Comparison of Automated Refraction with and without Cycloplegia for Detection of Refractory Errors: A Cross-Sectional Study

Ch M Subramanyeswara Rao; M Sarada Devi; R Thilagavathi

Ch M Subramanyeswara Rao Associate Professor, Department of Opthalmology
M Sarada Devi Post-graduate student, Department of Opthalmology
R Thilagavathi Lecturer, Department of Biostatistics

Keywords: Automated, Ocular refraction, Retinoscopy

Abstract

Background: Refraction is the most common eye problem among children. Refractory assessment is an essential visual
assessment tool.
Objectives: To compare the performance of automated refraction with and without cycloplegia for its agreement with conventional
cycloplegic retinoscopy.
Methods: A sample of 200 children between the age of 8 and 15 years attending an ophthalmology outpatient department of a
government medical college teaching hospital were assessed using conventional cycloplegic retinoscopy, automated refraction
with cycloplegia and without cycloplegia and the measurements compared.
Results: There was a tendency toward minus over correction in automated refraction without cycloplegia compared to automated
refraction with cycloplegia. There was good agreement between conventional cycloplegic retinoscopy and automated refraction
with cycloplegia. Automated refraction with cycloplegia has a reasonable sensitivity (70.2%) and specifi city (70.8%) for assessment
of refraction among children that is higher than automated refraction without cylcoplegia.
Conclusions: Automated refraction with cycloplegia can be used as an easy to use the method for refraction where skilled
human resources are not easily available to check for cycloplegic retinoscopy.

Author Biographies

Ch M Subramanyeswara Rao, Associate Professor, Department of Opthalmology

Rangaraya Medical College, Government General Hospital, Kakinada, Andhra Pradesh, India

M Sarada Devi, Post-graduate student, Department of Opthalmology

Rangaraya Medical College, Government General Hospital, Kakinada, Andhra Pradesh, India

R Thilagavathi, Lecturer, Department of Biostatistics

School of Public Health, SRM University, Kattankulathur, Chennai, Tamil Nadu, India

References

1. Abrams D. Duke-Elder’s Practice of Refraction. 10th ed. Philadelphia:
Elsevier Science; 2002. p. 45-71.
2. Khurana AK. Theory and Practice of Optics and Refraction. India: Elsevier
Publisher; 2008. p. 237-53.
3. Ramanjit S, Tandon R. Parsons’ Diseases of the Eye. India: Elsevier India;
2011.
4. Myron Y, Duker JS, editors. Ophthalmology: Expert Consult: Online and
Print. US: Elsevier Health Sciences; 2013.
5. Elkington AR, Frank HJ, Greaney MJ. Clinical Optics. Oxford: Blackwell
Scientifi c Publications; 1999.
6. Murthy GV, Gupta SK, Ellwein LB, Muñoz SR, Pokharel GP, Sanga L,
et al. Refractive error in children in an urban population in New Delhi.
Invest Ophthalmol Vis Sci 2002;43:623-31.
7. Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muñoz SR, et al.
Refractive error in children in a rural population in India. Invest Ophthalmol
Vis Sci 2002;43:615-22.
8. Shneor E, Millodot M, Avraham O, Amar S, Gordon-Shaag A. Clinical
evaluation of the L80 autorefractometer. Clin Exp Optom 2012;95:66-71.
9. Mohan K, Sharma A. Optimal dosage of cyclopentolate 1% for cycloplegic
refraction in hypermetropes with brown irides. Indian J Ophthalmol
2011;59:514-6.
10. Dahlmann-Noor AH, Comyn O, Kostakis V, Misra A, Gupta N, Heath J,
et al. Plusoptix Vision Screener: The accuracy and repeatability of refractive
measurements using a new autorefractor. Br J Ophthalmol 2009;93:346-9.
11. Funarunart P, Tengtrisorn S, Sangsupawanich P, Siangyai P. Accuracy of
noncycloplegic refraction in primary school children in Southern Thailand.
J Med Assoc Thai 2009;92:806-11.
12. Jorge J, Queiros A, González-Méijome J, Fernandes P, Almeida JB,
Parafi ta MA. The infl uence of cycloplegia in objective refraction.
Ophthalmic Physiol Opt 2005;25:340-5.
13. Jorge J, Queirós A, Almeida JB, Parafi ta MA. Retinoscopy/autorefraction:
which is the best starting point for a noncycloplegic refraction? Optom Vis
Sci 2005;82:64-8.
14. Harvey EM, Miller JM, Dobson V, Tyszko R, Davis AL. Measurement
of refractive error in Native American preschoolers: Validity and
reproducibility of autorefraction. Optom Vis Sci 2000;77:140-9.
15. Wesemann W, Dick B. Accuracy and accommodation capability of a
handheld autorefractor. J Cataract Refract Surg 2000;26:62-70.
16. Williams C, Lumb R, Harvey I, Sparrow JM. Screening for refractive errors
with the Topcon PR2000 pediatric refractometer. Invest Ophthalmol Vis Sci
2000;41:1031-7.
17. Celebi S, Aykan U. The comparison of cyclopentolate and atropine in
patients with refractive accommodative esotropia by means of retinoscopy,
autorefractometry and biometric lens thickness. Acta Ophthalmol Scand
1999;77:426-9.
18. Choong YF, Chen AH, Goh PP. A comparison of autorefraction and
subjective refraction with and without cycloplegia in primary school
children. Am J Ophthalmol 2006;142:68-74.
19. 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.
20. Zhao J, Mao J, Luo R, Li F, Pokharel GP, Ellwein LB. Accuracy of
noncycloplegic autorefraction in school-age children in China. Optom Vis
Sci 2004;81:49-55.