Plusoptix A09 Research Articles

Normal Gelişim Gösteren Çocuklar ve Otizmli Çocuklarda Plusoptix A09 ile Ölçülen Pupil Çapı, Korneal Refleks ve İnterpupiller Mesafenin Karşılaştırılması

Aim: Autism Spectrum Disorder (ASD) is a developmental disorder that can present with an abnormality of the autonomic nervous system (ANS symptoms).Method: In this study, 38 eyes of 19 ASD were included with 19 healthy children (control group). Participants were analyzed according to their characteristics. Here, used the Plusoptix A09 devices to measure the difference in pupil size, corneal reflex, and interpupillary distance (IPD) between ASD and healthy children.Results: The mean age±standard deviation (SD) for the autism group was 4,6±2,5 years (range 2-11 years). In the group of normally developing children, the mean age was±SD 5,02±2,6 years (range 2-11 years). The size of the right pupil (p=0,006) and left pupil (p=0,007) was found to be significantly different in the control and experimental groups. IPD (p=0,000) was statistically significant between groups unlike the corneal reflex was not (p=0,173). The p-value is less than 0,05 in all statistical results.Conclusion: As a result, pupil diameter and IPD of children with autism were found to be larger than the control group, but there was no significant difference in corneal reflex. Pupillary measurements reveal differences between people with ASD.

Comparison of the results of four different refraction measurement devices in children with retinoscopy.

Purpose: The purpose of this study was to compare the results of 4 different autorefractometer devices with the results of retinoscopy in children. Methods: A total of 120 eyes of 60 patients aged between 6 and 18, who applied to Afyonkarahisar Health Sciences University unit of Pediatric Ophthalmology, were included in the study. Refraction with Plusoptix A09 (photoscreener) without cycloplegia was the first to be measured. Spherical and cylindrical values were recorded. Then, half an hour after the patients were instilled 2 drops of cyclopentolate with an interval of 5 minutes, dilated retinoscopy was performed, and spherical and cylindrical values were recorded. Autorefractometer measurements with cycloplegia were performed with Canon RK-F1 autorefractometer, Nidek Tonoref III and Retinomax K-Plus 3, and spherical and cylindrical values were recorded. Results: The mean age of the patients was 11.02 ± 2.1. The mean spherical equivalents were Canon RKF1 autorefractometer +0.045 ± 2.49, Nidek TonoRef III +0.023 ± 2.48, Retinomax K-Plus 3 +0.078 ± 1.42, Plusoptix A09 -0.119 ± 2.20, retinoscopy +0.124 ± 2.65. Moreover, the mean cylindrical values were Canon RK-F1 autorefractometer -0.893 ± 0.69, Nidek TonoRef III -0.927 ± 0.72, Retinomax K-Plus 3 -0.888 ± 0.73, Plusoptix A09 -0.883 ± 0.719, retinoscopy -0.923 ± 0.71. The statistical values compared with retinoscopy; Canon RKF1 spherical equivalent (p=0.376), cylindrical (p=0.515), Nidek TonoRef III spherical equivalent (p=0.485), cylindrical (p=0.198), Retinomax K-Plus 3 spherical equivalent (p=0.141), cylindrical (p=0.058), Plusoptix A09 spherical equivalent (p=0.085) and cylindrical (p=0.086) values were not different. Conclusions: In spherical and cylindrical refractive error detection, all 4 devices showed reasonable and consistent results compared to retinoscopy.

Comparison between Plusoptix A09 and gold standard cycloplegic refraction in preschool children and agreement to detect refractive amblyogenic risk factors.

BACKGROUND:The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique.AIM:To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3–6 years children and agreement to detect refractive amblyogenic risk factors.SUBJECTS AND METHODS:A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis.STATISTICAL ANALYSIS:Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed.RESULTS:In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors.CONCLUSION:Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.

