between cycloplegic and non‐cycloplegic J0 and J45 (p = 0.486 and p = 0.594, respectively). The differences between cycloplegic and non‐cycloplegic M were statistically significant in the four to six years group (p = 0.002) and seven to 11 years group (p = 0.023), whereas there was no significant difference between cycloplegic and non‐cycloplegic M in the 12 to 16 years group (p = 0.151). The proportion of myopia decreased from 78.1 per cent before cycloplegia to 71.4 per cent after cycloplegia, while the proportion of hyperopia increased from 12.1 per cent before cycloplegia to 21.4 per cent after cycloplegia. Conclusion Non‐cycloplegic auto‐refraction is found to be inaccurate and not suitable for studies of refractive error in Chinese children.
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Affiliation(s)
- Tao Li
- Department of Ophthalmology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiaodong Zhou
- Department of Ophthalmology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jie Zhu
- Department of Ophthalmology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiaojing Tang
- Department of Ophthalmology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiaoyan Gu
- Department of Ophthalmology, Jinshan Hospital of Fudan University, Shanghai, China
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19
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Sun YY, Wei SF, Li SM, Hu JP, Yang XH, Cao K, Lin CX, Du JL, Guo JY, Li H, Liu LR, Morgan IG, Wang NL. Cycloplegic refraction by 1% cyclopentolate in young adults: is it the gold standard? The Anyang University Students Eye Study (AUSES). Br J Ophthalmol 2018; 103:bjophthalmol-2018-312199. [PMID: 29930099 DOI: 10.1136/bjophthalmol-2018-312199] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/19/2018] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
AIMS To document the difference between non-cycloplegic and cycloplegic refraction and explore its associated factors in Chinese young adults. METHODS A school-based study including 7971 undergraduates was conducted in Anyang, Henan Province, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) with a 5 min interval. Non-cycloplegic and cycloplegic refractions were measured by an autorefractor. A paired-sample t-test and Spearman correlation analysis were used for analysis with data from only the right eyes included. RESULTS: Of the 7971 students examined, 7793 (97.8%) with complete data were included, aging 20.2±1.5 years. Male students accounted for 36.8%. Overall, there was a significant difference between non-cycloplegic and cycloplegic SE (spherical equivalent) of 0.83±0.81D (p<0.01). The difference was 1.80±1.11D, 1.26±0.93D and 0.69±0.69D for those with cycloplegic hyperopia, emmetropia and myopia, respectively (p<0.01 for all). Those with a hyperopic shift less than 0.25D and 0.5D accounted for 11.1% and 34.1%, respectively. A significant relationship was found between difference in SE and cycloplegic refraction (r=0.33, b=0.11, p<0.01). Without cycloplegia, prevalence of hyperopia and emmetropia would be underestimated by 6.2% (1.0% vs 7.2%) and 5.7% (3.8% vs 9.5%), respectively, with prevalence of myopia and high myopia overestimated by 12.1% (95.3% vs 83.2%) and 6.1% (17.2% vs 11.1%). CONCLUSION: Lack of cycloplegia will lead to significant misclassification of myopia, emmetropia and hyperopia in Chinese young adults. Cycloplegia is therefore essential for this age-group in epidemiological studies.
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Affiliation(s)
- Yun-Yun Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Shi-Fei Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Shi-Ming Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jian-Ping Hu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Xiao-Hui Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Cai-Xia Lin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jia-Ling Du
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Ji-Yuan Guo
- Anyang Eye Hospital, Anyang, Henan Province, China
| | - He Li
- Anyang Eye Hospital, Anyang, Henan Province, China
| | - Luo-Ru Liu
- Anyang Eye Hospital, Anyang, Henan Province, China
| | - Ian G Morgan
- Australian National University, Visual Sciences Group, Research School of Biological Sciences and Centre for Visual Science, Canberra, Australian Capital Territory, Australia
| | - Ning-Li Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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20
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Hashemi H, Khabazkhoob M, Asharlous A, Yekta A, Emamian MH, Fotouhi A. Overestimation of hyperopia with autorefraction compared with retinoscopy under cycloplegia in school-age children. Br J Ophthalmol 2018; 102:1717-1722. [PMID: 29439996 DOI: 10.1136/bjophthalmol-2017-311594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 11/03/2022]
Abstract
