Agreement Between Retinoscopy, Autorefractometry and Subjective Refraction for Determining Refractive Errors in Congolese Children

Retinoscopes: Past and present

BACKGROUND

Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills.

AIM

To discuss the history of retinoscopes and examine current literature on the subject.

METHODS

A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term "Retinoscopy," with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)].

RESULTS

This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope.

CONCLUSION

The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.

Method comparison and overview of refractive measurements in children: implications for myopia management

OBJECTIVE

This study investigated the agreement between objective wavefront-based refraction and subjective refraction in myopic children. It also assessed the impact of cyclopentolate and refraction levels on the agreement.

METHODS

A total of 84 eyes of myopic children aged 6-13 years were included in the analysis. Non-cycloplegic and cycloplegic objective wavefront-based refraction were determined and cycloplegic subjective refraction was performed for each participant. The data were converted into spherical equivalent, J0 and J45, and Bland-Altman plots were used to analyse the agreement between methods.

RESULTS

Linear functions were used to determine the dependency between the central myopic refractive error and the difference between the method of refraction (=bias). The influence of central myopia was not clinically relevant when analysing the agreement between wavefront results with and without cyclopentolate (comparison 1). The bias for wavefront-based minus subjective spherical equivalent refraction (comparison 2) was ≤-0.50 D (95% limits of agreement -0.010 D to -1.00 D) for myopia of -4.55 D and higher when cycloplegia was used (p<0.05). When no cyclopentolate was used for the wavefront-based refraction (comparison 3), the bias of -0.50 D (95% limits of agreement -0.020 D to -0.97 D) was already reached at a myopic error of -2.97 D. Both astigmatic components showed no clinically relevant bias.

CONCLUSION

The spherical equivalent, measured without cycloplegic agents, led to more myopic measurements when wavefront-based refraction was used. The observed bias increased with the amount of myopic refractive error for comparisons 2 and 3, which needs to be considered when interpreting wavefront-refraction data.

TRIAL REGISTRATION NUMBER

NCT05288335.

Auto-refraction versus subjective refraction in different phakic and pseudophakic conditions: the Tehran Geriatric Eye Study (TGES)

AIM

To compare the subjective refraction data with non-cycloplegic auto-refraction findings in the geriatric population above 60 years of age according to the different crystalline lens conditions.

METHODS

This report is a part of the Tehran Geriatric Eye Study (TGES) that was conducted from January 2019 to January 2020 on elderly population 60 years of age and above in Tehran. The samples were selected by multi-stage stratified random cluster sampling. Of 3791 individual invitees, 3310 (response rate: 87.3%) participated in this study. All study participants underwent non-cycloplegic auto-refraction (auto-refractometer/keratometer Nidek ARK-510) and subjective refraction.

RESULTS

Regarding the sphere, eyes with mixed cataract had the worst limits of agreement (LoA: -1.24 to 0.87) and the best agreement was related to the pseudophakic eyes (LoA: -0.83 to 0.54). The highest (0.27±0.31 D) and lowest (0.21±0.27 D) differences between the two methods regarding the cylinder power were observed in eyes with cortical cataract and normal eyes, respectively. The worst LoA between the two methods in measuring the cylinder power was related to the eyes with mixed cataract (LoA: -0.44 to 0.96). Regarding the J0 (horizontal/vertical components of astigmatism), the mean values of J0 obtained by auto-refraction were tended more toward against the rule direction in all crystalline lens conditions, and the two methods had the greatest difference in cortical cataract cases (0.05±0.17 D). Regarding the J45 (oblique components of astigmatism), the lowest (0±0.11 D) and highest (-0.01±0.12 D) differences were observed in normal eyes and eyes with cortical cataract, respectively.

CONCLUSION

The auto-refractometer/keratometer Nidek ARK-510 results in the elderly with different phakic and pseudophakic conditions do not correspond well with subjective refraction findings. This discrepancy in spherical findings is more pronounced in individuals with mixed cataract than in other cases.

Comparisons of objective and subjective refraction with and without cycloplegia using binocular wavefront optometer with autorefraction and retinoscopy in school-age children

Purpose

To compare school-age children’s objective and subjective refraction using a binocular wavefront optometer (BWFOM) with autorefraction and retinoscopy before and after cycloplegia.

Methods

Eighty-six eyes from 86 children (6–15 years old) were enrolled in this cross-sectional study. BWFOM objective and subjective refractions were compared with autorefraction and retinoscopy under cycloplegia. BWFOM refraction was evaluated before and after cycloplegia. Measurements were compared using a paired t-test; agreement was assessed using Bland–Altman plots.