Assessment of the Utility of Plusoptix A09 Handheld Photo-refractometer in Screening Refractory Errors and Amblyopia in Children

AbstractThe aim of this study is to find out the frequency of anisometropic amblyopia in children and to increase awareness about this disease. All children between the ages of 4 and 10 years who were attending 11 kindergarten and primary schools determined by provincial directorate for national education in the center of Malatya were included. A screening team including interns and a resident from the Department of Pediatrics have used Plusoptix A09 handheld photo-refractometer device for detecting amblyopia and its reasons. A total of 7,000 students were screened. The mean age of the students was 7.4 ± 2 years. Amblyopia was suspected in 357 cases with the Plusoptix S09 screening. After eye examinations performed by an ophthalmologist, 303 cases were found to have pathologic eye examination. Amblyopia was found in 67 (18.8%) of the 303 cases, and anisometropic amblyopia was found in 59 of 67 cases. As a result of the screening, sensitivity of Plusoptix A09 was found to be 88.1%, while its specificity was found to be 88.6%. Its positive predictive value was found to be 64.0% and its negative predictive value was found to be 97.0%. We believe that with screenings performed by health professionals who are given short-term training by using a device that can conduct remote measurements, detection of anisometropic amblyopia, which is the most frequent reason for amblyopia, can be done in a fast and relatively less expensive way and with the minimum number of specialist physician required. This way, children with amblyopia can reach the ophthalmologist earlier for treatment.

Comparison of Adult Refractive Disorder Measurements Using HandyRef-K, Retinomax, Plusoptix, and Table-top Autorefractometer Devices.

Objectives:This study was conducted to compare refractive error measurements recorded using the Nidek HandyRef-K handheld autorefractometer (HDY; Nidek Co. Ltd., Tokyo, Japan), Plusoptix A09 photorefractor (PO; Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (RTX; Right Mfg. Co. Ltd., Tokyo, Japan), and a table-mounted autorefractometer/keratometer (TTR; URK 800, Unicos Co. Ltd., Daejeon, Republic of Korea).Methods:Patients aged ≥18 years underwent measurement of refraction without cycloplegia using 4 devices and the spherical power (SP), cylindrical power (CP), and spherical equivalent (SE) values were analyzed and compared.Results:A total of 181 eyes of 181 patients were enrolled in the study. The mean age of the patients was 33.08±0.95 years (range: 18-79 years). There was a significantly significant difference in the SP, CP, and SE values determined by the devices (p<0.001). The SP and SE values of the RTX and the HDY were similar, while the other device results were different (Wilcoxon signed-rank test, p=0.004). The CP values of the PO and the TTR, the HDY and the TTR were also comparable.Conclusion:The HDY, RTX, and the PO are suitable for screening in clinical practice, but the findings strongly suggest that they should be used with caution.

ON THE ROLE OF MICRO ANISOMETROPIA (THE “BUTTERFLY” EFFECT) IN THE OCCURRENCE OF ESOTROPIA IN CHILDREN

Purpose: This report presents 3 cases of esotropia in children and an attempt is made to explain the cause of the development of esotropia in these children.Methods: A comprehensive ophthalmic examination was carried out in the following order: photorefraction using the Plusoptix A09 photoscreener without cycloplegia; orthoptic examination with the alternate prism cover test; anterior segment assessment using a slit lamp; fundus examination and cycloplegic retinoscopy; and, for autorefractometry measurements, Sure-Sight.Results: Threecases of esotropia in children are presented. In all cases, a slight microanisometropia was observed along the cylindrical component ofthe squinting eye.Conclusion:Our three examples show how a slight degree of ametropia can cause a deviation of the eyeball. Therefore, case-by-case analysis can be more informative than large statistical studies. Thus, it is appropriate to evaluate eachcase from these new perspectives. The timely elimination of a small degree of anisometropia in the astigmatic or spherical components can lead to the restoration of the symmetrical position of the eyes

Performance of Plusoptix A09 Photo Screener in Refractive Error Screening in School Children Aged between 5 and 15 Years in the Southern Part of India.

