Refractive Error in Preschool Children

Abstract

Giordano et al1Giordano L. Friedman D.S. Repka M.X. et al.Prevalence of refractive error among preschool children in an urban population: the Baltimore Pediatric Eye Disease Study.Ophthalmology. 2009; 116 (746): 739-746Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar recently reported interesting findings from the Baltimore Pediatric Eye Disease Study (BPEDS) on the prevalence of refractive errors in a sample of African-American and non-Hispanic white children, aged 6 to 71 months. The authors noted that despite the relatively large number of studies on school-aged children, very few large population-based studies have focused on the refractive status of preschool children.2Lai Y.H. Hsu H.T. Wang H.Z. et al.The visual status of children ages 3 to 6 years in the vision screening program in Taiwan.J AAPOS. 2009; 13: 58-62Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar This area is of particular importance as uncorrected anisometropic refractive errors in young children can potentially predispose them to long-term vision impairment from amblyopia.3Weakley Jr, D.R. The association between nonstrabismic anisometropia, amblyopia, and subnormal binocularity.Ophthalmology. 2001; 108: 163-171Abstract Full Text Full Text PDF PubMed Scopus (181) Google Scholar Handheld autorefractors, including the Retinomax K-Plus (Nikon Corporation, Tokyo, Japan), have been reported to be accurate in the measurement of refraction in children, along with streak retinoscopy and table-mounted autorefractors.4Wesemann W. Dick B. Accuracy and accommodation capability of a handheld autorefractor.J Cataract Refract Surg. 2000; 26: 62-70Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar Handheld autorefractors have many advantages over other methods of measuring refraction, particularly for large-sample epidemiological studies, as they are relatively quick to use and produce quite repeatable results. Many studies have reported a high correlation between handheld autorefraction and gold-standard retinoscopy with cycloplegia, both in adult and childhood populations.4Wesemann W. Dick B. Accuracy and accommodation capability of a handheld autorefractor.J Cataract Refract Surg. 2000; 26: 62-70Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar However, a recent report by Prabakaran et al5Prabakaran S. Dirani M. Chia A. et al.Cycloplegic refraction in preschool children: comparisons between the hand-held autorefractor, table-mounted autorefractor and retinoscopy.Ophthalmic Physiol Opt. 2009; 29: 422-426Crossref PubMed Scopus (37) Google Scholar found significant differences between refractive measurements obtained with Retinomax compared with those obtained using either the Canon (Canon Inc., Tokyo, Japan) autorefractor or retinoscopy. Prabakaran et al found a less hyperopic spherical equivalent refraction (SER, mean = 0.80 diopter [D], P = 0.004) when using the Retinomax than the SER obtained using streak retinoscopy (1.09D) or a Canon autorefractor (1.03D), in a sample of 51 Singaporean preschool children after cycloplegia.5Prabakaran S. Dirani M. Chia A. et al.Cycloplegic refraction in preschool children: comparisons between the hand-held autorefractor, table-mounted autorefractor and retinoscopy.Ophthalmic Physiol Opt. 2009; 29: 422-426Crossref PubMed Scopus (37) Google Scholar In contrast, no statistically significant difference was found between streak retinoscopy and the table-mounted Canon autorefractor measurements (P = 0.66). We observed similar findings in our preliminary data from the Sydney Paediatric Eye Disease Study (SPEDS), which has adopted similar methodology to the BPEDS. We recruited and examined 2473 preschool children, aged 6 months to 6 years, from various ethnic groups in Sydney, Australia. Cycloplegia was achieved using amethocaine 0.5%, followed by cyclopentolate (0.5% in children aged younger than 12 months and 1% in children aged older than 12 months). Cycloplegic autorefraction was attempted on all children using the handheld Retinomax K-Plus 2, yielding a confidence level of 8 or greater. Canon RK-F1 autorefraction was attempted on all children aged 30 months or older. In those children for whom both handheld and table-mounted autorefraction failed, streak retinoscopy in a dimly lit room was performed. Similar to the Singaporean cohort, we found that the Retinomax produced more “minus” refractions than either retinoscopy or the table-mounted autorefractor, especially among children in the youngest age group. We wonder whether the authors had a similar experience with Retinomax refraction measurements? Could the authors please provide such data? The Sydney Paediatric Eye Disease Study was supported by the Australian National Health and Medical Research Council grant number 402425 . Prevalence of Refractive Error among Preschool Children in an Urban Population: The Baltimore Pediatric Eye Disease StudyOphthalmologyVol. 116Issue 4PreviewTo determine the age-specific prevalence of refractive errors in white and African-American preschool children. Full-Text PDF