AIM To compare sphere and cylinder refraction values using retinoscopy and autorefraction under cycloplegic conditions in children. METHODS This cross-sectional study was carried out using multistage cluster sampling. The target population was children aged 6-12 years in Shahroud, a northern city in Iran. Examinations included measurements of visual acuity, subjective refraction and objective refraction. Objective refraction was measured with and without cycloplegia with a retinoscope and an autorefractometer. RESULTS After applying the exclusion criteria, data from 5053 children were analysed. Spherical refraction results with autorefraction were significantly higher than results with retinoscopy (P<0.001). Refraction overestimation was significant in all age groups (P<0.0001). Comparison of differences in different spherical ametropia subgroups also showed a significant intermethod difference in all refractive states (P<0. 01). Overall, autorefraction tended to over plus hyperopics and under minus myopic cases compared with retinoscopy. The 95% limits of agreement for spherical values measured with the two techniques were -0.35 Diopter (D) to 0.50 D. The values of J0 and J45 vectors with autorefraction were significantly higher than those with retinoscopy (P<0.001). The 95% limits of agreement between the two methods for vectors J0 and J45 were -0.12 D to 0.15 D and -0.10 D to 0.11 D, respectively. CONCLUSION Since the observed differences in spherical refraction and the cylindrical components obtained through retinoscopy and autorefraction are statistically significant, but clinically insignificant, and the two methods have a strong correlation and agreement, it can be concluded that autorefraction can be a suitable substitute for retinoscopy in children under cycloplegic conditions.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Asharlous
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Abbasali Yekta
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashad, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Kara C, Petriçli İS. Inability of Open-Field Autorefraction to Eliminate Accommodation in Preschoolers. J Pediatr Ophthalmol Strabismus 2017; 54:311-318. [PMID: 28510771 DOI: 10.3928/01913913-20170329-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of the Shin-Nippon NVision-K 5001 autorefractometer (Rexxam Co. Ltd., Osaka, Japan) (also branded as the Grand Seiko WR-5100K; Grand Seiko Co. Ltd., Hiroshima, Japan) based on the open-field refractometry principle in refractive measurements of preschool children and to determine its ability to eliminate accommodation adequately. METHODS The refractive results of 114 preschool children who presented to the ophthalmology outpatient department for screening were evaluated. The measurements were obtained before and after cycloplegia with the Shin-Nippon NVision-K 5001 autorefractometer and after cycloplegia with retinoscopy, which is the gold standard. The results underwent vectorial transformation to produce the spherical equivalent (M) and two Jackson cross-cylinder (J0 and J45) values. All results were then subjected to statistical analysis. The difference between the measurements was evaluated with repeated measures analysis of variance. RESULTS Included in the study were 106 preschool children (51 boys and 55 girls). The mean age was 5.3 ± 0.9 years (range: 3 to 6 years). Although statistically significantly more myopic results were obtained with non-cycloplegic measurements using the Shin-Nippon NVision-K 5001 autorefractometer (P < .001), no difference was observed in cylindrical values (P > .05). Cycloplegic J0 measurements were significantly lower (P < .001), but no difference was found between J45 values before and after cycloplegia (P > .05). CONCLUSIONS The Shin-Nippon NVision-K 5001/Grand Seiko WR-5100K open-field autorefractometer seems to be inadequate in eliminating accommodation in childhood. Measurements under cycloplegia continue to be the best method to ensure accurate results. [J Pediatr Ophthalmol Strabismus. 2017;54(5):311-318.].
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Does astigmatism alter with cycloplegia? J Curr Ophthalmol 2016; 28:131-6. [PMID: 27579457 PMCID: PMC4992111 DOI: 10.1016/j.joco.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/15/2016] [Accepted: 05/15/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine the effect of the cyclopentolate 1% on the cylindrical and spherical components of the refraction. METHODS Three hundred seventy-five eyes of 195 subjects, including 74 males and 121 females, aged from 3 to 59 years were refracted before and 30 min after cyclopentolate 1% eye drop instillation. To compare cylindrical data, power vector analysis (J0 and J45 cross cylinder) was applied. RESULTS A statistically significant difference between the J0 values of the noncycloplegic and cycloplegic refraction was revealed (P = 0.006) while the J45 values did not significantly differ. 95% limit of agreement for dry and cycloplegic values of the J0 and J45 were -0.22 to 0.25 and -0.19 to 0.20, respectively. Astigmatism difference was separately analyzed in emmetropic, myopic and hyperopic eyes. The J0 difference was significant (P = 0.014) only in hyperopic eyes. Spherical equivalent (SE) values in cycloplegic refraction were significantly more hyperopic than those yielded in dry refraction by mean difference of +1.16 ± 1.20 diopters (P < 0.0001). Spherical equivalent difference (SED) values were negatively correlated with age. CONCLUSIONS Our findings indicated that cycloplegic drops caused a statistically significant shift in the "with the rule" and "against the rule" astigmatisms, although the oblique astigmatisms remained unaffected. Further research with larger sample sizes are needed to answer what mechanisms are involved in changing cylinder with cycloplegia.
