plusoptiX S04 Research Articles

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.

How Many Plusoptix S04 Measures Yield the Most Sensitive Amblyopia Screening?

To analyze how the Plusoptix S04 (Plusoptix, Atlanta, GA), a widely used technology for amblyopia screening, predicts amblyopia. A total of 1,547 children aged 3 to 4 years underwent a non-invasive eye examination in a whole population screening. The Plusoptix was measured binocularly three consecutive times. Seven models were developed: the first (P1), second (P2), and third (P3) measure of Plusoptix, the mean of P1, P2, and P3 (Pmean123), the maximal value of P1, P2, and P3 (Pmax123), the mean of P1 and P2 (Pmean12), and the maximal value of P1 and P2 (Pmax12). Internal consistency was excellent for sphere, cylinder (alpha = 0.92 vs 0.97), aniso-sphere, and aniso-cylinder (alpha = 0.87 vs 0.86). All models predicted amblyopia (P < .001); there was 2.3% new diagnosis and 5.1 events per variable. A bootstrap analysis with 1,000 samples confirmed the stability of the model. Astigmatism (P < .001; odds ratio [OR] = 2.1 to 3.6) and aniso-sphere (P < .001; OR = 3.6 to 9.0) predicted amblyopia. Although sphere, when measurable, did not predict amblyopia (P > .19; OR = 1.2 to 1.3), the likelihood of amblyopia presence was 100 times higher when the Plusoptix displayed "hyper." All receiver operating characteristic (ROC) curves were significant (P < .001), with no differences between them (all P > .16). Adjusting the cut-off from ROC curves for the highest sensitivity, Pmax12 referred 31.9% and 16.1% fewer patients than P1 and Pmean12, respectively. A third measure revealed accommodation-related false-negative results; therefore, adding measurements showed no benefit. This was the first study to assess the Plusoptix's prediction of amblyopia. When aiming for maximal sensitivity, the Plusoptix refers many children (> 20% children in all models). The first measure refers more children than two measures. Non-measurable results must be considered abnormal because the chance of amblyopia presence was high. [J Pediatr Ophthalmol Strabismus. 2019;56(5):305-312.].

Comparison of the PlusOptix S09 and Spot Vision photorefractor to cycloretinoscopy

The purpose of this study was to compare refraction measurements for children with the PlusOptix S09 and Spot Vision with cycloplegic retinoscopy. One hundred thirty-six eyes of 68 children (26 boys and 42 girls) were evaluated prospectively. The subjects were separated into two groups. Group 1 comprised the subjects age between 5 and 9years. Group 2 comprised the subjects age between 10 and 18years. Photorefraction with PlusOptix S09, photorefraction with Spot Vision and cycloplegic retinoscopy were performed in each patient. Spherical equivalents, spherical power, cylindrical power and axis values were compared between three methods. The mean age of the patients was 7.12 ± 1.5years in group 1 and 12.24 ± 1.8years in group 2. Spherical equivalent and spherical power measured with PlusOptix S09 were statistically smaller than measured with cycloplegic retinoscopy for group 1 (p = 0.001, p = 0.001) and for group 2 (p = 0.000, p = 0.000). The mean cylindrical power measured with PlusOptix S09 was not statistically different compared to cycloplegic retinoscopy for both groups (p = 0.314, p = 0.05). Spherical equivalents measured with Spot Vision were statistically smaller than measured with cycloplegic retinoscopy for both groups (p = 0.000, p = 0.012). Spherical power measured with Spot Vision was statistically smaller than measured with cycloplegic retinoscopy for group 1 (p = 0.000), but the difference was not statistically significant for group 2 (p = 0.084). The mean cylindrical power measured with Spot Vision was statistically higher than cycloplegic retinoscopy for both groups (p = 0.000, p = 0.012). PlusOptix S09 and Spot Vision devices give acceptable results for screening, but prescription of spectacles should not be made according to PlusOptix S09 or Spot Vision devices alone.

