Content area
Full Text
Introduction
Detection of impaired visual acuity in children of all age groups is a critical issue. Early detection and intervention may potentially improve vision, performance, and quality of life. Refraction errors are important objective measures and a common source for visual impairment. Retinoscopy is the gold standard for refraction in infants.1,2 However, it requires learning, experience, and cooperation from the child. Automated refractometers have been widespread in the past few decades.3
Although some studies claim automated refraction is accurate compared to cycloplegic refraction using retinoscopy, other studies claim it is not or that it can be used only for screening purposes. Moreover, some authors limit their results to children 4 to 6 years or older.4–8
The results of studies comparing their results to the gold standard are inconsistent, and some devices may not be suitable for all ages. Guidelines for detecting amblyopia and its risk factors are available9; however, no device has been proven to be accurate with these criteria to date. This may lead to misuse and errors in treatment. The Retinomax K-plus 3 (Right Mfg. Co., Ltd.) was previously found to have comparable results to cycloplegic retinoscopy.10 The current study presents our results comparing cycloplegic refraction using retinoscopy to a handheld autorefractometer device (Retinomax K-plus 5).
Patients and Methods
This study included 213 children (age range: birth to 20 years) who arrived for a routine pediatric ophthalmic examination in our pediatric ophthalmology outpatient clinic. Pseudophakic eyes and children with developmental delay were excluded. Children were randomly assigned to one of two pediatric optometrists (YN, DG). The sample was divided into two groups: children 5 years or younger and children older than 5 years.
All children underwent a complete ophthalmic examination according to their age, which included visual acuity, eye movements, stereopsis, a cover test, and cycloplegic refraction using two methods (automated and manual). Anterior and posterior segments were examined by one of two pediatric ophthalmologists using slit-lamp biomicroscopy and an indirect ophthalmoscope.
Cycloplegia was induced by instilling one drop of cyclopentolate 1% and one drop of tropicamide 1%, repeated after 10 minutes. Forty minutes after instillation of the first drop, pupils were examined for dilation and refraction was performed.
Retinoscopy was performed by one of the two...