Results

Under cycloplegia, the sphere, spherical equivalence, and J45 were significantly more negative on BWFOM objective refraction than autorefraction (− 1.39 ± 2.20 D vs. − 1.28 ± 2.23 D, P = 0.003; − 1.84 ± 2.38 D vs. − 1.72 ± 2.43 D, P = 0.001; − 0.02 ± 0.17 D vs. 0.03 ± 0.21 D, P = 0.004). The subjective sphere of BWFOM was less myopic, and the cylinder and the J45 were more negative than those with retinoscopy (− 1.17 ± 2.09 D vs. − 1.25 ± 2.20 D, P = 0.02; − 0.91 ± 0.92 D vs. − 0.76 ± 0.92 D, P < 0.001; − 0.01 ± 0.15 D vs. 0.03 ± 0.21 D, P = 0.028). For both BWFOM objective and subjective refraction, sphere and spherical equivalence with noncycloplegia were more myopic than those with cycloplegia (objective: − 1.76 ± 2.10 D vs. − 1.39 ± 2.20 D, − 2.21 ± 2.30 D vs. − 1.84 ± 2.38 D, P < 0.001; subjective: − 1.57 ± 1.92 D vs. − 1.17 ± 2.09 D, − 2.01 ± 2.13 D vs. − 1.62 ± 2.27 D, P < 0.001). Bland–Altman plots showed good agreement in spherical equivalence between BWFOM objective refraction and autorefraction (mean difference = 0.12 D, 95% confidence interval [CI] − 0.52 to 0.76), subjective refraction with retinoscopy (mean difference =  − 0.01 D, 95% CI − 0.65 to 0.64), and BWFOM refractions with or without cycloplegia (objective: mean difference =  − 0.37 D, 95% CI − 1.31 to 0.57; subjective: mean difference =  − 0.39 D, 95% CI − 1.30 to 0.51). The time cost by BWFOM was significantly less than the total time of autorefraction and retinoscopy (264.88 ± 90.67 s vs. 315.89 ± 95.31 s, P < 0.001).

Conclusion

BWFOM is a new device that realizes both objective and subjective refraction. For children’s refractive errors, it is more convenient and quicker to obtain the proper prescription at a 0.05-D interval, and it is more accurate than autorefraction and retinoscopy under cycloplegia.

Evaluation of Ocular Residual Astigmatism in Eyes with Myopia and Myopic Astigmatism and Its Interaction with Other Forms of Astigmatism

Purpose

To evaluate the prevalence, magnitude, and direction of ocular residual astigmatism (ORA) in eyes with myopia and myopic astigmatism, and its interaction with refractive, anterior corneal, posterior corneal, and true net power astigmatism.

Patients and Methods

Refractive surgery candidates with myopia and myopic astigmatism were studied. Refractive astigmatism (RA) was measured using the Nidek® AR-310A autorefractometer. Anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), and true net power astigmatism (TNP) were measured using the Wavelight® Oculyzer II. Astigmatism was converted from polar to vector notation. ORA was calculated by vector subtraction of ACA from RA vertexed to corneal plane. Compensation factor (CF) was calculated as the ratio of ORA that compensates ACA for both J0 and J45.

Results

154 eyes of 88 patients (mean age 31.7±7.1 years) were included. With-the-rule (WTR) astigmatism was the most common for both RA (55.6%) and ACA (74%), while against-the-rule (ATR) was the most common for PCA (87.7%) and ORA (74.0%). The axes of RA and ACA were within 10° of each other in 46.8% of the eyes, and within 30° of each other in 76.0%. The mean difference in value between the axis of RA and ACA was 25.6°. 71.4% of eyes in the study had an ORA ≥ 0.5D, 44.1% had ORA ≥ 0.75D and 26% had ORA ≥ 1D. There was a statistically significant difference between ACA and each of RA and TNP. Using TNP to calculate ORA instead of ACA reduced its magnitude. RA is positively correlated to ACA and more strongly to TNP. The most common pattern of compensation between ORA and ACA was under-compensation for J0 (49%) and same-axis-augmentation for J45 (35%).

Conclusion

ORA, PCA, and the interaction between ORA and ACA can affect results during refractive planning.