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Sanfilippo PG, Chu BS, Bigault O, Kearns LS, Boon MY, Young TL, Hammond CJ, Hewitt AW, Mackey DA. What is the appropriate age cut-off for cycloplegia in refraction? Acta Ophthalmol 2014; 92:e458-62. [PMID: 24641244 DOI: 10.1111/aos.12388] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/09/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the age range for which cycloplegia provides additional information compared with non-cycloplegic refraction in teenagers and young adults. METHODS Data for 1295 subjects (704 female; 591 male) from the Twins Eye Study in Tasmania (TEST) and the Brisbane Adolescent Twin Study (mean age: 19.65 ± 3.56, range: 13-26 years) were included. For all participants, cycloplegia was induced by instillation of either one drop of 1% cyclopentolate (13-14 years) or one drop of 1% tropicamide (15-26 years). Pre- and postcycloplegic refractive errors for both eyes were measured using a Humphrey-598 automated refractor and spherical equivalents of refractive error were calculated. Generalized Estimating Equations (GEE) were used to model the spherical equivalent refraction (SER) for each eye against age (by year) and axial length (in the given eye). RESULTS The mean group difference between pre- and postcycloplegic SER (post minus pre) was 0.17 ± 0.52 D and 0.12 ± 0.51 D for the right and left eyes, respectively, indicating that postcycloplegic refraction was generally more hyperopic/less myopic. The mean difference between pre- and postcycloplegic SER decreased from 0.36 ± 0.41 D in the 13-year-olds to 0.06 ± 0.50 D in people aged 25 years. After adjusting for family-relatedness, the difference between pre- and postcycloplegia SER was significant in all age groups up until the age of 20 years. CONCLUSIONS Non-cycloplegic autorefraction can result in group mean SER differences of greater myopia than cycloplegic autorefraction and occurs in teenagers (13-19 years of age), but not in adults 20-26 years. These data suggest that cycloplegia is not required in population estimates of refractive error for young adults once they reach approximately 20 years of age.
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Affiliation(s)
- Paul G. Sanfilippo
- Department of Ophthalmology; Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Vic. Australia
| | - Byoung-Sun Chu
- School of Optometry and Vision Science; Catholic University of Daegu; Daegu Korea
| | - Olivia Bigault
- Department of Ophthalmology; Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Vic. Australia
| | - Lisa S. Kearns
- Department of Ophthalmology; Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Vic. Australia
| | - Mei-Ying Boon
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
| | | | | | - Alex W. Hewitt
- Department of Ophthalmology; Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Vic. Australia
- Centre for Ophthalmology and Visual Science; Lions Eye Institute; University of Western Australia; Perth WA Australia
| | - David A. Mackey
- Centre for Ophthalmology and Visual Science; Lions Eye Institute; University of Western Australia; Perth WA Australia
- Discipline of Medicine; University of Tasmania; Hobart Australia
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Durr NJ, Dave SR, Lage E, Marcos S, Thorn F, Lim D. From Unseen to Seen: Tackling the Global Burden of Uncorrected Refractive Errors. Annu Rev Biomed Eng 2014; 16:131-53. [DOI: 10.1146/annurev-bioeng-071813-105216] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicholas J. Durr
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Shivang R. Dave
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Eduardo Lage
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Susana Marcos
- Instituto de Óptica “Daza de Valdés,” Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Frank Thorn
- New England College of Optometry, Boston, Massachusetts 02115
| | - Daryl Lim
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
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Zhu X, Chen M, Dai J, Lu Y. The effect of 0.5% tropicamide/0.5% phenylephrine mixed eye drop in Chinese adults with myopia and its inter-eye difference in refractive outcomes. Curr Med Res Opin 2014; 30:481-7. [PMID: 24215472 DOI: 10.1185/03007995.2013.861348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the effect of 0.5% tropicamide/0.5% phenylephrine mixed eye drop and make the inter-eye comparison of refractive outcomes in Chinese adults with myopia. METHODS Refractive measurements were performed without cycloplegia and repeated 30 minutes later with 0.5% tropicamide/0.5% phenylephrine mixed eye drop (Mydrin-P*) on 341 myopic adults. Vector analysis was used to analyze the data. Changes of spherical equivalent (M) and astigmatism for both J0 and J45 components between these two refractions were calculated as Error_M, Error_J0 and Error_J45. Inter-eye correlations were studied. The inter-eye difference after cycloplegics were described as Diff M, Diff J0 and Diff J45. The effect of anisometropia, age and the higher order aberrations (HOAs) on inter-eye differences toward the cycloplegic agent were analyzed. RESULTS Difference was found only for the Error_J45 component between the two eyes (p=0.0040). Pearson correlation coefficients between the two eyes for Error_M, Error_J0, and Error_J45 were 0.3140 (p<0.0001), 0.1464 (p=0.0068), and 0.0099 (p=0.8558), respectively. The inter-eye differences (Diff) in response to cycloplegic agent increased with the amount of anisometropia. The oldest group had the highest Diff M values. However, HOAs were found not to be related to the inter-eye differences. CONCLUSIONS Accommodation was still relaxed by tropicamide/phenylephrine eye drops in myopic adults. The changes of refraction due to cycloplegia were not well correlated between the two eyes in myopic patients. Anisometropia and ocular dominance might be an important factor for the inter-eye difference.