Purpose:To evaluate the performance of Plusoptix A09 in detecting ametropia, warranted against frequently-used technique of retinoscopy in children attending school (5–15 years) and its probability as a screening tool.Methods:This study was the subset of a larger epidemiological study visual acuity refractive error squint conducted in schools to determine the prevalence of ocular morbidity among the 5–15 years' school children population. Every 7th student in the class (each school had mean value of 100 students) was randomly selected for this study after ascertaining their eligibility as per the inclusion criteria. A cohort of a total of 150 children within the age group of 5–15 (mean, 10.21 ± 2.83) years were recruited from 11 schools of Udupi district. Students with best corrected visual acuity of 20/20, refractive error within ±5.00 diopter (D), without any eccentric fixation, and no history of ocular pathology or seizures were recruited. Refractive error was tested by Plusoptix photorefractor followed by non-cycloplegic and cycloplegic retinoscopic techniques. The examiners performing these tests were masked and unware of the findings. Bland Altman plotted the agreement between the techniques, followed by the receiver operating characteristic curve (ROC), and sensitivity of Plusoptix.Results:One-way analysis of variance calculated statistical differences among Plusoptix, objective retinoscopy, and cycloplegic retinoscopy for mean spherical value (1.12 ± 1.16 D, 0.65 ± 0.69 D, and 0.8 ± 0.82 D), cylindrical value (−0.83 D ± 1.27, −0.32 D ± 0.86, and −0.34 D ± −0.93), and spherical equivalent value (0.71 D ± 1.06, 0.45 D ± 0.7, and 0.61 D ± 0.81), with P = 0.0001, 0.0001, and 0.097, respectively. Bland Altman plots showed good agreement for spherical equivalent values of Plusoptix and objective retinoscopy. However, the area under the ROC curve (0.386) suggests that lower diagnostic ability of this device in this age group population in comparison to retinoscopy (0.575) with the sensitivity and specificity of Plusoptix was 69.2% and 84.8%.Conclusions:This study fails to report ideal sensitivity mandated for a screening tool, although good specificity and agreement are observed. Along with retinoscopy, this tool will be effective in screening a children's population aged between the age group of 5 and 15 years.

Comparison of Autorefraction and Photorefraction with and without Cycloplegia Using 1% Tropicamide in Preschool Children.

Purpose We aimed to investigate whether the accuracy of the Plusoptix A09 photorefractor in children with ametropia is enhanced by cycloplegia with 1% tropicamide. Methods A total of 70 eyes (70 children) were retrospectively reviewed. Noncycloplegic photorefraction, cycloplegia with 1% tropicamide, cycloplegic photorefraction, and cycloplegic refraction with a tabletop autorefractometer were performed on all subjects in this order. Measurements were compared statistically. Results The mean age was 45.9 ± 11.4 months. The mean spherical equivalent (0.61 ± 1.03 diopters (D); range, −2.38 to 3.63 D) and mean spherical power (1.16 ± 0.92 D; range, −1.25 to 3.75 D) values that were acquired from the photorefraction without cycloplegia showed statistically significant differences from those of the autorefraction with cycloplegia (mean spherical equivalent = 1.00 ± 1.27 D; range, −1.50 to 4.25 D, mean spherical power = 1.60 ± 1.14; range, −1.25 to 4.50 D). The mean difference for the spherical equivalent was −0.39 ± 0.93 D (P=0.021; 95% limits of agreement (LoA) = −2.22 D to 1.44 D) and for spherical power was −0.44 ± 1.02 D (P=0.016; LoA = −2.44 D to 1.56 D). Without cycloplegia, Plusoptix A09 showed myopic shift, while after cycloplegia, it showed hyperopic shift. Spherical equivalent (mean difference (MD) ± SD = 0.78 ± 1.00 D, P < 0.001; LoA = −1.17 D to 2.72 D) and spherical power (MD ± SD = 0.73 ± 1.04 D, P < 0.001; LoA = −1.31 D to 2.77 D) values were significantly different from those of autorefraction with cycloplegia. Cylindrical power values obtained by photorefraction both with and without cycloplegia were not statistically different from those of autorefraction with cycloplegia (P > 0.05). Conclusion Cycloplegia with 1% tropicamide did not improve the accuracy of photorefraction using Plusoptix A09 in preschool children. The spherical equivalent and spherical power values obtained by photorefraction with cycloplegia were significantly higher from those obtained by autorefraction with cycloplegia.

