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Musa M, Enaholo E, Bale BI, Salati C, Spadea L, Zeppieri M. Retinoscopes: Past and present. World J Methodol 2024; 14:91497. [DOI: 10.5662/wjm.v14.i3.91497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
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.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
| | - Ehimare Enaholo
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa, Nkpor 434101, Nigeria
| | | | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Peñaranda A, Torrado O, Márquez A, Baptista AM, Serra PM. The effect of cycloplegia in the accuracy of autorefraction, keratometry and axial length using the Myopia Master. BMC Ophthalmol 2024; 24:321. [PMID: 39090603 PMCID: PMC11295713 DOI: 10.1186/s12886-024-03529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/18/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. METHODS A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). RESULTS Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. CONCLUSIONS Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.
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Affiliation(s)
- Agustin Peñaranda
- Ophthalmology Clinic Vista Sánchez Trancón, Vista Sánchez Trancón Building Tecnolaser, Room 14 Calle La Violeta, Badajoz, 06005, Spain
| | - Oscar Torrado
- Ophthalmology Clinic Vista Sánchez Trancón, Vista Sánchez Trancón Building Tecnolaser, Room 14 Calle La Violeta, Badajoz, 06005, Spain
| | - Ana Márquez
- Ophthalmology Clinic Vista Sánchez Trancón, Vista Sánchez Trancón Building Tecnolaser, Room 14 Calle La Violeta, Badajoz, 06005, Spain
| | | | - Pedro Miguel Serra
- Ophthalmology Clinic Vista Sánchez Trancón, Vista Sánchez Trancón Building Tecnolaser, Room 14 Calle La Violeta, Badajoz, 06005, Spain.
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Ichimura M, Ueki S, Fukuchi T. Test-Retest of the Spot Vision Screener among Children with Ophthalmological Diseases including Strabismus. J Ophthalmol 2024; 2024:2173860. [PMID: 38741691 PMCID: PMC11090673 DOI: 10.1155/2024/2173860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
Background The spot vision screener (SVS) has been widely used for eye health examinations of infants and young children. The purpose of this study was to evaluate the reproducibility of two SVS measurements in children with ophthalmological diseases. Methods 29 patients aged 15 years or younger who visited our hospital for refraction examinations with SVS before and at least 60 minutes after administration of 2 drops of 1% cyclopentolate ophthalmic solution (before and after cycloplegia) were included in this study. Two SVS measurements were made before and after cycloplegia, respectively. Intraclass correlation coefficients (ICCs) and Bland-Altman analysis for spherical, spherical equivalent (SE), cylindrical, J0, and J45 values before and after cycloplegia were analyzed. Results The mean age ± standard deviation (SD) of the 29 patients was 7.6 ± 2.4 years. There were 11 males and 18 females. The mean spherical values based on the SVS before and after cycloplegia were 0.42 ± 1.67 diopter (D), and 1.47 ± 2.23 D for the first measurement and 0.60 ± 1.74 D, and 1.42 ± 2.27 D for the second measurement, respectively. The mean cylindrical values based on SVS before and after cycloplegia were -1.45 ± 0.96 D and -1.65 ± 0.89 D for the first measurement and -1.58 ± 1.13 D and -1.66 ± 0.91 D for the second measurement, respectively. The ICCs for the first and second spherical, SE, cylindrical, J0, and J45 values before cycloplegia were 0.95, 0.98, 0.83, 0.86, and 0.86, respectively. The ICCs for the first and second spherical, SE, cylindrical, J0, and J45 values after cycloplegia were 0.99, 0.99, 0,87, 0.73, and 0.80, respectively. The Bland-Altman analysis of the first and second spherical and SE values before cycloplegia showed fan-shaped variation as hyperopia increased. Conclusions Two consecutive SVS refraction measurements have a high degree of reproducibility for spherical and SE values but a low degree for cylindrical, J0, and J45 values. From these results, multiple measurements are required to obtain reliable results for cylindrical values.
