Are the results of handheld auto-refractometer as valid as the result of table-mounted refractometer?

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.].

Refractive outcomes of table-mounted and hand-held auto-refractometers in children: an observational cross-sectional study

BACKGROUND

To compare the refractive results of hand-held and table-mounted autorefractors.

METHODS

We designed this study as an observational, cross-sectional study. We compared the mean spheric and cylinder power, spherical equivalent, Jackson cross-cylinder values, determined the limits of agreement (LoA), and evaluated the reliability of two autorefractors.

RESULTS

We evaluated 256 eyes of 256 pediatric patients (mean age, 9.12 ± 2.26 years; range, 5-16 years). 49% of the patients were female, and 51% were male. The Nidek HandyRef-K autorefractor measured relatively more astigmatism (P < 0.001) and less hyperopia (P = 0.024). The mean differences and 95% LoA were 0.06 D ± 0.47 D (- 0.82 D to 0.98 D) in spherical power, 0.08 D ± 0.28 D (- 0.47 D to 0.64 D) in cylindrical power, 0.11 D ± 0.47 D (- 0.81 D to 1.01 D) in spherical equivalent, 0.02 D ± 0.36 D (- 0.73 D to 0.69 D) in Jackson cross-cylinder power at 0°, 0.005 D ± 0.54 D (- 1.07 D to 1.06 D) in Jackson cross-cylinder power at 45°. We found the difference within 0.50 D in 244 (95%) eyes for spherical power, in 245 (96%) eyes for cylindrical power, 228 (89%) eyes for spherical equivalent, 224 (87%) eyes for Jackson cross-cylinder power at 0°, 213 (83%) eyes for Jackson cross-cylinder power at 45°. When comparing devices, there were strong correlations for spherical power (Spearman's rho = 0.99, P < 0.001), cylindrical power (Spearman's rho = 0.88, P < 0.001), and spherical equivalent (Spearman's rho = 0.98, P < 0.001).

CONCLUSION

Two autorefractors showed clinically applicable agreement limits; excellent reliability for spherical power and spherical equivalent and good reliability for cylindrical power; high positive percent agreement for spherical and cylindrical power, spherical equivalent, Jackson cross-cylinder power at 0°and 45°. These results showed that both devices might be used interchangeably for screening of refractive error in children.

Hand-Held Nidek versus Table-Mounted Huvitz Autorefractors and Their Agreement with Subjective Refraction in Adults

Objective

To compare the agreement between commercially available table mounted and a hand-held autorefractors and their agreement with subjective refraction. The effect of different body position with the handheld autorefractometer was also evaluated.

Methods

A prospective study was performed on 253 healthy eyes. Refraction was acquired by a table-mounted Huvitz and hand-held Nidek autorefractometer, subjective refraction was acquired. Refractive errors were compared in terms of spherical equivalent (SE), cylinder power, and the J0 and J45. The level of agreement was evaluated by Bland–Altman plots.

Results

There was a significant difference in SE measurements between both devices and between them and subjective refraction (P=0.00). The Huvitz SE readings tended to be less myopic. However, limits of agreement (LOA) for SE were narrowest for Nidek sitting vs supine followed by Huvitz vs subjective SE refraction. The LOA for SE for Nidek sitting vs subjective SE were of wider range. For cylinder values, LOA were similar for all devices and positions and between them and subjective cylinder refraction.

Conclusion

Table mounted Huvitz and Nidek portable autorefractor cannot be used interchangeably in clinical practice except for estimation of the cylinder power. No difference in refraction between sitting and supine positions for portable Nidek autorefractor but with caution in cylinder axis. High agreement was achieved between subjective refraction and Huvitz readings but not with Nidek hand-held autorefractor. A highly reliable spectacle prescription could be done based on Huvitz readings. Both devices and positions could be used interchangeably in estimation of K-readings.