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Clinical relevance: Knowing the agreement and interobserver variability of the 2WIN-S photorefractometer with cycloplegic retinoscopy and prism cover test is important for judging the clinical usefulness of the device. Background: This study aims to determine an agreement and interobserver reliability between 2WIN-S photorefractometer and cycloplegic retinoscopy for estimating refractive errors and between 2WIN-S and prism cover test for measuring horizontal ocular deviation in children. Methods: Two groups of 129 and 64 participants (range, 5 to 16 years) were recruited for the agreement and interobserver reliability studies, respectively. Non-cycloplegic 2WIN-S refraction was compared with cycloplegic retinoscopy for low and moderate myopia and hyperopia. Similarly, corneal reflex-function (CR-function) of 2WIN-S was compared with prism cover test for horizontal ocular deviation. Bland-Altman plots were used to depict agreement, and the intraclass correlation coefficient (ICC) was used for determining interobserver reliability of repeated measures. Results: The mean differences in spherical equivalent, J0 (Cartesian astigmatism) and J45 (oblique Jackson cross-cylinder) between cycloplegic retinoscopy and 2WIN-S were 1.10 (95% CI = 0.97 to 1.21, p < 0.001), −0.06 (95% CI = −0.09 to −0.03, p < 0.001) and 0.009 (95% CI = −0.01 to 0.03, p = 0.35), respectively. The overall median difference in the horizontal ocular deviation between prism cover test and 2WIN-S was −4.5 (Interquartile range = −12.0 to 4.0). For constant strabismus, this difference was insignificant (median= −2.0, interquartile range = −11.0 to 6.7, p = 0.19) between prism cover test and 2WIN-S. The ICC was high for the spherical equivalent (0.997; p < 0.001), J0 (0.932; p < 0.001) and J45 (0.901; p < 0.001), whereas it was low-to-moderate for horizontal ocular deviation (0.50; p < 0.001). Conclusion: 2WIN-S refraction was in agreement with cycloplegic retinoscopy for low and moderate myopia and hyperopia, and requires an adjustment for the consistent differences between cycloplegic retinoscopy and 2WIN-S refraction. The measurement of constant strabismus with 2WIN-S is comparable to that of prism cover test. [ABSTRACT FROM AUTHOR]

Objetivo: comparar los resultados de la refracción bajo cicloplejia frente al Spot Vision Screener en la detección de errores de refracción en niños de 6 a 12 años que asisten a una clínica institucional de servicios de salud visual de la Fundación Universitaria del Área Andina, Bogotá. Metodología: estudio prospectivo que evaluó a 65 niños de 6 a 12 años con la versión 1.0.3 del Spot Vision Screener. Se realizó un examen visual completo que incluyó la retinoscopía bajo cicloplejia y se compararon los resultados para establecer correlaciones entre los valores de hipermetropía, astigmatismo y miopía. Resultados: se encontró que no existen diferencias estadísticas ni clínicamente significativas entre las medianas de los valores medidos con el Spot Vision Screener y los obtenidos mediante la retinoscopía bajo cicloplejia para cada tipo de error refractivo, incluidos hipermetropía OD (p=0.060) OI (p=0.907), astigmatismo OD (p=0.173) OI (p=0.696) y miopía OD (p=0.699) OI (p=0.918). Asimismo, se observó que el promedio de tres mediciones con el Spot Vision Screener mejoró la concordancia en la medición (p=0.0306). Conclusiones: los hallazgos indican que el Spot Vision Screener, en particular cuando se promedian 3 mediciones, demuestra una congruencia satisfactoria en comparación con la refracción bajo cicloplejia, sobre todo en la muestra de estudio. Por tanto, podría considerarse como una herramienta fiable para detectar errores de refracción en la población infantil. No obstante, se requieren estudios con muestras más representativas que permitan confirmar estos resultados.

The ESCRS calculator compares in performance with the SRK/T for some formulas, and the refined IOL constants provided by the calculator improve predictability of postoperative residual refraction in pediatric eyes. Purpose: To evaluate the ESCRS online calculator for intraocular lens (IOL) calculation in children undergoing lens extraction and primary IOL implantation. Setting: Department of Ophthalmology, Goethe-University Frankfurt, Frankfurt am Main, Germany. Design: Retrospective, consecutive case series. Methods: Eyes that received phacoemulsification and IOL implantation (Acrysof SN60AT) due to congenital or juvenile cataract were included. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of formulas provided by the recently introduced online calculator provided by the ESCRS with the SRK/T formula, as well as the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4 to 12 weeks postoperatively. Results: 60 eyes from 47 patients with a mean age of 6.5 ± 3.2 years met the inclusion criteria. Mean axial length was 22.27 ± 1.19 mm. Mean preoperative spherical equivalent (SE) was −0.25 ± 3.78 D, and mean postoperative SE was 0.69 ± 1.53 D. The MedAE was lowest in the SRK/T formula (0.56 D, ± 1.03) performed significantly better (P =.037) than Hoffer QST and Kane, followed by BUII (0.64 D, ± 0.92), Pearl DGS (0.65 D, ± 0.94), EVO (0.69 D, ± 0.94), Hoffer QST (0.75 D, ± 0.99), and Kane (0.78 D, ± 0.99). All of those were significantly above zero (P <.001). 41 eyes received an intraoperative optic capture (68%). When excluding eyes that did not receive intraoperative optic capture (n = 19; 32%), the MedAE was shown to be lower. Conclusions: Using modern IOL calculation formulas provided by the ESCRS calculator provides good refractive predictability and compares for most of the formulas with the results with SRK/T. In addition, the formulas seem to anticipate the postoperative refraction better for eyes that receive a posterior optic capture. [ABSTRACT FROM AUTHOR]