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Affiliation(s)
- Mika Ichimura
- Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Satoshi Ueki
- Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takeo Fukuchi
- Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Thakur S, Maldoddi R, Vangipuram M, Kalivemula M, Ch SNSH, Karthikesh A, Verkicharla PK. Peripheral Refraction Using Ancillary Retinoscope Component (P-ARC). Transl Vis Sci Technol 2024; 13:7. [PMID: 38568607 PMCID: PMC10996980 DOI: 10.1167/tvst.13.4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose To assess the agreement of retinoscope-based peripheral refraction techniques with the criterion standard open-field autorefractor. Methods Fifty young adults (mean age, 24 ± 3 years) participated in this study. Two masked, experienced senior examiners carried out central refraction and peripheral refraction at the temporal 22° (T22°) and nasal 22° (N22°) eccentricities. Peripheral refraction techniques were (a) peripheral refraction using ancillary retinoscope component (P-ARC), (b) retinoscopy with eye rotation, and (c) open-field autorefractor. Peripheral refraction with retinoscopy values was compared with an open-field autorefractor (Shinn Nippon NVision-K) to assess the agreement. All measurements were taken from the right eye under noncycloplegic conditions. Results The mean difference ±95% limits of agreement of peripheral refraction values obtained using P-ARC from T22° (+0.11 diopters [D] ± 1.20 D; P = 0.20) or N22° (+0.13 D ± 1.16 D; P = 0.13) were comparable with open-field autorefractor. The eye rotation technique compared to autorefractor showed a significant difference for T22° (+0.30 D ± 1.26 D; P = 0.002); however, there was an agreement for N22° (+0.14 D ± 1.16 D; P = 0.10). With respect to the identification of peripheral refraction patterns, examiners were able to identify relative peripheral hyperopia in most of the participants (77%). Conclusions Peripheral refraction with P-ARC was comparable with open-field autorefractor at T22° and N22° eccentricities. Peripheral retinoscopy techniques can be another approache for estimating and identifying peripheral refraction and its patterns in a regular clinical setting. Translational Relevance Retinoscope with P-ARC has high potential to guide and enable eye care practitioners to perform peripheral refraction and identify peripheral refraction patterns for effective myopia management.
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Affiliation(s)
- Swapnil Thakur
- Myopia Research Lab - Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, LV Prasad Eye Institute, Hyderabad, India
| | - Rakesh Maldoddi
- Myopia Research Lab - Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, LV Prasad Eye Institute, Hyderabad, India
| | - Manogna Vangipuram
- Center for Technology Innovation, LV Prasad Eye Institute, Hyderabad, India
| | - Manasa Kalivemula
- Center for Technology Innovation, LV Prasad Eye Institute, Hyderabad, India
| | | | - Anche Karthikesh
- Center for Technology Innovation, LV Prasad Eye Institute, Hyderabad, India
| | - Pavan K Verkicharla
- Myopia Research Lab - Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, LV Prasad Eye Institute, Hyderabad, India
- Infor Myopia Centre (prevention & control), LV Prasad Eye Institute, Hyderabad, India
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Doyle M, O' Dwyer V, Harrington S. Comparison of cycloplegia at 20- and 30-minutes following proxymetacaine and cyclopentolate instillation in white 12-13-year-olds. Clin Exp Optom 2023; 106:890-895. [PMID: 36750050 DOI: 10.1080/08164622.2023.2166398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
CLINICAL RELEVANCE Reducing the time between drop instillation and refraction reduces the time paediatric patients and young adults spend in practice, facilitating more eye examinations daily. BACKGROUND The current procedure for paediatric cycloplegic refraction is to wait for at least 30-minutes post-instillation of a cycloplegic before measuring spherical equivalent refraction. This study compared cycloplegia at 20- and 30-minutes following 0.5% proxymetacaine and 1.0% cyclopentolate in 12-13-year-olds. METHODS Participants were 99 white 12-13-year-olds. One drop of proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) followed by one drop of cyclopentolate hydrochloride (Minims, 1.0% w/v, Bausch & Lomb, UK) was instilled into both eyes. Spherical equivalent refraction was measured by autorefraction (Dong Yang Rekto ORK-11 Auto Ref-Keratometer) at 20- and 30-minutes post-instillation. Data were analysed through paired t-testing, correlations, and linear regression analysis. RESULTS There was no significant difference in level of cycloplegia achieved at 20- (Mean spherical equivalent refraction (standard deviation) 0.438 (1.404) D) and 30-minutes (0.487 (1.420) D) post-eyedrop instillation (t (98) = 1.667, p = 0.099). The mean spherical equivalent refraction difference between time points was small (0.049 (0.294) D, 95% confidence interval =-0.108 ̶ 0.009D). Agreement indices: Accuracy = 0.999, Precision = 0.973, Concordance = 0.972. Spherical equivalent refraction at 20- and 30-minutes differed by ≤0.50D in 92% of eyes, and by <1.00D in 95%. CONCLUSIONS There was no clinically significant difference in spherical equivalent refraction or level of cycloplegia at 20- and 30-minutes post-eyedrop instillation. The latent time between drop instillation and measurement of refractive error may be reduced to 20 minutes in White 12-13-year-olds and young adults. Further studies must determine if these results persist in younger children and non-White populations.