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Affiliation(s)
- Xiangjia Zhu
- EYE and ENT Hospital of Fudan University , Shanghai , China
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Abstract
PURPOSE To explore the effectiveness of combining uncorrected visual acuity (UCVA) and noncycloplegic autorefraction (NCAR) for large-scale myopia screening in schoolchildren with a high prevalence of myopia. METHODS A total of 1687 children aged between 6 and 12 years, from five primary schools in the Baoshan district of Shanghai participated in the study. We measured UCVA and autorefraction before and after cycloplegia by a Topcon KR-8800. We drew receiver operating characteristic curves to achieve the best cutoff points and their corresponding sensitivities and specificities for the UCVA and NCAR, respectively. We then combined the UCVA and NCAR in serial order to explore the optimal criterion and its effectiveness. A specificity of 90% was set to compare the sensitivities among the three tests. The children were divided into three age groups (aged 6 to 7, 8 to 10, 11 to 12 years) to further examine this new method. RESULTS A total of 1639 children with an average age of 9.35 (SD, 1.6) years were finally included, among which 428 (26.11%) children were diagnosed as being myopic (spherical equivalent refraction (SER) less than or equal to -0.5 diopters [D]). For the UCVA, the cutoff point is 0.2 logarithm of the minimum angle of resolution (20/32), with a sensitivity and specificity of 63.6% and 94.0%, respectively. For NCAR, the cutoff point is SER less than or equal to -0.75 D, with a sensitivity and specificity of 88.6% and 86.1%, respectively. When UCVA is combined with NCAR, the best cutoff point is UCVA less than or equal to 0 logarithm of the minimum angle of resolution (20/20) and SER less than or equal to -0.75 D, with a sensitivity and specificity of 84.4% and 90.5%, respectively. At a specificity of 90%, the sensitivities are 63.55%, 78.50%, and 84.35%, respectively, for UCVA, NCAR, and the combination test. In all age groups, the combination test had the highest sensitivities among the three tests. CONCLUSIONS In a population with a high prevalence of myopia, combining the UCVA and NCAR in serial order achieved higher sensitivity than either of the two tests alone, when specificity was set at 90%.
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Lin HZ, Chen CC, Lee YC. Effect of pharmacologic pupil dilation with tropicamide and phenylephrine on wavefront measurements. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2013.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
PURPOSE The prevalence of refractive errors in children has been extensively researched. Comparisons between studies can, however, be compromised because of differences between accommodation control methods and techniques used for measuring refractive error. The aim of this study was to compare spherical refractive error results obtained at baseline and using two different accommodation control methods-extended optical fogging and cycloplegia-for two measurement techniques-autorefraction and retinoscopy. METHODS Participants included 25 school children aged 6 to 13 years (mean age, 9.52 ± 2.06 years). The refractive error of one eye was measured at baseline and again under two different accommodation control conditions: extended optical fogging (+2.00DS for 20 minutes) and cycloplegia (1% cyclopentolate). Autorefraction and retinoscopy were both used to measure the most plus spherical power for each condition. RESULTS A significant interaction was demonstrated between measurement technique and accommodation control method (p = 0.036), with significant differences in spherical power evident between accommodation control methods for each of the measurement techniques (p < 0.005). For retinoscopy, refractive errors were significantly more positive for cycloplegia compared with optical fogging, which were in turn significantly more positive than baseline; whereas for autorefraction, there were significant differences between cycloplegia and extended optical fogging and between cycloplegia and baseline only. CONCLUSIONS Determination of refractive error under cycloplegia elicits more plus than using extended optical fogging as a method to relax accommodation. These findings support the use of cycloplegic refraction compared with extended optical fogging as a means of controlling accommodation for population-based refractive error studies in children.