Objectives: Determining the accuracy of cycloplegic refractive error measurements made with the Spot Vision Screener (SVS, Welch Allyn Inc, Skaneateles Falls, NY, USA) is important for refractive assessment of uncooperative patients during optometric examinations. This study compared cycloplegic refractive errors measured by SVS and tabletop autorefractometer to cycloplegic retinoscopy in children. Materials and Methods: Eighty-eight eyes of 44 subjects were examined in the study. Refractive error measurements were obtained under cycloplegia using retinoscopy, SVS, and Nidek ARK-530 tabletop autorefractometer (ARK-530, Nidek, Japan). Spherical and cylindrical values, spherical equivalents (SE), and Jackson cross-cylinder values at axes of 0° (J0) and 45° (J45) were recorded. Correlations between methods were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: The mean age was 7 years (range: 6 months-17 years). Sixteen (36%) of the subjects were female and 28 (64%) were male. For SE there was excellent agreement between retinoscopy and SVS (ICC: 0.924) and between retinoscopy and tabletop autorefractometer (ICC: 0.995). While there was a moderate correlation between retinoscopy and SVS for cylindrical values (ICC: 0.686), excellent correlation was detected between retinoscopy and autorefractometer (ICC: 0.966). J0 and J45 crosscylinder power values were not correlated between retinoscopy and SVS (ICC: 0.472) or retinoscopy and tabletop autorefractometer (ICC: 0.442). Retinoscopy was correlated with both SVS and tabletop autorefractometer for all parameters within ±1.96 standard deviations in Bland-Altman analysis. Conclusion: Cycloplegic retinoscopy is the gold standard for refractive error measurement in the pediatric population. However, it requires time and experienced professionals. This study revealed moderate to good agreement between SVS and retinoscopy, with better agreement in spherical errors than cylindrical errors. Although the SVS is intended for screening programs, it may also be useful in the pediatric eye office to estimate spherical refractive error in uncooperative patients.

Purpose: to compare the refractive error measurements achieved through three distinct techniques: retinoscopy, subjective method, and the subjective fogging method. Methods: Participants included 223 young adults aged 18 to 36 years (mean age: 25.63±5.31). The refractive error of one eye was measured under three different accommodation control conditions: subjective refraction, fogging subjective refraction and retinoscopy.Results: Data were collected for 223 young adults. The average Spherical value obtained by the retinoscopy method was 0.21 and the average cylinder was -0.76. These values were -0.01 and -0.75, respectively, in the subjective with fog method: The Spherical value and cylinder obtained by the regular subjective method were -0.13 and -0.74 D, respectively; The mean spherical equivalent with subjective refraction method was more minus than fogging subjective refraction and retinoscopy provided the most plus results. the difference in spherical and spherical equivalent value between three methods was significant (p- value< 0.001) but the difference in cylindrical value between three groups was not significant (p- value> 0.05). According to the Intraclass Correlation Coefficient analysis, the agreement between three methods for measuring sphere (ICC= 0.99), cylinder (ICC= 0.95) and spherical equivalent (ICC= 0.99) was good.Conclusions: The results showed that retinoscopy and fogging subjective refraction were the most similar methods, with a small mean difference. However, the comparison between retinoscopy and subjective refraction had wider limits of agreement than retinoscopy and fogging subjective refraction. Key words: Retinoscopy, subjective, refraction, fogging