Inter-rater reliability for visual acuity, refractive error, corneal reflex, and inter-pupillary distance among two masked optometrists in school children population

Purpose: To observe the inter-rater reliability between the observers for visual acuity, refractive error, corneal reflex, and inter-pupillary distance.&#x0D; Methods: A random subset of 50 students from primary (1st to 4th grade), higher primary (5th to 7th grade) and secondary school (8th to 10th grade), for a total of 150 students were selected by stratified sampling from the prevalence study VARES (Visual acuity, refractive error, and squint) performed among 1752 school children of Udupi district, India in 2013-2014. The Institutional Ethical Committee &amp; District Health Administration board permission was acquired. There were two examiners: Examiner 1 (JT), a qualified optometrist with two years of experience, and Examiner 2 (MT), an optometry student. Examiners 1 and 2 performed a single measurement for visual acuity using the COMPlog computerized logMAR vision chart at 3 metres; Landolt C or Sloan letter optotypes used. Refractive error, corneal reflex, and inter-pupillary distance was measured by Plusoptix Power-refractor twice by Examiner 1 and thrice by Examiner 2; the average of each value was considered for analysis. Data was tested for normality using the Kolmogorov-Smirnov test. Statistical significance was considered p &lt; 0.05. The agreement between the observers for the two procedures was traced by a Bland-Altman plot.&#x0D; Results: The mean age of the students was 10.21 years (± 2.80 SD). The measurement of agreement for visual acuity (COMPlog) between the examiners was tested using Kappa statistics with 0.79 for OD, p &lt; 0.05 and 1.0 for OS, p &lt; 0.05 supported by Wilcoxon sign rank test showing 0.067 for OD and 0.564 for OS between the observers. The Bland-Altman plot also showed good agreement between the observers. Paired t-test for refractive error showed 0.117 (CI: -0.11­–0.10) for OD &amp; 0.067 (CI: -0.005–0.157) for OS, with Bland-Altman plot showing good agreement between the observers. Paired t-test showed 0.323 for corneal reflex and 0.520 for inter-pupillary distance.&#x0D; Conclusion: From the results we report that there is no interobserver variability for visual acuity, refractive error, corneal reflex and inter-pupillary distance in school screening with COMPlog and Plusoptix A09.

Opportunities for osteopathic correction for treatment infants with refraction disorders

Introduction. In paediatric population the prevalence of refraction pathology, including astigmatism of more than 0,75 diopters, exceeds 30 % in average. Visual perception disorder with underlying non-corrected ametropia in children, especially in sensitive period of visual system development, can manifest itself in amblyopia, strabismus, binocular and stereoscopic vision dyspoiesis. Astigmatism of more than 0,75 diopters requires a mandatory correction, even at 1 year age, to provide conditions for the complete vision formation. It is possible that if we try osteopathic methods on astigmatism triggers, it will decrease the astigmatism degree in infants.Goal of research— to explore the opportunities of osteopathic treatment for infants with refraction disorders based on age, and develop recommendations for pediatric ophthalmologists.Materials and methods.37 infants from 3 to 11 month were divided in two groups. An experimental group consists of 21 infant, and control group consists of 16 infants. Before starting the study, an ophthalmologic and osteopathic examination was done to all infants. «Plusoptix A09» pediatric autorefractometer was used to determine the refraction. Osteopathic treatment for the experimental group included 4–6 sessions with an interval of 7–14 days. The control group did not receive osteopathic treatment, they were just observed. Observation period was 6–12 months.Results.For all the examined children with astigmatism, regional somatic head dysfunctions were determined and characteristic. Regional somatic dysfunction of dura mater was detected in 75– 90,9 % of cases. Regional somatic dysfunctions of the neck were found in 60–75 % of cases. It was found that in experimental group, astigmatism rate was decreased by 2,2 times in infants less than 6 months of life and by 1,4 times in infants older than 6 months due to osteopathic correction of somatic dysfunctions. In control group, no signifi cant changes in astigmatism rate were observed at the end of the observation period. Statistically signifi cant differences with a high confi dence level between the degree of astigmatism severity and somatic dysfunctions of the head and dura mater regions were revealed.Conclusion.Osteopathic treatment should be recommended for infants with astigmatism under 1 year old.