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Lai YH, Tseng HY, Hsu HT, Chang SJ, Wang HZ. Uncorrected visual acuity and noncycloplegic autorefraction predict significant refractive errors in Taiwanese preschool children. Ophthalmology 2012. [PMID: 23182455 DOI: 10.1016/j.ophtha.2012.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To investigate the accuracy of uncorrected visual acuity (UCVA), stereopsis, and noncycloplegic autorefraction (NCAR) tests performed by vision-screening technicians and to determine the best referral criteria when using these methods to screen for significant refractive errors in preschool children. DESIGN Retrospective, case-control, and cross-sectional study. PARTICIPANTS We reviewed 1000 records for a population-based preschool vision-screening program. The target conditions were defined as myopia ≤-3.0 diopters (D), hyperopia ≥ 4.5 D, astigmatism ≥ 2.0 D, and anisometropia ≥ 2.0 D. METHODS Receiver operating characteristic (ROC) curve was used to calculate optimal referral cutoff values. The examination results obtained by the vision-screening technicians were compared with those obtained by a pediatric ophthalmologist, which were considered the gold standard. MAIN OUTCOME MEASURES The efficacies (sensitivity, specificity, positive predictive value, and negative predictive value) of different tests were evaluated. RESULTS In 7.0% (95% confidence interval [CI], 5.3-8.7) of the children, at least 1 eye showed 1 of the target conditions. If only the right eyes were considered, the prevalence of target conditions was 4.2% (95% CI, 2.9-5.5). The ROC curve analysis indicated that the NCAR cylinder test (cutoff value ≥ 0.875 D) was the best test for screening target conditions. With regard to age groups, UCVA ≤ 0.75 (Snellen equivalent) and ≤ 0.85 were the best referral criteria for ages ≤ 4 years and ≥ 5 years, respectively. Combining the UCVA test with the NCAR test (the child was referred after failing both tests) increased specificity without significantly decreasing sensitivity. CONCLUSIONS The UCVA and NCAR tests performed by vision-screening technicians are adequately sensitive and specific for preschool vision screening. The ROC curve analysis was used for determining the appropriate screening criteria for these tests, and combining the tests increased their accuracy. The screening criteria should be age dependent. When analyzing the test accuracy in ophthalmic problems, if the disease of interest does not symmetrically (in terms of disease severity and prevalence) involve both eyes, the prevalence based on only 1 eye should be interpreted with caution.
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Affiliation(s)
- Yu-Hung Lai
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Fotouhi A, Morgan IG, Iribarren R, Khabazkhoob M, Hashemi H. Validity of noncycloplegic refraction in the assessment of refractive errors: the Tehran Eye Study. Acta Ophthalmol 2012; 90:380-6. [PMID: 20977697 DOI: 10.1111/j.1755-3768.2010.01983.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the sensitivity and specificity of noncycloplegic autorefraction for determining refractive status compared to cycloplegic autorefraction. METHODS The target population was noninstitutionalized citizens of all ages, residing in Tehran in 2002, selected through stratified cluster sampling. From 6497 eligible residents, 70.3% participated in the study, from August to November 2002. Here, we report data on 3501 people over the age of 5 years who had autorefraction with and without cycloplegia (two drops of cyclopentolate 1.0% 5 min apart, with autorefraction 25 min after the second drop). RESULTS Overall, the sensitivity of noncycloplegic autorefraction for myopia was 99%, but the specificity was only 80.4%. In contrast, the sensitivity for hyperopia was only 47.9%, but the specificity was 99.4%. At all ages, noncycloplegic autorefraction overestimated myopia and underestimated hyperopia. Overestimation of myopia was highest in the 21-30 and 31-40 year groups. Underestimation of hyperopia was high up to the age of 50 (20-40%), but decreased with age, to about 8% after the age of 50, down to almost 0% after 70. The difference in mean spherical equivalent with and without cycloplegia fell from 0.71 dioptres (D) in the 5-10 age group to 0.14D in those over 70. CONCLUSION Use of noncycloplegic autorefraction in epidemiological studies leads to considerable errors relative to cycloplegic measurements, except in those over 50-60. The difference between cycloplegic and noncycloplegic measurements varies with age and cycloplegic refractive category, and there is considerable individual variation, ruling out adjusting noncycloplegic measurements to obtain accurate cycloplegic refractions.