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Affiliation(s)
- Megan Doyle
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Centre for Eye Research Ireland, School of Physics & Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Veronica O' Dwyer
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Centre for Eye Research Ireland, School of Physics & Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Síofra Harrington
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Centre for Eye Research Ireland, School of Physics & Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
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Moreno JRA, Micó V, Albarrán Diego C. Subjective refraction using power vectors by updating a conventional phoropter with a Stokes lens for continuous astigmatic power generation. Ophthalmic Physiol Opt 2023; 43:1029-1039. [PMID: 37264763 DOI: 10.1111/opo.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To implement a pure power vector method for monocular subjective refraction using a regular phoropter with the only modification being the inclusion of a Stokes lens. The proposed methodology was tested with three different Stokes lenses, and the results were compared with conventional clinical refraction procedures. METHODS Power vector subjective refraction was performed by attaching a Stokes lens to the Risley prism holder. Stokes lenses allow for pure astigmatic compensation in the form of the J0 , J45 components while the spherical lenses in the phoropter allow determination of the spherical component in the form of M (spherical equivalent). The proposed routine is presented step-by-step using three Stokes lenses having different astigmatic powers. RESULTS Monocular subjective refraction was performed on 26 healthy subjects with a mean age of 44 ± 16 years, mean spherical equivalent of -0.56 D (range -5.50 to +2.38 D) and refractive astigmatism ≤1.50 D. No differences were found between the results obtained with the conventional technique versus the vector-based procedure for the spherical equivalent (p = 0.28) or astigmatic components (p = 0.34). In addition, visual acuity (VA) was equivalent through the refractions measured with the conventional and vector procedures (p = 0.12). Repeatability coefficients for J0 and J45 with the new vector methodology were <0.38 D. CONCLUSIONS The proposed routine could be helpful for cases where it is difficult to get a valid starting point for conventional refraction (e.g., irregular corneas and media opacities), for testing facilities with limited resources/equipment and/or for motivated clinicians who wish to know about alternative methods of refractive error determination.