Prevalence of visual impairment in school-going children among the rural and urban setups in the Udupi district of Karnataka, India: A cross-sectional study

AIM:The aim of this study is to estimate the prevalence of visual impairment among school-going children in Udupi district, Karnataka.MATERIALS AND METHODS:A cross-sectional study across eleven schools from both urban and rural parts of Udupi taluk was conducted to report the magnitude of visual impairment among the schoolchildren. Complex survey design was used in allocating the sample size through stratification and clustering. Totally 1784 schoolchildren between the age groups of 5 and 15 years participated in the study. Presenting visual acuity and objective refraction was measured using computerized logMAR acuity charts and Plusoptix A09 photorefractor, respectively. Manifest ocular deviation or squint was also recorded.RESULTS:The mean age of the students was found to be 10.62 ± 2.72 years. The prevalence of visual impairment, i.e., visual acuity worse than or equal to 20/40 in the better eye was found to be 4.32% (95% confidence interval: 3.38%, 5.26%). The prevalence rate was significantly higher among students from urban area (5.6%) compared to those from rural area (3.6%) (P = 0.011).CONCLUSION:Visual impairment was found to be 4.32% in the school-going population of Udupi district. Effective and user-friendly devices aided the visual deficit screening including refractive error and squint.

HandyRef-K: Comparison of the Latest Handheld Auto Refracto-keratometer with Retinomax and Plusoptix in Patients Younger than Three Years of Age.

Objectives:The purpose of the study was to compare the refractive error measurements of pediatric patients performed with a Plusoptix A09 photorefractor (PO; Plusoptix AG, Nuremberg, Germany), a Retinomax K-plus 3 (RTX; Right Group, Tokyo, Japan), and the new handheld auto refracto-keratometer, the Nidek HandyRef-K (HDY; Nidek SA, Créteil, France), and to evaluate the intermethods agreement.Methods:A total of 194 eyes of 194 children were included in the study. All of the children underwent refraction measurement with the PO before cycloplegia and 2 autorefractors were used after cycloplegia: the RTX and the HDY.Results:The mean age of the patients was 16.65±10.04 months (range: 3-34 months). There were no statistically significant differences between the spherical values (SV) or cylindrical axis values (CAV) measured with the PO (SV: 1.61±1.79 diopters [D]; CAV: 94.25±72.47 D), the RTX (SV: 1.91±2.06 D; CAV: 94.3±73.44 D), and the HDY (SV: 1.89±2.04 D; CAV: 93.55±73.71 D) (p>0.05).There was a statistically significant difference in the cylindrical values (CV) assessed with the RTX (CV: -0.97±0.75 D) and the HDY (CV: -1.11±0.76 D) (p=0.003) and the HDY and the PO (CV: -0.92±0.68 D)(p=0.002), while there was no statistically significant difference between the values determined with the RTX and the PO (p>0.05). Statistically significant differences were demonstrated for spherical equivalent values (SEV) obtained with the RTX (SEV: 1.43±1.97 D) and the PO (SEV: 1.15±1.74 D) (p=0.02), and the HDY (SEV: 1.34±1.95 D) and the PO (p=0.03), but no significant difference was found between the RTX and the HDY values (p>0.05).Conclusion:No significant difference was found between the SEV measured by the RTX and the HDY, but the PO was significantly less hyperopic than the RTX and the HDY. The CV measured by HDY was higher than that of other devices. These devices can be used for screening in crowded pediatric ophthalmology clinics and may be an easier way of measuring refractive errors in children younger than 3 years of age, but high SEV and CV results should serve as an alert to physicians. It should also be kept in mind that cycloplegic retinoscopy is still the gold standard and these alternative methods can only be used for screening. The prescription of eyeglasses should not be made without cycloplegic retinoscopy.

The performance of Plusoptix A09 in detection of Refractive Amblyopia Risk Factors