Objectives: Determining the accuracy of cycloplegic refractive error measurements made with the Spot Vision Screener (SVS, Welch Allyn Inc, Skaneateles Falls, NY, USA) is important for refractive assessment of uncooperative patients during optometric examinations. This study compared cycloplegic refractive errors measured by SVS and tabletop autorefractometer to cycloplegic retinoscopy in children. Materials and Methods: Eighty-eight eyes of 44 subjects were examined in the study. Refractive error measurements were obtained under cycloplegia using retinoscopy, SVS, and Nidek ARK-530 tabletop autorefractometer (ARK-530, Nidek, Japan). Spherical and cylindrical values, spherical equivalents (SE), and Jackson cross-cylinder values at axes of 0° (J0) and 45° (J45) were recorded. Correlations between methods were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: The mean age was 7 years (range: 6 months-17 years). Sixteen (36%) of the subjects were female and 28 (64%) were male. For SE there was excellent agreement between retinoscopy and SVS (ICC: 0.924) and between retinoscopy and tabletop autorefractometer (ICC: 0.995). While there was a moderate correlation between retinoscopy and SVS for cylindrical values (ICC: 0.686), excellent correlation was detected between retinoscopy and autorefractometer (ICC: 0.966). J0 and J45 cross- cylinder power values were not correlated between retinoscopy and SVS (ICC: 0.472) or retinoscopy and tabletop autorefractometer (ICC: 0.442). Retinoscopy was correlated with both SVS and tabletop autorefractometer for all parameters within ±1.96 standard deviations in Bland-Altman analysis. Conclusion: Cycloplegic retinoscopy is the gold standard for refractive error measurement in the pediatric population. However, it requires time and experienced professionals. This study revealed moderate to good agreement between SVS and retinoscopy, with better agreement in spherical errors than cylindrical errors. Although the SVS is intended for screening programs, it may also be useful in the pediatric eye office to estimate spherical refractive error in uncooperative patients. [ABSTRACT FROM AUTHOR]

Introduction: To compare the refractive error measurements achieved through three distinct techniques: retinoscopy, subjective method, and the subjective fogging method. Methods: Participants included 223 young adults aged 18 to 36 years (mean age: 25.63±5.31). The refractive error of one eye was measured under three different accommodation control conditions: subjective refraction, fogging subjective refraction and retinoscopy. Results: Data were collected for 223 young adults. The average spherical value obtained by the retinoscopy method was 0.21 D, and the average cylinder was -0.76 D. These values were -0.01 D and -0.75 D, respectively, in the subjective with fog method. The spherical value and cylinder obtained by the regular subjective method were -0.13 D and -0.74 D, respectively. The mean spherical equivalent with subjective refraction method was more minus than fogging subjective refraction, and retinoscopy provided the most plus results. The difference in spherical and spherical equivalent value between three methods was significant (p < 0.001), but the difference in cylindrical value between three groups was not significant (p > 0.05). According to the Intraclass Correlation Coefficient analysis, the agreement between the three methods for measuring sphere (ICC= 0.99), cylinder (ICC= 0.95), and spherical equivalent (ICC= 0.99) was good. Conclusion: The results showed that retinoscopy and fogging subjective refraction were the most similar methods, with a small mean difference. However, the comparison between retinoscopy and subjective refraction had wider limits of agreement than retinoscopy and fogging subjective refraction. Therefore, combining different methods may lead to more accurate results in determining refractive errors in young people. [ABSTRACT FROM AUTHOR]

Background: Seeking a quick way to estimate refractions for challenging pediatric patients, we studied two non-contact methods with particular attention to accuracy and level of stress in uncovering cycloplegic hyperopia. Methods: Newly referred and follow-up pediatric eye patients had timed school bus accommodation-relaxing skiascopy (SBARS) and Plusoptix A12 (Px) photoscreener testing before cyclopentolate 1% confirmatory examinations. The ABCD ellipsoid univariate method based on relative blur and vector components was used to compare dry sphero-cylinder refraction estimates with cycloplegic. Receiver operating characteristic (ROC) curves were used to determine screening value. Results: Three compared refractions were attempted in 191 racially diverse children of whom 100 were age 0.2– 3.9 years and 91 were 4 to 14 years. Plusoptix failed to yield a result in 21 and an additional 21 were interpreted as an excess sphere. Median spherical equivalent did not differ between Px and SBARS for 149 with Px readings but in hyperopic patients, Plusoptix uncovered 27% less hyperopia. The ellipsoid for SBARS of 0.8 was better than 2.4 for Plusoptix (Mann–Whitney p< 0.001). Plusoptix was fastest (3– 15 seconds) followed by SBARS (15– 30 seconds) compared to 30– 45 minutes for cycloplegic exam. Conclusion: Non-contact quick refractive methods enhanced confirmatory cycloplegic pediatric exam in high-risk pediatric patients. [ABSTRACT FROM AUTHOR]