Normative pediatric data for three tests of functional vision

ObjectiveTo provide the normative pediatric data for three tests of functional vision. DesignProspective, cross-sectional study. ParticipantsThe participants were 281 children between 3 and 5 years of age (mean 4.2 ± 0.8 years) participating in a preschool vision screening study. MethodsParticipants completed monocular testing with the Precision Vision Visual Acuity Testing (PVVAT) system, a computerized test of visual acuity. Stereoacuity was assessed using the Pass Test 3 Stereo Test. Noncycloplegic refractive error was measured using the Plusoptix S09 Vision Screener (PS09). The mean and 95% tolerance limits were determined for each test. ResultsVisual acuity improved significantly from 0.31 logMAR at 3 years to 0.18 logMAR at 5 years (p < 2.4 × 10−15). Stereoacuity improved from 104 arcsec at 3 years to 81 arcsec at 5 years (p = 0.0058). Spherical refractive error remained relatively stable at 0.29 D at 3 years and 0.24 D at 5 years (p = 0.543). Cylindrical refractive error was also relatively stable, measuring 0.39 D at 3 years and 0.31 D at 5 years (p = 0.109). ConclusionsBoth visual acuity and stereoacuity improved significantly from 3 to 5 years of age. Note, however, that the norms obtained using the PVVAT system were somewhat lower than those reported in previous studies using other tests. The norms for the PS09 were stable and showed relatively good agreement with the manufacturer-suggested referral criteria.

Photoscreening for amblyogenic risk factors in 1-year-olds: results from a single center in Portugal over a 9-year period

To report the experience of a single center in photoscreening 1-year-olds for amblyogenic risk factors over a 9-year period and to estimate amblyopia prevalence in this population. The records of 11,029 children 11-18months of age who were screened for amblyogenic risk factors at Centro Hospitalar de Entre o Douro e Vouga between 2004 and 2012 were reviewed. Measurements were performed with MTI (until 2008) and plusoptiX S04 (from 2009). The screening results were evaluated according to criteria adapted from Donahue and colleagues. The screening was negative in 8,985 children (82%), positive in 519 (5%), unreadable in 201 (2%), and borderline in 1,324 (12%). The overall positive predictive value (PPV) for the presence of at least one amblyogenic risk factor was 56.8%. The estimated prevalence of meaningful refractive errors in this population was 2.2%; of strabismus, 0.3%. The rate of unreadable screenings was low. The overall PPV was lower than other large studies, at older ages, but higher than those of the same-age children. Considering the potential benefits of early intervention in preventing the development of amblyopia, this study demonstrates the feasibility of screening 1-year-olds.

A comparison of the Plusoptix S09 with an autorefractometer of noncycloplegics and cycloplegics in children

The aim of the study is to compare outcome measures of refractive error obtained using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics in children.We reviewed the medical records of 40 patients (77 eyes) who were classified using 2 methods. The patients were first assigned to 2 groups consisting of 11 eyes with ≥+3.0 D and 66 eyes with <+3.0 D, and then to 2 groups of 12 and 65 eyes with cycloplegic and noncycloplegic refraction of spherical powers ≥+2.0 D and <+2.0 D, respectively. We compared the outcome measures of refractive error using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics.There was no statistically significant difference between the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent. In contrast, there was a statistically significant difference between the Plusoptix S09 photorefractor and noncycloplegic autorefractometer (P < 0.001). There was a statistically significant difference between the spherical equivalent of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in children with hyperopia ≥+3.0D and with cycloplegic and noncycloplegic refraction of spherical power ≥+2.0 D. We also found a significant difference between the outcomes of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent for children with hyperopia ≥+3.0 D.The refractive error of the Plusoptix S09 photorefractor was similar to that of the cycloplegic autorefractometer, in contrast to the noncycloplegic autorefractometer. However, the Plusoptix S09 photorefractor is an inaccurate tool to estimate the refractive errors of children with moderate hyperopia.