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Affiliation(s)
- Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Matta NS. Implementing and evaluating a school-based program to improve childhood vision. THE JOURNAL OF SCHOOL HEALTH 2011; 81:295-296. [PMID: 21592123 DOI: 10.1111/j.1746-1561.2011.00593.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Tkatchenko TV, Tkatchenko AV. Ketamine-xylazine anesthesia causes hyperopic refractive shift in mice. J Neurosci Methods 2010; 193:67-71. [PMID: 20813132 DOI: 10.1016/j.jneumeth.2010.07.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 07/23/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
Abstract
Mice have increasingly been used as a model for studies of myopia. The key to successful use of mice for myopia research is the ability to obtain accurate measurements of refractive status of their eyes. In order to obtain accurate measurements of refractive errors in mice, the refraction needs to be performed along the optical axis of the eye. This represents a particular challenge, because mice are very difficult to immobilize. Recently, ketamine-xylazine anesthesia has been used to immobilize mice before measuring refractive errors, in combination with tropicamide ophthalmic solution to induce mydriasis. Although these drugs have increasingly been used while refracting mice, their effects on the refractive state of the mouse eye have not yet been investigated. Therefore, we have analyzed the effects of tropicamide eye drops and ketamine-xylazine anesthesia on refraction in P40 C57BL/6J mice. We have also explored two alternative methods to immobilize mice, i.e. the use of a restraining platform and pentobarbital anesthesia. We found that tropicamide caused a very small, but statistically significant, hyperopic shift in refraction. Pentobarbital did not have any substantial effect on refractive status, whereas ketamine-xylazine caused a large and highly significant hyperopic shift in refraction. We also found that the use of a restraining platform represents good alternative for immobilization of mice prior to refraction. Thus, our data suggest that ketamine-xylazine anesthesia should be avoided in studies of refractive development in mice and underscore the importance of providing appropriate experimental conditions when measuring refractive errors in mice.
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Affiliation(s)
- Tatiana V Tkatchenko
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Krantz EM, Cruickshanks KJ, Klein BEK, Klein R, Huang GH, Nieto FJ. Measuring refraction in adults in epidemiological studies. ACTA ACUST UNITED AC 2010; 128:88-92. [PMID: 20065223 DOI: 10.1001/archophthalmol.2009.349] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare refraction measured before and after pharmacologic cycloplegia. METHODS This study used preliminary data from the Beaver Dam Offspring Study, which includes adult children of participants in the population-based Epidemiology of Hearing Loss Study of older adults living in Beaver Dam, Wisconsin. Data were available for 5018 eyes of 2529 participants. Refraction was defined by the spherical equivalent (SE), using autorefractor readings. Differences were calculated as the SE after drops were administered minus the SE before drops were administered. Myopia was defined as SE of -1 diopter (D) or less; emmetropia, as SE more than -1 D and less than 1 D; and hyperopia, as SE of 1 D or more. RESULTS The mean age was 48 years (range, 22-84 years). The mean difference in SE between measurements before and after cycloplegia was 0.29 D (95% confidence interval, 0.28-0.31). The difference decreased with age and varied by refractive status for participants younger than 50 years, with the largest differences observed among young persons with hyperopic refractive errors. Across all age groups, agreement on classifications of refraction was high (84%-92%). CONCLUSIONS Overall, clinically inconsequential differences were observed between SEs before and after pharmacologic cycloplegia, suggesting that cycloplegia may not be necessary in epidemiological studies of refraction in adults.
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Affiliation(s)
- Elizabeth M Krantz
- Departments of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, USA.
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Ahn JM, Ahn HS, Seo KY, Kim EK, Kim TI. Comparison of the Refractive Error Measurement Using Different Methods in Wavefront-Guided LASEK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.9.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Min Ahn
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
| | - Hyun Seok Ahn
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Queirós A, González-Méijome J, Jorge J. Influence of fogging lenses and cycloplegia on open-field automatic refraction. Ophthalmic Physiol Opt 2008; 28:387-92. [PMID: 18565095 DOI: 10.1111/j.1475-1313.2008.00579.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare refractive values measured with and without cycloplegia, or with fogging lenses, using an open-field auto-refractor. METHODS One hundred and forty-two young adults were enrolled from a university population; 96 were female (67.6%) and 46 were male (32.4%), the age range was 18-26 years (mean 22.3 +/- 3.7 years). The refraction measurement was obtained for the right eye of each subject with the Grand Seiko Auto Ref/Keratometer WAM-5500 (GS) under three conditions, always in this sequence: (1) without cycloplegia (GS), (2) without cycloplegia but using a + 2.00 D fogging lens (GS_2D) and (3) with cycloplegia (GS_cycl). RESULTS When the average values of spherical equivalent were compared, both accommodation control strategies were almost equally successful: GS, M = -0.85 +/- 2.21 D; GC_2D, M = -0.53 +/- 2.10 D and GS_cycl, M = -0.57 +/- 2.24 D (Kruskal-Wallis test, p < 0.001). When the results were analysed separately for different refractive groups, emmetropes and hyperopes show statistically significant differences while myopes did not. When both accommodation strategies were compared there was a trend for more myopic subjects to display more negative values under cycloplegia, while low myopes, emmetropes and hyperopes tend to display more negative values with the +2.00 D fogging lenses, suggesting this was less effective for accommodation control. CONCLUSIONS Over-refraction through +2.00 D fogging lenses is useful to achieve additional relaxation of the accommodative response in a similar way to cycloplegia when open-field autorefraction is performed in young adults.