We conducted a prospective study to evaluate the efficacy of simulation-based education using a three-dimensional (3D)-printed schematic eye model in improving the retinoscopy refraction skills of medical students. A schematic eye model was printed using a fused deposition modeling-based 3D printer. Twenty medical students randomized into 3D (n = 10) and control (n = 10) groups received a 1-h lecture on the principles and methods of manifest refraction and were shown how to use the retinoscope and sciascope bars. The 3D group additionally attended a tutorial on the schematic eye. Both groups performed refractive examinations on four eyes of volunteer patients, and the results were recorded as a baseline. Instructor feedback and refraction practice was provided with the 3D group or with control group. To account for subject fatigue, patients spent no more than 8 min on the examination. After a 1-h break to allow for fatigue and familiarity, refraction tests were repeated on four randomly selected eyes of patients. Students' refraction readings were compared with the autorefractor values using a spherical equivalent value and blur strength. All participants measured the time required to complete the refraction test and reported their subjective confidence in the results of each refraction test. Refractive errors before and after training did not differ between the control and 3D groups, with a significant improvement in errors observed in both groups (p = 0.005 and 0.008, respectively). The time to complete refraction before and after training did not differ between the two groups, both of which showed a significant reduction in time (p = 0.005 and 0.028, respectively). Pre- and post-training confidence scores for the accuracy of each refraction on a 10-point Likert scale were not significantly different. However, when comparing score changes between pre- and post-training, only the control group showed a significant increase in confidence (p = 0.005). Tests for the non-inferiority of refractive errors after training indicated that the 3D group was non-inferior to the control group. In conclusion, training in retinoscopy refraction skills using a 3D-printed eye model resulted in significant improvement in accuracy and speed compared to practice with real patients. Except for better confidence in the control group, schematic eye model training was not inferior to practice with real patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To assess the performance of a portable autorefractor as refractor and screening tool for refractive errors in schoolchildren. Methods: Cross-sectional observational study. Refractometric measurements of children between 5 and 10 years old were obtained through four methods: 2WIN under non-cycloplegic conditions, and 2WIN, conventional autorefractor, and retinoscopy, under cycloplegic conditions. Correlations and agreement between the methods and accuracy of the portable autorefractor to define whether to prescribe glasses were assessed. Results: The mean age ± standard deviation was 6.87 ± 1.42 years. The portable autorefractor without cycloplegia showed a high correlation with retinoscopy (0.77) but tended to underestimate hyperopia and overestimate high astigmatism. Regarding screening for prescription of glasses in comparison with the reference method “retinoscopy,” the sensitivity of the portable autorefractor without cycloplegia was calculated to be 100,00% and the specificity, 34.3%. Conclusion: The portable autorefractor should be used as a screening tool and, when prescribing glasses, the tendency of underestimating hyperopia and overestimating high astigmatism should be kept in mind.

Abstract Background Retinoscopy is one of the most effective objective techniques for evaluating refractive status, especially in non-cooperative patients. However, it presents a slow learning curve that often leads to student frustration. With the current Covid-19 pandemic and the need for social isolation, clinical education based on simulation has become more relevant. Therefore, we implemented retinoscopy laboratories and learning protocols to reduce student stress and learning time. Methods We conducted a study to evaluate the retinoscopy learning curve using a new training protocol proposal. One hundred trainees were assessed in four stages, corresponding to 08, 12, 16, and 20 hours of training. Six different refractive defects were used trying to reproduce frequent conditions of care. The time spent on the assessment was not considered as additional training time. To analyze the data, we used non-parametric statistics and linear regression to assess the variables associated with training time and performance rate. Results The mean performance score at 08 hrs was 32.49% (±16.69 SD); at 12 hrs was 59.75% (±18.80 SD); at 16 hrs was 70.83% (±18.53 SD) and at 20 hrs was 84.26% (±13.18 SD). Performance at 12 hrs was significative higher than 08 hrs of training, but did not show significant differences with the performance rate at 16 and 20 hrs. We found a strong positive correlation between performance and training time in retinoscopy (R = 0.9773, CI: 0.2678 - 0.9995 p = 0.0227). Conclusion This study showed that an increasing number of hours of practice positively correlates with performance in retinoscopy. The elaboration of a protocol and standardization of performance per hour also allowed us to estimate that a minimum of 13.4 hrs of practice is required to achieve 60% performance. Using the resulting formula, it is possible to determine the number of hours of retinoscopy practice are necessary to reach a certain level of performance.

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Purpose: Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy. Methods: In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland–Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted. Results: The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland–Altman plot revealed the limits of agreement as 1.06 and −0.71 D. Conclusion: Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics. [ABSTRACT FROM AUTHOR]

Background: Retinoscopy is one of the most effective objective techniques for evaluating refractive status, especially in non-cooperative patients. However, it presents a slow learning curve that often leads to student frustration. With the current Covid-19 pandemic and the need for social isolation, clinical education based on simulation has become more relevant. Therefore, we implemented retinoscopy laboratories and learning protocols to reduce student stress and learning time. Methods: We conducted a study to evaluate the retinoscopy learning curve using a new training protocol proposal. One hundred trainees were assessed in four stages, corresponding to 08, 12, 16, and 20 hours of training. Six different refractive defects were used trying to reproduce frequent conditions of care. The time spent on the assessment was not considered as additional training time. To analyze the data, we used non-parametric statistics and linear regression to assess the variables associated with training time and performance rate. Results: The mean performance score at 08 hrs was 32.49% (±16.69 SD); at 12 hrs was 59.75% (±18.80 SD); at 16 hrs was 70.83% (±18.53 SD) and at 20 hrs was 84.26% (±13.18 SD). Performance at 12 hrs was significative higher than 08 hrs of training, but did not show significant differences with the performance rate at 16 and 20 hrs. We found a strong positive correlation between performance and training time in retinoscopy (R = 0.9773, CI: 0.2678 - 0.9995 p = 0.0227). Conclusion: This study showed that an increasing number of hours of practice positively correlates with performance in retinoscopy. The elaboration of a protocol and standardization of performance per hour also allowed us to estimate that a minimum of 13.4 hrs of practice is required to achieve 60% performance. Using the resulting formula, it is possible to determine the number of hours of retinoscopy practice are necessary to reach a certain level of performance. [ABSTRACT FROM AUTHOR]