Purpose: To assess the accuracy of the Plusoptix A09 noncycloplegic photorefraction for detection of refractive amblyopia risk factors (RARFs) in children and determine cutoff points. Methods: This study included 402 children observed in Pediatric Ophthalmology Clinic between June and December 2014. All children underwent initially photorefraction using Plusoptix A09 followed by cycloplegic retinoscopy (obtained during a complete ophthalmologic examination). Patients were considered to have RARFs based on American Association for Pediatric Ophthalmology and Strabismus 2013 guidelines. Considering cycloplegic retinoscopy as the gold standard, accuracy parameters of noncycloplegic photorefraction were calculated for detection of RARFs. Results: RARFs were found in 148 (36.8%) and 151 (37.6%) cases by cycloplegic retinoscopy and photorefraction, respectively. Plusoptix showed an overall 85.1% sensitivity for 90% specificity, 83.4% positive predictive value and 91.2% negative predictive value for detection of RARFs. Plusoptix had good specificity for detection of all specific types of RARFs (between 93.0 and 98.1%), and good sensitivity for detection of myopia (96.6%) and astigmatism (91.0%), however its sensitivity for detecting hyperopia RARFs was only 48.9%. Using a cutoff point of +1,5D for hyperopia instead of +3.5D (in children > 48 months), sensitivity can be improved to 88.6% in this group. Conclusions: The Plusoptix A09 is a useful, portable and accurate tool for the detection of RARFs in pediatric populations. However, in hyperopic RARFs an alternative cutoff value should be used.

Accuracy of PlusOptix A09 distance refraction in pediatric myopia and hyperopia.

BackgroundThe PlusOptix photoscreeners (PlusOptix GmbH, Nuremberg, Germany) is used in many vision screening programs. The purpose of the present study was to further explore the accuracy of the PlusOptix A09 photoscreener in children with ametropia (myopia or hyperopia).MethodsA total of 70 eyes (35 children) were prospectively included. Before administration with the cycloplegia treatment 1 % cyclopentolate hydrochloride, children underwent refraction measurement with the PlusOptix A09. A refraction was then performed after cycloplegia with either Retinomax hand-held or Nidek autorefractor before and after 3 years old, respectively.ResultsThe median (interquartile range) age was 58 (18 to 86) months. The mean (SD) spherical equivalent differed between PlusOptix A09 and cycloplegic autorefraction (+0.54 [1.82] D vs +1.06 [2.04] D, p = 0.04). PlusOptix A09 refraction was positively correlated with cycloplegic autorefraction (r = 0.81, p < 0.001) with higher coefficient in myopic than in hyperopic children (r = 0.91, p = 0.0002 and r = 0.52, p = 0.01, respectively). The mean (SD) difference between PlusOptix A09 and cycloplegic autorefraction was higher with hyperopia than myopia (0.73 [1.34] vs 0.05 [0.66], p = 0.01). The proportion of children with < 1-D difference between cycloplegic and PlusOptix A09 refraction was 68.8 %, higher with myopia than hyperopia (90 % vs 54.5 %, p = 0.01).ConclusionThe spherical equivalent value with non-cycloplegic PlusOptix A09 refraction is closer to that with cycloplegic autorefraction than non-cycloplegic autorefraction. The PlusOptix A09 photoscreener underestimated the hyperopia of 0.73 D and slightly overestimated myopia of 0.05 D. The PlusOptix A09 could be used for screening with higher accuracy in myopic than hyperopic children.

Erişkin Populasyonda Plusoptix A09 Fotorefraktometre ve Standart Bir Otorefraktometre ile Ölçülen Refraksiyon Kusurlarının Karşılaştırılması

Erişkin Populasyonda Plusoptix A09 Fotorefraktometre ve Standart Bir Otorefraktometre ile Ölçülen Refraksiyon Kusurlarının Karşılaştırılması

Performance of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in Chinese children attending an eye clinic.

PurposeTo assess the accuracy of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in children and determine referral criteria when using Plusoptix A09 for a large-scale vision screening.MethodsPediatric patients attending our eye clinic underwent a comprehensive ophthalmic examination that included photorefraction, orthoptic examination, anterior segment assessment, fundus examination and cycloplegic retinoscopy. The measurements were collected for statistical analyses.ResultsOne hundred and seventy-eight children (mean age ± SD: 6.2±2.4 years, range: 2.2 to 14.1 years) were included in the study. The mean spherical equivalent (SE) obtained using Plusoptix A09 (PSE) was 0.57 D lower than that obtained from cycloplegic retinoscopy (CRSE) (P = 0.00). However, there was no statistically significant difference of Jackson cross cylinder J0 and J45 between Plusoptix A09 (PJ) and cycloplegic retinoscopy (CRJ) (P = 0.14, P = 0.26). The relationship of SE obtained from Plusoptix A09 and SE obtained from cycloplegic retinoscopy was presented as the equation: CRSE = 0.358 + 0.776 PSE + 0.064 PSE 2 + 0.011 PSE 3. Based on the Receiver Operating Characteristic (ROC) curve, the Plusoptix A09 had an overall sensitivity of 94.9% and specificity of 67.5% for detecting refractive amblyopia risk factors. The sensitivity and specificity of the Plusoptix A09 for detection of strabismus were 40.7% and 98.3%, respectively; detection of amblyopia and/or strabismus was 84.7% and 63.2%, respectively.ConclusionsThe Plusoptix A09 photoscreener underestimated hyperopia and overestimated myopia according to SE when compared with cycloplegic retinoscopy. The accuracy of the Plusoptix A09 in detecting amblyopia risk factors in children could be improved by the regression equation and optimized criteria for refractive amblyopia risk factors developed in the present study. Moreover, the Plusoptix A09 photoscreener is not suitable for a large-scale strabismus screening when it is applied solely.