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Affiliation(s)
| | - Vicente Micó
- Departamento de Óptica y Optometría y Ciencias de la Visión, Universitat de València, Burjassot, Spain
| | - Cesar Albarrán Diego
- Departamento de Óptica y Optometría y Ciencias de la Visión, Universitat de València, Burjassot, Spain
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Rao DP, Negiloni K, Gurunathan S, Velkumar S, Sivaraman A, Baig AU, B K, Murali K. Validation of a Simple-to-Use, Affordable, Portable Wavefront Aberrometry-Based Auto Refractometer in a Paediatric Population. Clin Ophthalmol 2022; 16:4281-4291. [PMID: 36578668 PMCID: PMC9792114 DOI: 10.2147/opth.s387831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose InstaRef R20 is a handheld, affordable auto refractometer based on Shack Hartmann aberrometry technology. The study's objective was to compare InstaRef R20's performance for identifying refractive error in a paediatric population to that of standard subjective and objective refraction under both pre- and post-cycloplegic conditions. Methods Refraction was performed using 1) standard clinical procedure consisting of retinoscopy followed by subjective refraction (SR) under pre- and post-cycloplegic conditions and 2) InstaRef R20. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 20 children was assessed. Results The refractive error was measured in 132 children (mean age 12.31 ± 3 years). The spherical equivalent (M) and cylindrical components (J0 and J45) of the device had clinically acceptable differences (within ±0.50D) and acceptable agreement compared to standard pre- and post-cycloplegic manual retinoscopy and subjective refraction (SR). The device agreed within ± 0.50D of retinoscopy in 67% of eyes for M, 78% for J0 and 80% for J45 and within ± 0.50D of SR in 70% for M and 77% for cylindrical components. Conclusion InstaRef R20 has an acceptable agreement compared to standard retinoscopy in paediatric population. The measurements from this device can be used as a starting point for subjective acceptance. The device being simple to use, portable, reliable and affordable has the potential for large-scale community-based refractive error detection.
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Affiliation(s)
- Divya Parthasarathy Rao
- R&D, Remidio Innovative Solutions Inc, Glen Allen, VA, USA,Correspondence: Divya Parthasarathy Rao, R&D, Remidio Innovative Solutions Inc, 11357 Nuckols Road, #102, Glen Allen, VA, 23059, USA, Tel +1 855 513-3335, Email
| | - Kalpa Negiloni
- R&D, Remidio Innovative Solutions Pvt Ltd, Bengaluru, India
| | | | | | | | | | - Kumari B
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Bengaluru, India
| | - Kaushik Murali
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Bengaluru, India
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Validation of a simple-to-use, affordable, portable, wavefront aberrometry-based auto refractometer in the adult population: A prospective study. BMC Ophthalmol 2022; 22:498. [PMID: 36536321 PMCID: PMC9764520 DOI: 10.1186/s12886-022-02684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Refraction is one of the key components of a comprehensive eye examination. Auto refractometers that are reliable and affordable can be beneficial, especially in a low-resource community setting. The study aimed to validate the accuracy of a novel wave-front aberrometry-based auto refractometer, Instaref R20 against the open-field system and subjective refraction in an adult population. METHODS All the participants underwent a comprehensive eye examination including objective refraction, subjective acceptance, anterior and posterior segment evaluation. Refraction was performed without cycloplegia using WAM5500 open-field auto refractometer (OFAR) and Instaref R20, the study device. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 40 adults was assessed. RESULTS The refractive error was measured in 132 participants (mean age,30.53 ± 9.36 years, 58.3% female). The paired mean difference of the refraction values of the study device against OFAR was - 0.13D for M, - 0.0002D (J0) and - 0.13D (J45) and against subjective refraction (SR) was - 0.09D (M), 0.06 (J0) and 0.03D (J45). The device agreed within +/- 0.50D of OFAR in 78% of eyes for M, 79% for J0 and 78% for J45. The device agreed within +/- 0.5D of SR values for M (84%), J0 (86%) and J45 (89%). CONCLUSION This study found a good agreement between the measurements obtained with the portable autorefractor against open-field refractometer and SR values. It has a potential application in population-based community vision screening programs for refractive error correction without the need for highly trained personnel.
