Performance of Plusoptix A09 Photo Screener in Refractive Error Screening in School Children Aged between 5 and 15 Years in the Southern Part of India

The impact of the COVID 19 pandemic on myopia prevalence in 5 year old Israeli children

To determine whether the COVID-19 pandemic restrictions among 5-year-old kindergarten children in Israel affected the prevalence of uncorrected myopia. A nationwide community-based study assessed and compared the prevalence of uncorrected myopia in 101,626 kindergarten children, aged 5 years, from 2013 to 2023. The photo-screening was conducted annually across Israeli kindergartens, utilizing PlusOptiX S12, to obtain refractive data. Among the 101,626 kindergarten children, the prevalence of uncorrected myopia increased approximately three-fold following COVID-19 confinement, rising from 3.7 to 12.6%. For over a decade, linear regression analyses consistently indicated that annual myopia odds increased by 1.2 (95% CI 1.19-1.22). In comparing the uncorrected myopia prevalence in the years before and after the COVID-19 pandemic (2018-2019 versus 2023), the risk of myopia in 2023 was 2.72 times higher (Prevalence Odds Ratio; 95% CI 2.47-2.99). The highest prevalence of uncorrected myopia was in 2023 (12.6%), of which 7.84% were mild myopia, 4.61% moderate myopia, and 0.14% severe myopia. The mean spherical equivalent declined from 0.58 D pre-pandemic to 0.26 D in 2023. This research identified an increase in uncorrected myopia prevalence after the COVID-19 pandemic, potentially driven by altered environmental factors and behavioral habits.

Evaluation of Portable, Low-Cost Autorefractor in School Students with Limited Eye Care Access in Northeastern Brazil

This study compared the refraction measurements of the ClickCheck™ device (CCD), Topcon KR-8000, and subjective clinical refractometry (SCR) in Brazilian public school students with limited access to eye care. Eighty-seven eyes of healthy students aged 7 to 17 underwent refractometry using the CCD, Topcon KR-8000, and SCR methods under cycloplegia, with only the right-eye data analyzed. For comparison, the measurements were converted into spherical equivalents (SEs) and vector magnitudes. The mean SE difference between CCD and Topcon KR-8000 was -0.27 ± 0.58 (p < 0.0001), while the vector magnitudes at the 90° and 135° meridians were -0.23 ± 0.55 (p = 0.0001) and +0.04 ± 0.47 (p = 0.2246), respectively, demonstrating no clinical relevance. Similarly, the mean SE difference between CCD and SCR was -0.18 ± 0.58 (p = 0.065), with vector magnitudes of -0.20 ± 0.50 (p = 0.0003) at 90° and +0.03 ± 0.46 (p = 0.3730) at 135°, also lacking clinical relevance. Despite statistically significant differences between the methods, the findings confirm strong agreement, validating CCD as an effective refractive assessment tool for children in low-resource settings. These methods can enhance access to refraction services in underserved populations.

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.

Priorities in school eye health in low and middle-income countries a scoping review

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Accuracy of a low-cost, portable, refractive error estimation device: Results of a diagnostic accuracy trial

Purpose

To assess the accuracy of refraction measurements by ClickCheck^TM compared with the standard practice of subjective refraction at a tertiary level eye hospital.

Design

Diagnostic accuracy trial.

Methods

All participants, recruited consecutively, underwent auto-refraction (AR) and subjective refraction (SR) followed by refraction measurement using ClickCheck^TM (CR) by a trained research assistant. Eyeglass prescriptions generated using ClickCheck^TM and the resulting visual acuity (VA) was compared to SR for accuracy. Inter-rater reliability and agreement were determined using Intra-class correlation and Bland Altman analysis respectively.

Results

The 1,079 participants enrolled had a mean (SD) age of 39.02 (17.94) years and 56% were women. Overall, 45.3% of the participants had refractive error greater than ±0.5D. The mean (SD) spherical corrections were -0.66D (1.85) and -0.89D (2.20) in SR and CR respectively. There was high level of agreement between the spherical power measured using SR and CR (ICC: 0.940 (95% CI: 0.933 to 0.947). For the assessment of cylindrical correction, there was moderate level of agreement between SR and CR (ICC: 0.493 (0.100 to 0.715). There was moderate level of agreement between the VA measurements performed by using corrections from SR and CR (ICC: 0.577 (95% CI: 0.521–0.628). The subgroup analysis based on the age categories also showed high level of agreement for spherical corrections between the two approaches (ICC: 0.900). Bland Altman analysis showed good agreement for spherical corrections between SR and CR (Mean difference: 0.224D; 95% LoA: -1.647 D to 2.096 D) without evidence of measurement bias.

Conclusions

There was a high level of agreement for spherical power measurement between CR and SR. However, improvements are needed in order to accurately assess the cylindrical power. Being a portable, low-cost and easy-to-use refraction device, ClickCheck^TM can be used for first level assessment of refractive errors, thereby enhancing the efficiency of refractive services, especially in low- and-middle-income countries.

Comparison of Adult Refractive Disorder Measurements Using HandyRef-K, Retinomax, Plusoptix, and Table-top Autorefractometer Devices

OBJECTIVES

This study was conducted to compare refractive error measurements recorded using the Nidek HandyRef-K handheld autorefractometer (HDY; Nidek Co. Ltd., Tokyo, Japan), Plusoptix A09 photorefractor (PO; Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (RTX; Right Mfg. Co. Ltd., Tokyo, Japan), and a table-mounted autorefractometer/keratometer (TTR; URK 800, Unicos Co. Ltd., Daejeon, Republic of Korea).

METHODS

Patients aged ≥18 years underwent measurement of refraction without cycloplegia using 4 devices and the spherical power (SP), cylindrical power (CP), and spherical equivalent (SE) values were analyzed and compared.

RESULTS

A total of 181 eyes of 181 patients were enrolled in the study. The mean age of the patients was 33.08±0.95 years (range: 18-79 years). There was a significantly significant difference in the SP, CP, and SE values determined by the devices (p<0.001). The SP and SE values of the RTX and the HDY were similar, while the other device results were different (Wilcoxon signed-rank test, p=0.004). The CP values of the PO and the TTR, the HDY and the TTR were also comparable.

CONCLUSION

The HDY, RTX, and the PO are suitable for screening in clinical practice, but the findings strongly suggest that they should be used with caution.