Comparison of non-cycloplegic photorefraction, cycloplegic photorefraction and cycloplegic retinoscopy in children.

To compare the results of noncycloplegic photorefraction, cycloplegic photorefraction and cycloplegic refraction in preschool and non-verbal children. One hundred and ninety-six eyes of 98 children (50 females, 48 males) were included in the study. Firstly, non-cycloplegic photorefraction was achieved with Plusoptix A09; secondly, cycloplegic photorefraction was carried out with Plusoptix A09 after 10 min cyclopentolate. Finally, 30min after instillation of twice cyclopentolate, cycloplegic refraction was obtained with autorefraction and/or standard retinoscopy. Spheric equivalent, spheric power, cylindric power and cylindrical axis measurements were statistically compared. The mean age was 28.8±18.5mo (range 12-72mo). The differences in spherical equivalent, spheric power and cylindrical power measured by the three methods were found statistically significant (P<0.05). The spherical equivalent and spheric power measured by cycloplegic photorefraction were statistically higher than the measurements of the other methods (P<0.05). The cylindrical power measured by cycloplegic refraction was statistically lower than the measurements of the photorefraction methods (P<0.05). There was no significant difference in cylindrical axis measurements between three methods (P>0.05). For the determination of refractive errors in children, the Plusoptix A09 measurements give incorrect results after instillation of cyclopentolate. Additionally, the cylindrical power measured by Plusoptix A09 with or without cycloplegia is higher. However, the non-cycloplegic Plusoptix A09 measures spheric equivalent and spheric power similar to cycloplegic refraction measurements in preschool and non-verbal children.

Photoscreeners in the Pediatric Eye Office: Compared Testability and Refractions on High-Risk Children

To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy. Prospective, interventional case series. After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (-1.35 diopters [D] and -0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898). The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.

Comparison of the Spot and plusoptiX A09 vision screeners for the detection of refractive error in various ethnic groups

Comparison of the Spot and plusoptiX A09 vision screeners for the detection of refractive error in various ethnic groups

Comparing the SureSight autorefractor and the plusoptiX photoscreener for pediatric vision screening

Purpose: Both the plusoptiX photoscreener photoscreener and the SureSight autorefractor can be used to objectively screen for amblyogenic risk factors in children. We compare the plusoptiX and the SureSight to a pediatric ophthalmology examination on a single cohort of children.Methods: We performed a retrospective medical records review of 90 children. Each patient was screened with both the PlusoptiX A09 and SureSight devices on the same day as part of a comprehensive pediatric ophthalmic examination. The ages of the patients ranged from <1 to 17 years. All patients had a cycloplegic refraction on the day of their exam, or within the previous 6 months.Results: Of the children reviewed, 71% had amblyopia risk factors. The plusoptiX demonstrated a sensitivity of 98% and a specificity of 88%. The SureSight demonstrated a sensitivity of 95% and a specificity of 65% utilizing the manufacturer’s criteria.Conclusion: The SureSight and plusoptiX were both found to be reliable objective vision screening devices, though the plusoptiX did have a higher sensitivity and specificity than the SureSight using the manufacturer’s referral criteria. Using the Vision In Preschoolers Study (VIPS) referral criteria, the specificity of the SureSight improved but the sensitivity was reduced.