A Comparison of Refraction Defects in Childhood Measured Using Plusoptix S09, 2WIN Photorefractometer, Benchtop Autorefractometer, and Cycloplegic Retinoscopy

ABSTRACTPurpose: To compare Plusoptix (Gmbh, Nuremberg, Germany), 2WIN (Adaptica, Padua, Italy), the benchtop refractometer (Auto-Kerato-Refractometer KR-8900; Topcon Co, Tokyo, Japan), and retinoscopy with regard to the consistencies. Materials and Methods: In our prospective study, 200 eyes of 100 patients were included. We analyzed the demographics and characteristics of the patients, the percentage of patients from whom measurements could not be obtained, the measurements from both patients’ eyes of pupil diameter, spherical, cylindrical, axis, and spherical equivalence. Results: The mean age ± SD was 7.8±4.5 years (range, 1–18 years). Pupil diameter measurements were found to be consistent (Cronbach’s alpha value >0.8). The sphere and spherical equivalence measurements for both eyes were found to be consistent with each other in all apparatus (Cronbach’s alpha value >0.8). However, consistency was found to be lower in cylindrical values and the Jackson cross-cylinder measurements at 0° and 45° axis were found to be inconsistent with each other (Cronbach’s alpha value <0.8). Conclusions: While consistency was observed in all methods in terms of sphere and spherical equivalence, consistency dropped in cylindrical values and no consistency was observed in axis values. It is important to take this point into consideration, especially in axis measurements.

Case of extremely high refractive error misdiagnosed as normal by PlusoptiX S09 photoscreener

PlusoptiX S09 (Plusoptix®GmbH,Nuremberg, Germany) is a binocular, port-able infrared video refractor which uses thedynamic photosciascopy method. As adigital photoscreener, it records digitalvideousinginfraredbeamsandanalysesdatain seconds using software installed on theminicomputer of the handpiece. At thebeginning of a measurement, the PlusoptiXcamera takes a few pictures to determinewhether the refractive error is outside meas-urement range. If it is, a ‘measurement outof range’ error message is shown on screen.In addition, the operator will find the words‘myopia’ or ‘hyperopia’ instead of refractivereadings in the output to indicate whichlimitation was exceeded. The measurementis aborted in this case and the screeningresult is ‘refer’. The method used to detectwhether the refractive error is outside themeasurement range is proprietary (RJJacobs, personal communication).Studies suggest that non-cycloplegicphotorefraction has reasonable sensitivityand specificity compared with cycloplegicretinoscopy.

Field evaluation of the SPOT and PlusoptiX S08 vision screeners

Field evaluation of the SPOT and PlusoptiX S08 vision screeners

Reliability and Usefulness of Refractive Measurements by PlusoptiX S09 in Children

Purpose: To compare the refractive measurements obtained using a photorefractor (PlusoptiX S09, PlusoptiX GmbH, Germany) with those obtained using cycloplegic refraction in children. Methods: We assessed the refractive status of 268 eyes in 134 children. The values acquired via photorefraction with a PlusoptiX S09 device were compared with those obtained by cycloplegic retinoscopy. Hyperopia (≥+3.5 D), myopia (≥-3.0 D), with the rule or against the rule astigmatism (≥-1.5 D), and oblique astigmatism (≥-1.0 D) were set as diagnostic criteria for refractive amblyopia risk factors (RARFs). The difference in the detection of RARFs by the two methods was the main outcome measure. Results: The average spherical refractive power was -0.81 ± 1.68 D for PlusoptiX S09 versus -0.26 ± 2.00 D for cycloplegic retinoscopy (average difference -0.54 ± 0.61 D; p < 0.001). The average spherical equivalent was -1.20 ± 1.62 D for PlusoptiX S09 versus -0.64 ± 1.94 D for cycloplegic retinoscopy (average difference -0.56 ± 0.62 D; p < 0.001). The average cylinder power was -0.79 ± 0.93 D for PlusoptiX S09 versus -0.76 ± 0.94 D for cycloplegic retinoscopy (average difference -0.03 ± 0.33 D; p = 0.135). Even though cycloplegic retinoscopy is considered the gold standard, the sensitivity and specificity for detecting RARFs with the PlusoptiX S09 were 88.0% and 96.3%, respectively. Conclusions: PlusoptiX S09 is a relatively useful method for detecting RARFs, but the device tends toward myopic shift compared to cycloplegic refraction, and hyperopia is underestimated. J Korean Ophthalmol Soc 2014;55(7):1071-1076