Purpose: Assess the refractive states of donkeys and goats. Methods: Forty‐two donkeys and 28 goats were enrolled. The mean ± SD ages were 7.68 ± 7.33 years for donkeys and 4.26 ± 2.33 years for goats. Seven donkeys and one goat were <6 months old. Retinoscopy was performed in alert animals, following cycloplegia in goats but not in donkeys. Normality was determined using the Kolmogorov–Smirnov test. The two primary meridians and two eyes were compared using Pearson's correlation and paired Student's t–tests. The association between refractive states and age was examined using one‐way ANOVA in donkeys and a paired Student's t‐test in goats. One‐sample t‐tests were conducted to assess if the refractive error distributions were significantly different from "0". Results: The mean ± SD spherical equivalent (SE) refractive errors of the right and left donkey eyes were −0.80 ± 1.03 D and −0.35 ± 0.95 D, respectively. The majority (86%) of the donkeys had an astigmatic refraction and eight (19%) had anisometropia. The mean SE refractive errors of the right and left goat eyes were −0.15 ± 1.1 D and −0.18 ± 1.2 D, respectively. The majority (54%) of the goat eyes had an astigmatic refraction and five (18%) had anisometropia. The right and left eye SE refractive errors were positively correlated in both species (both p =.9). Age was not correlated with refractive error in both donkeys (p =.09) and goats (p =.6). Conclusions: Both goats and donkeys are emmetropic. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency of spasm of near reflex presenting to our clinic and outline the management outcomes. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022. Methodology: A patient who was suspected to have spasm of near reflex underwent subjective and objective refraction and detailed orthoptic evaluation. Dry and cycloplegic retinoscopy was obtained along with post-mydriatic refraction achieved after 3 days of Cycloplegic. Spasm of near reflex was categorized as mild if it resolves on administration of a weaker cycloplegic drug like cyclopentolate, moderate if administration of stronger cycloplegic i.e., atropine/homatropine is required or severe if long term home therapy of atropine 0.5% once daily is required. Results: Our study included 236 patients with suspected spasm of near reflex, among which it was confirmed in 200 only. Of the 200 patients with confirmed spasm of near reflex, there were 74 mild cases (37%), with no spasm of near reflex during their post-cycloplegic visit. Eighty-eight patients (44%) had moderate spasm of near reflex that was relieved by the post atropine examination. Whereas, 38 patients (19%) had severe spasm of near reflex, requiring long-term atropine 0.5% management. Conclusion: Spasm of near reflex is often a diagnostic dilemma which is otherwise not very difficult to treat. Most of such cases were found to be mild to moderate having good visual outcomes to once or twice application of moderate (Cyclopentolate 1%) to stronger acting Cycloplegic eye drops (Atropine 1%). [ABSTRACT FROM AUTHOR]

To compare EEG-patterns after instillation of cyclopentolate versus placebo eye drops. Prospective, randomized, placebo-controlled, and observational pilot study is presented. Ophthalmology outpatient clinic Dutch metropolitan hospital. Healthy 6- to 15-year-old volunteers with normal or low BMI requiring a cycloplegic refraction/retinoscopy. Randomized; 1 visit 2 drops cyclopentolate-1% and 1 visit 2 drops placebo (saline-0.9%). Single-blind: conducting researcher. Double blind: subjects, parents, clinical-neurophysiology staff, neurologist, and statistician. A 10-min baseline EEG-recording, drop-application, and follow-up to at least 45 min. Primary outcome: Detection of CNS changes, i.e. EEG-pattern changes, following two drops of cyclopentolate-1%. Secondary outcome: Determination of the extent of these pattern changes. Thirty-six cyclopentolate-1% saline-0.9% EEG registrations were made in 33 subjects; 18 males and 15 females. Three subjects were tested twice (interval 7 months). Nine out of fourteen (64%) of the 11- to 15-year-old children reported impaired memory, attention, alertness, as well as mind wandering following cyclopentolate. Drowsiness and sleep were seen in EEG-recordings of 11 subjects (33%) following cyclopentolate. We observed no drowsiness nor sleep during placebo recordings. The mean time to drowsiness was 23 min. Nine subjects arrived in stage-3 sleep but none arrived in REM-sleep. In subjects without sleep (N=24), significant changes compared to placebo-EEG were present for many leads and parameters. The main findings during awake eye-open recording were as follows: 1) a significant increase of temporal Beta-1,2 and 3-power, and 2) a significant decrease in: a) the parietal and occipital Alpha-2-power, b) the frontal Delta-1-power, c) the frontal total power, and d) the occipital and parietal activation synchrony index. The former finding reflects cyclopentolate uptake in the CNS, and the latter findings provide evidence for CNS suppression. Cyclopentolate-1% eye drops can affect the CNS and may cause altered consciousness, drowsiness, and sleep with concomitant EEG results in both young children and children in puberty. There is evidence that cyclopentolate has the potency to act as a short acting CNS depressant. Nevertheless, however, cyclopentolate-1% can safely be used in children and young adolescents. [ABSTRACT FROM AUTHOR]