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Zou H, Shi S, Yang X, Ma J, Fan Q, Chen X, Wang Y, Zhang M, Song J, Jiang Y, Li L, He X, Jhanji V, Wang S, Song M, Wang Y. Identification of ocular refraction based on deep learning algorithm as a novel retinoscopy method. Biomed Eng Online 2022; 21:87. [PMID: 36528597 PMCID: PMC9758840 DOI: 10.1186/s12938-022-01057-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The evaluation of refraction is indispensable in ophthalmic clinics, generally requiring a refractor or retinoscopy under cycloplegia. Retinal fundus photographs (RFPs) supply a wealth of information related to the human eye and might provide a promising approach that is more convenient and objective. Here, we aimed to develop and validate a fusion model-based deep learning system (FMDLS) to identify ocular refraction via RFPs and compare with the cycloplegic refraction. In this population-based comparative study, we retrospectively collected 11,973 RFPs from May 1, 2020 to November 20, 2021. The performance of the regression models for sphere and cylinder was evaluated using mean absolute error (MAE). The accuracy, sensitivity, specificity, area under the receiver operating characteristic curve, and F1-score were used to evaluate the classification model of the cylinder axis. RESULTS Overall, 7873 RFPs were retained for analysis. For sphere and cylinder, the MAE values between the FMDLS and cycloplegic refraction were 0.50 D and 0.31 D, representing an increase of 29.41% and 26.67%, respectively, when compared with the single models. The correlation coefficients (r) were 0.949 and 0.807, respectively. For axis analysis, the accuracy, specificity, sensitivity, and area under the curve value of the classification model were 0.89, 0.941, 0.882, and 0.814, respectively, and the F1-score was 0.88. CONCLUSIONS The FMDLS successfully identified the ocular refraction in sphere, cylinder, and axis, and showed good agreement with the cycloplegic refraction. The RFPs can provide not only comprehensive fundus information but also the refractive state of the eye, highlighting their potential clinical value.
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Affiliation(s)
- Haohan Zou
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Shenda Shi
- grid.31880.320000 0000 8780 1230School of Computer Science, School of National Pilot Software Engineering, Beijing University of Posts and Telecommunications, 10 Xitucheng Road, Hai-Dian District, Beijing, 100876 China ,HuaHui Jian AI Tech Ltd., Tianjin, China
| | - Xiaoyan Yang
- grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital Optometric Center, Tianjin, China
| | - Jiaonan Ma
- grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Qian Fan
- grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Xuan Chen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Yibing Wang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Mingdong Zhang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Jiaxin Song
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China
| | - Yanglin Jiang
- grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital Optometric Center, Tianjin, China
| | - Lihua Li
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital Optometric Center, Tianjin, China
| | - Xin He
- HuaHui Jian AI Tech Ltd., Tianjin, China
| | - Vishal Jhanji
- grid.21925.3d0000 0004 1936 9000UPMC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Shengjin Wang
- HuaHui Jian AI Tech Ltd., Tianjin, China ,grid.12527.330000 0001 0662 3178Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Meina Song
- grid.31880.320000 0000 8780 1230School of Computer Science, School of National Pilot Software Engineering, Beijing University of Posts and Telecommunications, 10 Xitucheng Road, Hai-Dian District, Beijing, 100876 China ,HuaHui Jian AI Tech Ltd., Tianjin, China
| | - Yan Wang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.216938.70000 0000 9878 7032Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, 4 Gansu Road, He-Ping District, Tianjin, 300020 China ,grid.216938.70000 0000 9878 7032Nankai University Eye Institute, Nankai University, Tianjin, China
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10
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Venkataraman AP, Brautaset R, Domínguez-Vicent A. Effect of six different autorefractor designs on the precision and accuracy of refractive error measurement. PLoS One 2022; 17:e0278269. [PMID: 36441778 PMCID: PMC9704684 DOI: 10.1371/journal.pone.0278269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the precision of objective refraction measurements with six different autorefractors that have different designs and measurement principles and to compare the objective refraction values with the subjective refraction. METHOD Objective refraction of 55 participants was measured using six autorefractors with different designs. The instrument features mainly varied in terms of measurement principles, inbuilt fogging, open or closed view, and handheld or stationary designs. Two repeated measurements of objective refraction were performed with each autorefractor. The objective refractions from the six autorefractors were compared with the standard subjective refraction. The repeatability limit and Bland-Altman were used to describe the precision and accuracy of each autorefractor, respectively. The analysis was done using the spherical component of the refraction and the power-vector components, spherical equivalent (M), and cylindrical vectors. RESULTS The repeatability of all autorefractors was within 1.00 and 0.35D for measuring the M and both cylindrical components, respectively. Inbuilt fogging was the common feature of the instruments that showed better repeatability. Compared to subjective refraction, the mean difference for sphere and M was below +0.50D, and it was close to zero for the cylindrical components. The instruments that had inbuilt fogging showed narrower limit of agreement. When combined with fogging, the open field refractors showed better precision and accuracy. CONCLUSIONS The inbuilt fogging is the most important feature followed by the open view in determining the precision and accuracy of the autorefractor values.