Plusoptix S08 sensitivity in detecting strabismus as amblyogenic risk factor

Purpose: To evaluate the sensitivity of photoscreener Plusoptix S08 in screening strabismus.Methods: Eighty-three consecutive patients were examined by a single expert to determine the type and amount of the deviation. Then photoscreening was done for all the patients via Plusoptix S08 photoscreener (Plusoptix GmbH, Nuremberg, Germany) on the same day, using the default software for referring the patients.Results: The age range was between 6 months and 40 years. The overall sensitivity of the device to detect strabismus is 70%; it was 25% for exophoria, 67% for esotropia, 73% for exotropia, and 89% in patients who had mixed strabismus. Regarding degree of deviation, sensitivity was 46% in deviations less than 30 prism diopters (PD) and rises while the degree of deviation increases.Conclusions: Our research shows that Plusoptix should not be used solely in evaluating strabismus because its sensitivity decreases significantly specially in esotropic patients with less than 30 PD deviations.

Comparison of photorefraction, autorefractometry and retinoscopy in children

Photorefractive devices have been evaluated for their effectiveness in detecting anisometropia, hyperopia, myopia, and astigmatism. We investigated the reliability of Plusoptix S08, the newest photoscreener, and Topcon autorefractometer by comparing them with cycloplegic retinoscopy. Plusoptix S08, cycloplegic retinoscopy, and cycloplegic autorefractometer measurements for 235 eyes of 118 children (59 female, 59 male) with a mean age of 4.9 ± 2.6 and median age of 5 years (range 1-12) were conducted. The Plusoptix S08 produced the following mean (± SD) results--spherical 0.27 ± 1.64, cylindrical power -0.81 ± 0.71, axis 89.73 ± 61.18, and spherical equivalent -0.05 ± 1.61. The cycloplegic retinoscopy produced the following mean (± SD) results--spherical 0.12 ± 1.35, cylindrical power -0.89 ± 0.71, axis 92.18 ± 68.39, and spherical equivalent -0.15 ± 1.31. The cycloplegic autorefractometer produced the following mean (± SD) results--spherical 0.16 ± 1.44, cylindrical power -0.88 ± 0.72, axis 90.86 ± 68.21, and spherical equivalent -0.12 ± 1.41. This study has shown that cycloplegic autorefractometer and retinoscopy results are similar and Plusoptix S08 is a very safe, easy-to-use and reliable screening method of refraction, especially for ophthalmologists unskilled in retinoscopy. Plusoptix S08 is a useful tool for estimating refraction in patients for whom conventional autorefraction is not an option.

The plusoptiX S08 photoscreener as a vision screening tool for children with autism

Children with autism and related disorders reportedly have an increased prevalence (40%) of ocular disorders, and comprehensive eye examinations by a pediatric ophthalmologist are recommended. Examinations can be very time consuming, expensive, and stressful for the child. A photoscreener such as the plusoptiX S08 may be a cost-effective, time-saving, and less invasive method for testing patients with autism. The purpose of this study was to determine the efficacy of photoscreening with the plusoptiX S08 in detecting amblyopia risk factors in children with autism. Photoscreening and complete ophthalmologic examinations were performed on 43 children with autism. Prevalence, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using ophthalmologic examination as the gold standard. The gold standard examination used American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee guidelines for the definition of amblyopia risk factors. The plusoptiX S08 referred 29 (67%) of 43 children. On examination, 16 patients (37%) had amblyopia risk factors. The plusoptiX S08 had a sensitivity of 94% (95% CI, 0.68-0.99). The specificity was 48% (95% CI, 0.29-0.68), the positive predictive value was 52% (95% CI, 0.33-0.70), and the negative predictive value was 93% (95% CI, 0.64-0.99). The plusoptiX S08 is sensitive but less specific at detecting treatable ocular conditions in children with autism. The majority of children with autism and amblyopia risk factors were detected on screening; however, about half of all referrals had no amblyopia risk factors. The plusoptiX S08 reduced the need for a full examination in one-third of the children screened.