Low-Concentration Atropine Monotherapy vs. Combined with MiSight 1 Day Contact Lenses for Myopia Management

Objectives: To assess the decrease in myopia progression and rebound effect using topical low-dose atropine compared to a combined treatment with contact lenses for myopic control. Methods: This retrospective review study included 85 children aged 10.34 ± 2.27 (range 6 to 15.5) who were followed over three years. All had a minimum myopia increase of 1.00 D the year prior to treatment. The children were divided into two treatment groups and a control group. One treatment group included 29 children with an average prescription of 4.81 ± 2.12 D (sphere equivalent (SE) range of 1.25−10.87 D), treated with 0.01% atropine for two years (A0.01%). The second group included 26 children with an average prescription of 4.14 ± 1.35 D (SE range of 1.625−6.00 D), treated with MiSight 1 day dual focus contact lenses (DFCL) and 0.01% atropine (A0.01% + DFCL) for two years. The control group included 30 children wearing single-vision spectacles (SV), averaging −5.06 ± 1.77 D (SE) range 2.37−8.87 D). Results: There was an increase in the SE myopia progression in the SV group of 1.19 ± 0.43 D, 1.25 ± 0.52 D, and 1.13 ± 0.36 D in the first, second, and third years, respectively. Myopia progression in the A0.01% group was 0.44 ± 0.21 D (p < 0.01) and 0.51 ± 0.39 D (p < 0.01) in the first and second years, respectively. In the A0.01% + DFCL group, myopia progression was 0.35 ± 0.26 D and 0.44 ± 0.40 D in the first and second years, respectively (p < 0.01). Half a year after the cessation of the atropine treatment, myopia progression (rebound effect) was measured at −0.241 ± 0.35 D and −0.178 ± 0.34 D in the A0.01% and A0.01% + DFCL groups, respectively. Conclusions: Monotherapy low-dose atropine, combined with peripheral blur contact lenses, was clinically effective in decreasing myopia progression. A low rebound effect was found after the therapy cessation. In this retrospective study, combination therapy did not present an advantage over monotherapy.

Rise of the Machines? Comparison of Cycloplegic Refraction Using Retinoscopy and the Retinomax K-Plus 5 in Children

PURPOSE

To compare the ability to detect refractive anomalies in children using automated refraction versus retinoscopic cycloplegic refraction.

METHODS

A pediatric population from a pediatric eye institute underwent complete ophthalmic examinations. Children were randomly assigned to one of two pediatric optometrists who performed manual cycloplegic refraction using retinoscopy and automated cycloplegic refraction using a handheld autorefractometer (Retinomax K-plus 5; Right Mfg. Co., Ltd.). Recorded patient data included refraction values for each eye (sphere, astigmatism, and axis), use of glasses, and degree of cooperation.

RESULTS

Two hundred thirteen children were included. The mean age was 6.2 years. For all ages, strong associations were found in sphere and spherical equivalent (SE) measurements between the two methods (b = 0.78, P < .001; b = 0.71, P < .001; respectively). Among children older than 5 years, associations between the two methods were significant in all parameters (sphere: b = 0.99, P < .001; astigmatism: b = 0.69, P < .001; axis: b = 0.19, P < .05; SE: b = 0.97, P < .001), whereas among children 5 years and younger, a significant association was found only in the axis measurements (b = 0.31, P < .01). Retinomax K-plus 5 measurements showed significantly more hyperopic results in sphere measurements and higher astigmatism in all children examined, but this difference was markedly higher in children 5 years and younger. Good cooperation was observed in 94.1% of children older than 5 years and 77% of children 5 years and younger (P < .001).

CONCLUSIONS

The Retinomax K-plus 5 may be used for screening in children older than 5 years. However, in all age groups, it may not be accurate enough for treatment and decision making, even with good cooperation. [J Pediatr Ophthalmol Strabismus. 2022;59(6):380-387.].

The Prevalence of Visual Impairment and Refractive Errors among a Youth Population in Mozambique: Evidence of the Need for Intervention

Visual impairment (VI) can significantly interfere in the child's daily activities and quality of life, having a negative effect on their development and learning. The aim of the study was to determine the prevalence of VI and associated demographic factors in students examined during the program "Moçambique te vejo melhor". This study was cross-sectional and retrospective, based on the 2018/19 edition of the program. Eye examinations were performed in secondary school students, aged between 12 and 20 years, of five districts in Nampula province. The examination included visual acuity, non-cycloplegic refraction and assessment of the anterior and posterior segment and ocular adnexa. The prevalence of uncorrected, presenting and best-corrected VI found was 18.3%, 10.8%, and 5.0%, respectively. Refractive error (RE) had a prevalence of 24.7%, and the age groups between 15-17 years and 18-20 years were significantly associated with myopia (with OR: 4.9 and OR: 8.8, respectively), as well as the 11th and 12th grade (OR: 8.1 and OR: 10.7, respectively), and Malema district had association with myopia (ORa: 0.4) and hyperopia (ORa: 0.4 and OR: 0.3) as a protective factor. The prevalence of RE and VI was relatively high, showing the need for greater intervention at the school level.