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Affiliation(s)
- Abinaya Priya Venkataraman
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Rune Brautaset
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Alberto Domínguez-Vicent
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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11
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Huang J, Li X, Yan T, Wen L, Pan L, Yang Z. The Reliability and Acceptability of RDx-Based Tele-Controlled Subjective Refraction Compared with Traditional Subjective Refraction. Transl Vis Sci Technol 2022; 11:16. [PMID: 36394842 PMCID: PMC9684619 DOI: 10.1167/tvst.11.11.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to compare the reliability and acceptability of tele-controlled subjective refraction supported by RDx, a new technique that involves optical software designed for controlling phoropters remotely, to traditional subjective refraction. Methods Sixty-five participants underwent tele-controlled subjective refraction and traditional subjective refraction randomly and nine of them underwent the second tele-controlled subjective refraction measurement on the same day. After their examinations, we distributed a validated satisfaction questionnaire to each participant. The elapsed time taken for refraction, sphere (S), cylinder (C), spherical equivalent (SE), vertical and oblique cylindrical vectors (J0 and J45), and best corrected visual acuity (BCVA) were compared. Age and refractive error type were included as covariates. Bland-Altman analysis was used to assess the agreement between both methods of refraction. Results The mean age was 20.5 ± 5.9 years for all participants (aged 9 to 40 years); 57% were female participants. The repeatability analysis of tele-controlled method showed no significant differences for all parameters (P > 0.05). We found no statistical differences (P > 0.05) between tele-controlled subjective refraction and traditional subjective refraction for all parameters in either group. The mean difference and 95% limits of agreement for SE, J0, and J45 were −0.03 ± 0.36 diopters (D), −0.00 ± 0.57 D, and −0.01 ± 0.79 D, respectively. The tele-controlled method took more time to perform than the traditional one (P < 0.05). Completed questionnaires were returned by 55 participants (85%), and they showed high satisfaction and acceptance of the tele-controlled method (98%). Conclusions Tele-controlled subjective refraction results agreed with traditional subjective refraction for all refraction components except for cylinder vectors. In addition, the broad acceptability of tele-controlled subjective refraction means practicability in clinical practice. Translation Relevance The RDx-based tele-controlled method can provide an alternative to subjective refraction, especially in areas that lack experienced optometrists.
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Affiliation(s)
- Jie Huang
- Aier School of Ophthalmology, Central South University, Changsha, China
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
| | - Xiaoning Li
- Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Xianning, China
- Changsha Aier Eye Hospital, Changsha, China
| | - Tao Yan
- Nanchang Aier Eye Hospital, Nanchang, China
| | - Longbo Wen
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
| | - Lun Pan
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha, China
- Hunan Province Optometry Engineering Technology Research Center, Changsha, China
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12
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Chen H, Liao Y, Zhou W, Dong L, Wang W, Wang X. The change of myopic prevalence in children and adolescents before and after COVID-19 pandemic in Suqian, China. PLoS One 2022; 17:e0262166. [PMID: 35312694 PMCID: PMC8937315 DOI: 10.1371/journal.pone.0262166] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/19/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The aim of this study was to investigate the change of myopic prevalence in students with different demographic characteristics before and after the COVID-19 pandemic in Suqian, China. Methods A retrospective, cross-sectional study was conducted. Student data from 52 schools in 2019 and 2020 were collected from the electronic medical records database through cluster sampling. Ophthalmic examinations were conducted on students from September to December in 2019 and 2020. Measurements of uncorrected visual acuity (UCVA) and noncycloplegic autorefraction were included to obtain the spherical