Purpose: To compare school-age children's objective and subjective refraction using a binocular wavefront optometer (BWFOM) with autorefraction and retinoscopy before and after cycloplegia. Methods: Eighty-six eyes from 86 children (6–15 years old) were enrolled in this cross-sectional study. BWFOM objective and subjective refractions were compared with autorefraction and retinoscopy under cycloplegia. BWFOM refraction was evaluated before and after cycloplegia. Measurements were compared using a paired t-test; agreement was assessed using Bland–Altman plots. Results: Under cycloplegia, the sphere, spherical equivalence, and J45 were significantly more negative on BWFOM objective refraction than autorefraction (− 1.39 ± 2.20 D vs. − 1.28 ± 2.23 D, P = 0.003; − 1.84 ± 2.38 D vs. − 1.72 ± 2.43 D, P = 0.001; − 0.02 ± 0.17 D vs. 0.03 ± 0.21 D, P = 0.004). The subjective sphere of BWFOM was less myopic, and the cylinder and the J45 were more negative than those with retinoscopy (− 1.17 ± 2.09 D vs. − 1.25 ± 2.20 D, P = 0.02; − 0.91 ± 0.92 D vs. − 0.76 ± 0.92 D, P < 0.001; − 0.01 ± 0.15 D vs. 0.03 ± 0.21 D, P = 0.028). For both BWFOM objective and subjective refraction, sphere and spherical equivalence with noncycloplegia were more myopic than those with cycloplegia (objective: − 1.76 ± 2.10 D vs. − 1.39 ± 2.20 D, − 2.21 ± 2.30 D vs. − 1.84 ± 2.38 D, P < 0.001; subjective: − 1.57 ± 1.92 D vs. − 1.17 ± 2.09 D, − 2.01 ± 2.13 D vs. − 1.62 ± 2.27 D, P < 0.001). Bland–Altman plots showed good agreement in spherical equivalence between BWFOM objective refraction and autorefraction (mean difference = 0.12 D, 95% confidence interval [CI] − 0.52 to 0.76), subjective refraction with retinoscopy (mean difference = − 0.01 D, 95% CI − 0.65 to 0.64), and BWFOM refractions with or without cycloplegia (objective: mean difference = − 0.37 D, 95% CI − 1.31 to 0.57; subjective: mean difference = − 0.39 D, 95% CI − 1.30 to 0.51). The time cost by BWFOM was significantly less than the total time of autorefraction and retinoscopy (264.88 ± 90.67 s vs. 315.89 ± 95.31 s, P < 0.001). Conclusion: BWFOM is a new device that realizes both objective and subjective refraction. For children's refractive errors, it is more convenient and quicker to obtain the proper prescription at a 0.05-D interval, and it is more accurate than autorefraction and retinoscopy under cycloplegia. [ABSTRACT FROM AUTHOR]

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Purpose:To investigate differences in sensitivity to myopia-inducing stimuli of two strains of pigmented guinea pigs. Methods:Eleven-day-old animals (New Zealand [NZ], n = 24 and Elm Hill strains [EH], n = 26) wore either a +2 or -2 diopter (D) lens over one eye and a plano lens over the fellow eye for 5 days; other 10-day-old EH (n = 9) and 7-day-old NZ (n = 9) animals were monocularly form-deprived (FD) for 28 days. Choroidal thickness and axial length were measured using A-scan ultrasonography at baseline and after 1 and 5 days for optical defocus treatments, and at baseline and after 28 days for the FD treatment. Refractive errors were measured by retinoscopy. Choroids of untreated animals were also evaluated using spectral-domain optical coherence tomography. Results:One day of optical defocus induced bidirectional (optical sign-dependent) choroidal responses in EH animals only (P < 0.01). Similar responses were detected in NZ animals after 5 days (P < 0.01), with concordant spherical equivalent refraction changes (P < 0.01). Compared with NZ animals, EH animals developed minimal myopia with FD after 28 days (-4.58 ± 0.97 vs. -0.69 ± 0.75 D for NZ versus EH, P < 0.001). Yet, EH animals showed paradoxical choroidal thickening, 20 ± 9 vs. -8 ± 8 μm for EH versus NZ, P < 0.001. Untreated EH animals also had significantly thicker choroids than NZ animals (147 ± 19 vs. 132 ± 16 μm, P < 0.05), with well-defined layering. Conclusions:As previously reported in chicks, guinea pigs show strain-related differences in response to myopia-inducing stimuli. The finding of a thicker, multilayered choroid in the strain showing decreased sensitivity to FD is provocative, suggesting a possible protective role of the choroid.