A comparison of the Plusoptix S08 photorefractor to retinoscopy and cycloretinoscopy

BackgroundThe aim was to compare outcome measures of refractive error by the Plusoptix S08 photorefractor with measures obtained by retinoscopy and cycloretinoscopy in children.MethodThe refractive error of the right eye of 144 non‐strabismic children, aged 2.5 to 5.5 years, was determined by Plusoptix S08 photorefraction, retinoscopy and cycloretinoscopy. Agreement between outcome measures of refractive error (spherical error, cylindrical error and spherical equivalent) by the three techniques were tested by Bland–Altman limits of agreement.ResultsThe mean difference for spherical equivalent results of photorefraction (Pse) minus those of retinoscopy (Rse) and photorefraction minus those of cycloretinoscopy (CRse) were +0.53 ± 0.62 and ‐0.22 ± 0.75-D, respectively. The 95 per cent limits of agreement for spherical photorefraction with retinoscopy and cycloretinoscopy were ±1.22 D (range ‐0.69 to +1.75) and ±1.47 D (range ‐1.69 to +1.25), respectively. The mean difference for cylindrical results of photorefraction (Pc) minus those of retinoscopy (Rc) and Pc minus those of cycloretinoscopy (CRc) were +0.11 ± 0.39 D and +0.13 ± 0.44 D, respectively. The 95 per cent limits of agreement for Pc with Rc and CRc were ±0.76 D (range ‐0.65 to +0.87) and ±0.86 D (range ‐0.73 to +0.99), respectively. The mean and standard deviation of weighted axes difference, comparing Plusoptix S08 and retinoscopy was 0.25 ± 0.36 and comparing Plusoptix S08 and cycloretinoscopy was 0.29 ± 0.51. Eighty‐two per cent of the spherical equivalent findings in photorefraction and cycloretinoscopy show a difference of within 1.00 D. Regarding cylindrical power, this percentage is 96.6 per cent.ConclusionAs the findings demonstrate a fairly good consistency between the results of the Plusoptix S08 Photorefractor without using cycloplegic agents and those of cycloretinoscopy, the Plusoptix S08 is a fairly accurate tool to estimate refractive errors of children in the limited working range of the instrument.

A Comparison of the PlusoptiX S04 and A09 Photoscreeners

Purpose: We compare the plusoptiX S04 and A09 photoscreeners on a single cohort of children.Methods: One hundred and thirteen children were evaluated on both the plusoptiX S04 and A09 photoscreener. A lay screener performed all of the testing prior to a pediatric ophthalmology examination. The order was alternated so that the S04 was performed first on one patient then second on the next to minimize fatigue bias.Results: Utilizing our modified criteria previously published, the plusoptiX S04 was found to have a sensitivity of 85%, specificity of 94%, false positive rate of 15%, and false negative rate of 6% in detecting American Association for Pediatric Ophthalmology and Strabismus–defined amblyopia factors. The plusoptiX A09 was found to have a sensitivity of 92%, specificity of 88%, false positive rate of 11%, and false negative rate of 8%.Conclusion: The plusoptiX S04 and A09 photoscreeners perform similarly when used by a lay screener to evaluate the same population of children.

Comparison of Ocular Alignment Using Corneal Reflex Measurements with Plusoptix S08 between Non–strabismic Amblyopes and Normal Controls

Aims: Purpose of this study is to compare corneal reflex value measurements performed by the Plusoptix S08 photo-screener between anisometropic non–strabismic amblyopic children and non-amblyopic children. Study Design: This is a randomized and controlled prospective study. Place and Duration of Study: Department of Ophthalmology, Medical Faculty of Istanbul Medipol University between September 2012 and December 2012. Methodology: Corneal reflex values of 39 amblyopic non-strabismic children and 28 normal children were compared after complete ophthalmoscopic examination by the same examiner. Only patients with anisometropic amblyopia without strabismus were included in the study group and only non-amblyopic children were included in the control group. Results: There was no statistical significance between the study and the control group in means of age (p=0.100) and sex distribution (p=0.818). Corneal reflex values of the amblyopic eyes was 3.8±3.2 degrees and corneal reflex values of normal eyes was 2.4±4.1 degrees. There was no statistical significance between study and control group in means of corneal reflex values (p=0.127). Research Article Demirci et al.; OR, Article no. OR.2013.006 Conclusion: Although Plusoptix has proved to be a reliable screener in terms of measurement of refraction, we did not know whether the corneal reflex value was also a reliable screening value, because there is no research about this value in the literature. According to the current literature this is the first research examining the corneal light reflex reliability of a Plusoptix S08 photo-screener and, in light of our results, the corneal reflex value of Plusoptix S08 is not a reliable tool for the screening of amblyogenic risk factors in non-strabismic children.

