Application of hand-held automated refractometer in refraction screening in children

Abstract

Objective To explore the agreement of the hand-held automated refractometer(NIDEK AR-20)and retinoscopy in examining refraction,to evaluate the value of clinical application of hand-held automated refractometer in refraction screening in children.Methods Firstly,248 eyes of 124 children(2 to 17 years old)were examined using hand-held refractometer under both mesopic situation with natural pupil size and under pupil dilated situation.Secondly,retinoscopy was performed respectively under pupil dilated situation.Results 1.Both the spherical diopter and the cylinder diopter obtained by hand-held refractometer and retinoscopy under pupil dilated situation presented good correlations(r=0.989,0.934,P＜0.001).Significant differences of both the spherical diopter and the cylinder diopter were found between the two methods(P＜0.001).80.2％ of the differences of spherical diopter between the two methods were within 0.50D,while accumulated 94.8％ were within 1.00D.76.2％ of the differences of cylinder diopter between the two methods were within 0.50D,while accumulated 95.6％ were within 1.00D.2.Both the spherical diopter and the cylinder diopter obtained by hand-held refractometer and retinoscopy under natural pupil situation presented good correlations(r=0.904,0.926,P＜0.001).Significant differences of both the spherical diopter and the cylinder diopter were found between the two methods(P＜0.001).30.7％ of the differences of spherical diopter between the two methods were within 0.50D,while accumulated 53.2％ were within 1.00D.77.0％ of the differences of cylinder diopter between the two methods were within 0.50D,while accumulated 95.6％ were within 1.00D.The differences in middle-high hypermetropia subjects were larger than in myopia,stigmatism and low hypermetropia subjects.Further analysis were conducted by age group,the refraction of pre-school students obtained by hand-held refractometer and retinoscopy under pupil dilated situation hold the biggest difference;the differences between refractometer and retinoscopy in two school-age children was relatively small.Conclusions There is a good agreement between hand-held automated refractometer and retinoscopy under dilated pupil situation;it is suggested to re-examine the status of refractive error of school-age children under dilated pupil situation when the spherical diopter ≥±1.50D or the cylinder diopter ≥±1.00D obtained under natural situation with hand-held automated refractometer.As to the preschool children,it is critical to perform refraction screening(using hand-held automated refractometer)under dilated pupil.Because of its easy manipulation,portable design and good agreement with retinoscopy,the hand-held automated refractometer(NIDEK AR-20)is considered a useful instrument in the refraction screening in children. Key words: Hand-held automated refractometer; Retinoscopy; Refraction; Screening; Children