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Affiliation(s)
- A Queirós
- Department of Physics (Optometry), School of Sciences, University of Minho, Braga, Portugal.
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Binocular Vision Changes in University Students: A 3-Year Longitudinal Study. Optom Vis Sci 2008; 85:E999-E1006. [PMID: 18832972 DOI: 10.1097/opx.0b013e3181890d35] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ferrer-Blasco T, González-Méijome JM, Montés-Micó R. Age-related changes in the human visual system and prevalence of refractive conditions in patients attending an eye clinic. J Cataract Refract Surg 2008; 34:424-32. [PMID: 18299067 DOI: 10.1016/j.jcrs.2007.10.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 10/24/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively report the trends of change in several parameters of the human visual system over a wide age range in patients attending an eye clinic. SETTING University of Valencia, Valencia, Spain. METHODS The clinical records of 2654 patients were retrospectively reviewed, and the age, sex, spherocylindrical refraction, visual acuity, keratometry, and intraocular pressure were obtained. Descriptive values for each parameter and the correlations with age and between different parameters were calculated. Vectorial components of refraction, including blur, were also derived from clinical refractive data and then analyzed. RESULTS Several parameters changed significantly with age, particularly in patients in their sixties and older. An increase in the blur component was mainly associated with astigmatic progression and a trend toward against-the-rule orientation and had the highest correlation with total astigmatism (r= -0.319; P<.001) and visual acuity (r= -0.442; P<.001). Refractive conditions had the most homogeneous distribution in the first decade of life and the most heterogeneous distribution in the group between 61 years and 70 years. CONCLUSIONS Best corrected visual acuity began to decrease after the 50s, while changes in the blur component were not patent until the 60s to 70s. This could be explained by the poorer optical quality of the human eye in adulthood and elderly persons. Clinically, these changes could be attributed to changes in ocular astigmatism and have an impact on the best visual acuity achievable with optical compensation.
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Affiliation(s)
- Teresa Ferrer-Blasco
- Human Vision Performance Research Group, Department of Optics, University of Valencia, Valencia, Spain
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Jorge J, Almeida JB, Parafita MA. Refractive, biometric and topographic changes among Portuguese university science students: a 3-year longitudinal study. Ophthalmic Physiol Opt 2007; 27:287-94. [PMID: 17470242 DOI: 10.1111/j.1475-1313.2007.00475.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate the changes in refractive, biometric and topographic ocular parameters among university students in Portugal during a 3-year period. METHODS A 3-year longitudinal study comprised 118 Portuguese university students from the School of Science (34 males and 84 females; mean age 20.6 +/- 2.3 years). Ocular refraction, corneal curvature (CR) and eccentricity, and A-scan biometry were conducted under cycloplegia. The sphero-cylindrical refractive results were converted into vector representations (M, J(0) and J(45)) for statistical analysis. Myopia was defined as M < or = -0.50 D, emmetropia as M > -0.50 D and < +0.50 D and hyperopia as M > or = +0.50 D. RESULTS At the beginning of the study sphero-cylindrical refraction (M) ranged from -6.75 to +3.00 D, with a mean value of 0.23 +/- 1.46 D [mean +/- standard deviation (S.D.)]. Eighty-three students presented astigmatism with a mean value (+/-S.D.) of -0.52 +/- 0.41 D, and a maximum of -2.25 D. After 3 years the mean refractive change for the M component was -0.29 +/- 0.38 D (p < 0.001) and non-significant changes of 0.02 +/- 0.16 D (p = 0.281) for the J(0) component and 0.01 +/- 0.09 D (p = 0.784) for the J(45) component. Prevalence of myopia increased by 5.1%, while the prevalence of hyperopia decreased by 9.4%. Myopia progression > or =0.5 D was observed in 22% of the population. Axial length, vitreous chamber depth and lens thickness increased significantly while anterior chamber depth and central CR did not change significantly. CONCLUSIONS This study shows a change in refraction towards myopia accompanied by a vitreous chamber elongation in a Portuguese population comprising science students during the first three years of their university course. Younger students were more likely to show clinically significant myopia progression.