Objective measurement of refractive errors: Comparison of plusoptix s08 with a standard autorefractometer

Amac: Cocuklarda ve eriskinlerdeki refraksiyon kusuru olcumunde, Plusoptix S08 ile standart bir oto refraktomet­re (Topcon RM 8000B) olcumlerinin karsilastirilmasi. Yontemler: Yas ortalamasi 8.06 ± 2.89 yil olan 110 cocu­gun 220 gozu Plusoptix S08 ile sikloplejisiz olarak, Top­con RM-8000B otorefraktometresiyle sikloplejili olarak olculdu. Elde edilen degerler karsilastirildi. Ayrica, yas ortalamasi 33,3 ± 13,4 olan 127 yetiskinin 254 gozu, Plu­soptix S08 ve Topcon RM 8000B otorefraktometre ile sik­loplejisiz olarak olculerek, bu olcumlerin karsilastirmasi yapildi. Tum olcumler uc kez tekrarlandi. Ortalama sferik, silindirik, sferik ekivalan ve silindirik aks degerleri istatis­tiksel olarak karsilastirildi. Bulgular: Ortalama sferik, silindirik, sferik ekivalan, J0 ve J45 gucleri cocuklarda sirasiyla: –0.25 D (p< 0.001), –0.25 D (p< 0.001), –0.25 D (p< 0.001), –0.02 (p= 0.038), 0.00 (p= 0.395) bulundu. Eriskinlerde ise 0.50 (p

The efficacy of the plusoptiX S04 photoscreener as a vision screening tool in children with autism

Children with autism and related disorders reportedly have an increased prevalence (40%) of ocular disorders. Comprehensive eye examinations by a pediatric ophthalmologist are recommended for all children with autism and related disorders. 1 Examinations can be very time consuming, expensive, and stressful for the child. A photoscreener such as the plusoptiX S04 may be a cost-effective, time-saving, and less invasive method for examining patients with autism. The purpose of this study is to determine the efficacy of photoscreening with the plusoptiX S04 in detecting treatable ocular conditions in children with autism and related disorders.

Effectiveness of Plusoptix vision screening in a school setting with modified referral criteria

Modifications to the plusoptiX S08 photoscreener manufacturer’s referral criteria (1) have been proposed to improve detection of amblyopia risk factors while minimizing overreferrals. These modifications are based on retrospective results from a pediatric ophthalmology patient population. We describe our experience applying the modified referral criteria to assess for amblyopia risk factors compared with on-site examination by a pediatric ophthalmologist in the public school setting.

Effect of cycloplegia on refractive errors measured with three different refractometers in school-age children

Aim: To compare 3 different refractometers with and without cycloplegia and to examine whether the photorefractometer necessitates cycloplegia in the measurement of refractive errors. Materials and methods: Included in the study were 62 eyes of 31 pediatric patients. The refractive errors of all of the eyes were measured with and without cycloplegia using a table-top autorefractometer (Potec PRK-6000), hand-held autorefractometer (Nidek ARK-30), and photorefractometer (Plusoptix S08), respectively. The spherical power, cylindrical power, cylindrical axis, spherical equivalent, and interpupillary distance values obtained were statistically compared. Results: The average age of the patients was 10.03 ± 2.79 years. There were statistically significant differences between the cycloplegic and noncycloplegic spherical powers and the spherical equivalent values of each device. However, the response to cycloplegia was not significant for the cylindrical values. The Jackson cross-cylinder values at axis 0° and 45° (J0 and J45) of each device similarly was not significantly affected by the cycloplegia. Noncycloplegic spherical equivalent, cylindrical power, and J0 and J45 values measured with the Plusoptix S08 did not have a significant difference from the same values measured with the Potec PRK-6000 for cycloplegia. Conclusion: Accommodation has a prominent effect on the detection of refractive errors of school-age children. The photorefractometer method eliminates the need for cycloplegia in the detection of refractive errors of children from this age group. In the measurements performed with a hand-held autorefractometer, the tendency of myopia as a result of marked accommodation can be seen.