equivalent refraction (SER) and prevalence of myopia. The difference in the rate of myopia and SER of students ages 6 to 18 with various demographic characteristics was compared between the two years. Results Records from 118,479 students in 2019 and the 121,881 students in 2020 were obtained. In 2019 and 2020, the prevalence of overall myopia increased from 43.1% to 48.9% (5.8 percentage point), and a substantial shift in myopic rate occurred in grades 4 to 6 (6.9 percentage point). The change in the prevalence of myopia in girls (5.9 percentage point) was approximately equal to that in boys (5.8 percentage point) and it was more common in rural students (5.9 percentage point) than in urban students (5.1 percentage point). The prevalence of low myopia increased more in children, and the prevalence of moderate myopia increased more in adolescents. The mean spherical equivalent refraction (SER) (-1.34±2.03 D) was lower in 2020 than in 2019 (-1.16±1.92 D), while SER decreased mainly at ages 7 to 15. The SER presented myopic status at the age of 9 (-0.55±1.26 D in 2019, -0.71±1.42 D in 2020), and attained moderate myopia at the age of 15 (-3.06±2.41 D in 2019, -3.22±2.40 D in 2020). Conclusions After the COVID-19 pandemic, myopia increased in this population with variable rates of increase in different demographic groups. The change of myopia in children was comparatively greater than that in adolescents. Therefore, we should take measures to prevent and control the development of myopia after the COVID-19 pandemic, especially for younger students.
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Affiliation(s)
- Hongyan Chen
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ya Liao
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Wen Zhou
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Lei Dong
- The Primary and Middle School Health Care Center in Suqian, Suqian, Jiangsu Province, China
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xiaojuan Wang
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
- * E-mail:
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13
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Arnold RW, Martin SJ, Beveridge JR, Arnold AW, Arnold SL, Beveridge NR, Smith KA. Ellipsoid Spectacle Comparison of Plusoptix, Retinomax and 2WIN Autorefractors. Clin Ophthalmol 2021; 15:3637-3648. [PMID: 34511869 PMCID: PMC8415895 DOI: 10.2147/opth.s326680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Handheld devices can automatically give an estimate of refraction. The established method for refraction comparison using spherical equivalent (M) and J0, J45 vector transformations by Bland-Altman analysis is too complex for non-eye doctors involved with vision screening and remote vision clinics. Therefore, a simpler comparison technique was developed. METHODS Based on the spectacle limit to resolve grade A 1 logMAR, B 3 logMAR and C 6 logMAR blur, J0, J45, and M are combined into the Alaska Blind Child Discovery (ABCD) composite ellipsoid GRADE system. Pediatric eye patients had confirmatory examination after dry refraction with three portable autorefractors: Plusoptix, 2WIN and Retinomax. The refractions were then compared using both Bland-Altman and ABCD composite. Performance to detect AAPOS amblyopia risk factors was also assessed. RESULTS A total of 202 children, mean age seven years, 28% high spectacle need and 43% AAPOS 2013 amblyopia risk factors showed high correlation with cycloplegic refraction (intraclass correlation 0.49 to 0.90) for sphere, J0 and J45 spectacle components. Plusoptix had more (10%) inconclusives due to patients out-of-range. The Retinomax was unable to screen some younger children and was less reliable for sphere but gave more precise astigmatism estimates. The proportion of autorefractions expected to give GRADE A/B high-need patients acuity improvement to 20/40 would be 41% for Plusoptix, 39% for 2WIN and 65% for Retinomax. Sensitivity/specificity for amblyopia risk factor detection was 80%/83% for Plusoptix, 72%/88% for 2WIN and 84%/73% for Retinomax. CONCLUSION The simplified spectacle comparison resembled Bland-Altman and could assist lay vision screeners and non-eye doctors attempting remote spectacle donation worldwide.
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Affiliation(s)
- Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, 99508, USA
| | | | | | | | | | | | - Kyle A Smith
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, 99508, USA
- Accurate Vision, Anchorage, AK, USA
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