BackgroundPhacoemulsification and intraocular lens (IOL) implantation during cataract surgery in horses occur with increasing frequency. To reduce the postoperative refractive error it is necessary to determine the proper IOL power. In the present study retinoscopy, keratometry and ultrasonographic biometry were performed on 98 healthy equine eyes from 49 horses. The refractive state, corneal curvature (keratometry) and the axial location of all optical interfaces (biometry) were measured. The influences of breed, height at the withers, gender and age on values obtained and the comparison between the left and right eye were evaluated statistically. Corresponding IOL power were calculated by use of Binkhorst and Retzlaff theoretical formulas.ResultsMean ± SD refractive state of the horses was + 0.32 ± 0.66 D. Averaged corneal curvature for Haflinger, Friesian, Pony, Shetland pony and Warmblood were 21.30 ± 0.56 D, 20.02 ± 0.60 D, 22.61 ± 1.76 D, 23.77 ± 0.94 D and 20.76 ± 0.88 D, respectively. The estimated postoperative anterior chamber depth (C) was calculated by the formula C = anterior chamber depth (ACD)/0.73. This formula was determined by a different research group. C and axial length of the globe averaged for Haflinger 9.30 ± 0.54 mm and 39.43 ± 1.26 mm, for Friesian 10.12 ± 0.33 mm and 42.23 ± 1.00 mm, for Pony 8.68 ± 0.78 mm and 38.85 ± 3.13 mm, for Shetland pony 8.71 ± 0.81 mm and 37.21 ± 1.50 mm and for Warmblood 9.39 ± 0.51 mm and 40.65 ± 1.30 mm. IOL power was calculated with the Binkhorst and Retzlaff theoretical formulas. Calculated IOL power for the several breeds ranged from 18.03 D to 19.55 D. The mean value across all horses was 18.73 D determined with Binkhorst formula and 18.54 D determined with Retzlaff formula.ConclusionsMean result of this study is: an 18.5 D IOL seemed to be the most appropriate to achieve emmetropia after IOL implantation in horses. Cataract surgery without IOL implantation results in hyperopic and visual compromised horses. Retinoscopy, keratometry and ultrasonographic biometry should be performed on every affected horse and postoperative visual outcome should be determined.

Background: Accommodative functions are known to differ between myopes and emmetropes. It is not known whether accommodative facility differs at near between younger adolescent and older adolescent myopes and emmetropes. Aim: To examine whether accommodative facility differs at near between younger and older adolescent myopes and emmetropes. Methods: 119 participants aged between 11–21 years were recruited. Refractive error was measured using cycloplegic retinoscopy. Near monocular accommodative facility was measured for 60 seconds, using a +2.00D/–2.00D handheld flipper and N6 print at 40 cm. Participants were classified into two age groups: (i) younger adolescents (range: 11–14 years) and (ii) older adolescents (range: 15–21 years). The criterion applied to define myopia was spherical equivalent refraction: ≥–0.50D) and spherical equivalent refraction: –0.25D to +0.75D) for emmetropia. Univariate Analysis of Variance was carried out to analyze the interaction of age groups and refractive groups on near accommodative facility. Results: Near monocular accommodative facility was significantly lower (p = 0.003) in younger adolescents (5.87 ± 3.72 cpm) compared to older adolescents (8.11 ± 4.11 cpm), indicating age as a significant main effect (F1,115 = 13.44; p = 0.0001). Younger adolescent emmetropes (4.77 ± 2.05 cpm, p = 0.005) and younger adolescent myopes (6.48 ± 4.12 cpm, p = 0.022) had significantly lower monocular near accommodative facility compared to older adolescent emmetropes (9.52 ± 3.27 cpm), but did not show any difference when compared to older adolescent myopes (p > 0.05). This indicates a significant association linking age and refractive error to near accommodative facility (F1,115 = 4.60; p = 0.03). Conclusion: Younger adolescent myopes and younger adolescent emmetropes had reduced monocular near accommodative facility than older adolescent emmetropes, but not when compared to older adolescent myopes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the effects of corneoconjunctival transposition (CCT), posterior lamellar keratoplasty (PLK) and modified deep lamellar endothelial keratoplasty (DLEK) on streak retinoscopy in equine cadaver eyes. Methods: Intraocular pressure (IOP) was maintained at 25 ± 3 mmHg in 35 equine cadaver eyes. Streak retinoscopy was performed prior to (NO VISCO) and following (VISCO) intracameral injection of 1.0 ml of viscoelastic. Following optical coherence tomography (OCT), an axial CCT [n = 11] or PLK [n = 12], or peripheral DLEK [n = 12] was performed. Streak retinoscopy and OCT were repeated postoperatively. Results: Postsurgical net meridional and spherical refraction for CCT [Horizontal (H): 3.4 (95% CI 2.4–4.4) diopters (D), p <.001, Vertical (V): 3.5 (95% CI 2.7–4.4) D, p <.001, Spherical: 3.5 (95% CI 2.6–4.3) D, p <.001] and PLK [H: 3.2 (95% CI 2.2–4.1) D, p <.001, V: 2.8 (95% CI 2.0–3.6) D, p <.001, Spherical: 3.0 (95% CI 2.2–3.8) D, p <.001] were significantly increased from presurgical (VISCO) values. No difference between presurgical (VISCO) and postsurgical values were identified for the DLEK. Postoperative OCT revealed space between anterior and posterior corneal grafts and corneal undulation associated with suture placement. Conclusion: Meridional and spherical refraction had a hyperopic shift following CCT and PLK, with a significantly higher value in the vertical meridian for the CCT. Pre‐ and postoperative refraction was not significantly different for the DLEK. This supports that the DLEK has a lesser effect on immediate postoperative refraction compared with CCT or PLK. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether cycloplegic autorefraction can provide similar results as cycloplegic retinoscopy, allowing more comprehensive ophthalmologists to be comfortable in managing pediatric refractive error and refractive amblyopia. Methods: This retrospective chart review was performed to determine the mean difference in sphere, cylinder, and axis between cycloplegic autorefraction and retinoscopy, both of which were obtained on the same eye at least 30 minutes after cycloplegia and dilation with a mixed solution of tropicamide, cyclopentolate, and phenylephrine. Results: A total of 34 eyes (18 right, 16 left) from 18 patients were included in the analysis. Mean sphere difference between cycloplegic autorefraction and retinoscopy was 0.044 ± 0.278 diopters (D) (95% CI: −1.275 to 1.363 D), mean cylinder difference was −0.081 ± 0.236 D (95% CI: −0.706 to 0.544 D), and mean axis difference was 7.059 ± 19.676 degrees (95% CI: −32.527 to 38.878 degrees). Mean differences in sphere, cylinder, and axis were not statistically significant (P =.362,.0541, and.377, respectively). Conclusions: In this small sample population, cycloplegic autorefraction was comparable to cycloplegic retinoscopy. Recognition of amblyopia should still prompt evaluation by a pediatric ophthalmologist. Further research is necessary to confirm whether uncomplicated refractive error in children may be sufficiently detected and managed by a comprehensive ophthalmologist. [J Pediatr Ophthalmol Strabismus. 2022:59(6):422–427.] [ABSTRACT FROM AUTHOR]