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Affiliation(s)
- J Jorge
- Department of Physics (Optometry), School of Sciences, University of Minho, Campus de Gualtar, Braga, Portugal.
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Fotedar R, Rochtchina E, Morgan I, Wang JJ, Mitchell P, Rose KA. Necessity of cycloplegia for assessing refractive error in 12-year-old children: a population-based study. Am J Ophthalmol 2007; 144:307-9. [PMID: 17659966 DOI: 10.1016/j.ajo.2007.03.041] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 03/22/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare pre- and postcycloplegic autorefraction in two separate age samples of Australian school children. DESIGN Population-based cross-sectional study of random cluster samples. METHODS Autorefraction was performed before and after cycloplegia, using 1% cyclopentolate, in the right eyes of 2,233 12-year-old and 210 6-year-old children. RESULTS The mean spherical equivalent (SEQ) difference between these measures was 0.84 diopters (D) (95% confidence interval (CI) 0.81 to 0.87 D), more hyperopic in post- than precycloplegic autorefractive assessments in the 12-year-old children and 1.18 D (95% CI 1.05 to 1.30 D) more hyperopic in the 6-year-old children. Precycloplegic autorefraction substantially overestimated the proportion of children with myopia, misclassifying 17.8% aged 12 years and 9.5% aged 6 years. Conversely, precycloplegic autorefraction did not detect moderate to high hyperopia in 2.28% of 12-year-olds and 17.14% of 6-year-olds. CONCLUSIONS Our findings reinforce the importance of using cycloplegic autorefraction in children up to age 12 years.
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Affiliation(s)
- Reena Fotedar
- Centre for Vision Research, Department of Ophthalmology, University of Sydney and Westmead Millennium Institute, Westmead Hospital, Westmead, Australia
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Cervino A, Hosking SL, Rai GK, Naroo SA, Gilmartin B. Wavefront Analyzers Induce Instrument Myopia. J Refract Surg 2006; 22:795-803. [PMID: 17061717 DOI: 10.3928/1081-597x-20061001-10] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the accuracy of three wavefront analyzers versus a validated binocular open-view autorefractor in determining refractive error in non-cycloplegic eyes. METHODS Eighty eyes were examined using the SRW-5000 open-view infrared autorefractor and, in randomized sequence, three wavefront analyzers: 1) OPD-Scan (NIDEK, Gamagori, Japan), 2) WASCA (Zeiss/Meditec, Jena, Germany), and 3) Allegretto (WaveLight Laser Technologies AG, Erlangen, Germany). Subjects were healthy adults (19 men and 21 women; mean age: 20.8 +/- 2.5 years). Refractive errors ranged from +1.5 to -9.75 diopters (D) (mean: +1.83 +/- 2.74 D) with up to 1.75 D cylinder (mean: 0.58 +/- 0.53 D). Three readings were collected per instrument by one examiner without anticholinergic agents. Refraction values were decomposed into vector components for analysis, resulting in mean spherical equivalent refraction (M) and J0 and J45 being vectors of cylindrical power at 0 degrees and 45 degrees, respectively. RESULTS Positive correlation was observed between wavefront analyzers and the SRW-5000 for spherical equivalent refraction (OPD-Scan, r=0.959, P<.001; WASCA, r=0.981, P<.001; Allegretto, r=0.942, P<.001). Mean differences and limits of agreement showed more negative spherical equivalent refraction with wavefront analyzers (OPD-Scan, 0.406 +/- 0.768 D [range: 0.235 to 0.580 D] [P<.001]; WASCA, 0.511 +/- 0.550 D [range: 0.390 to 0.634 D] [P<.001]; and Allegretto, 0.434 +/- 0.904 D [range: 0.233 to 0.635 D] [P<.001]). A second analysis eliminating outliers showed the same trend but lower differences: OPD-Scan (n=75), 0.24 +/- 0.41 D (range: 0.15 to 0.34 D) (P<.001); WASCA (n=78), 0.46 +/- 0.47 D (range: 0.36 to 0.57 D) (P<.001); and Allegretto (n=77), 0.30 +/- 0.62 D (range: 0.16 to 0.44 D) (P<.001). No statistically significant differences were noted for J0 and J45. CONCLUSIONS Wavefront analyzer refraction resulted in 0.30 D more myopia compared to SRW-5000 refraction in eyes without cycloplegia. This is the result of the accommodation excess attributable to instrument myopia. For the relatively low degrees of astigmatism in this study (<2.0 D), good agreement was noted between wavefront analyzers and the SRW-5000.
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Affiliation(s)
- Alejandro Cervino
- School of Life and Health Sciences, Aston University, United Kingdom
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