Purpose: To compare the ability to detect refractive anomalies in children using automated refraction versus retinoscopic cycloplegic refraction. Methods: A pediatric population from a pediatric eye institute underwent complete ophthalmic examinations. Children were randomly assigned to one of two pediatric optometrists who performed manual cycloplegic refraction using retinoscopy and automated cycloplegic refraction using a handheld autorefractometer (Retinomax K-plus 5; Right Mfg. Co., Ltd.). Recorded patient data included refraction values for each eye (sphere, astigmatism, and axis), use of glasses, and degree of cooperation. Results: Two hundred thirteen children were included. The mean age was 6.2 years. For all ages, strong associations were found in sphere and spherical equivalent (SE) measurements between the two methods (b = 0.78, P <.001; b = 0.71, P <.001; respectively). Among children older than 5 years, associations between the two methods were significant in all parameters (sphere: b = 0.99, P <.001; astigmatism: b = 0.69, P <.001; axis: b = 0.19, P <.05; SE: b = 0.97, P <.001), whereas among children 5 years and younger, a significant association was found only in the axis measurements (b = 0.31, P <.01). Retinomax K-plus 5 measurements showed significantly more hyperopic results in sphere measurements and higher astigmatism in all children examined, but this difference was markedly higher in children 5 years and younger. Good cooperation was observed in 94.1% of children older than 5 years and 77% of children 5 years and younger (P <.001). Conclusions: The Retinomax K-plus 5 may be used for screening in children older than 5 years. However, in all age groups, it may not be accurate enough for treatment and decision making, even with good cooperation. [J Pediatr Ophthalmol Strabismus. 2022;59(6):380–387.] [ABSTRACT FROM AUTHOR]

The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured.

Purpose:To determine whether latanoprost, a prostaglandin analog proven to be very effective in reducing intraocular pressure (IOP) in humans, can also slow myopia progression in the guinea pig form deprivation (FD) model. Methods:Two-week-old pigmented guinea pigs underwent monocular FD and daily topical latanoprost (0.005%, n = 10) or artificial tears (control, n = 10) starting 1 week after the initiation of FD, with all treatments continuing for a further 9 weeks. Tonometry, retinoscopy, and high-frequency A-scan ultrasonography were used to monitor IOP, refractive error, and ocular axial dimensions, respectively. Results:Latanoprost significantly reduced IOP and slowed myopia progression. Mean interocular IOP differences (±SEM) recorded at baseline and week 10 were -0.30 ± 0.51 and 1.80 ± 1.16 mm Hg (P = 0.525) for the control group and 0.07 ± 0.35 and -5.17 ± 0.96 mm Hg (P < 0.001) for the latanoprost group. Equivalent interocular differences for optical axial length at baseline and week 10 were 0.00 ± 0.015 and 0.29 ± 0.04 mm (P < 0.001; control) and 0.02 ± 0.02 and 0.06 ± 0.02 mm (P = 0.202; latanoprost), and for refractive error were +0.025 ± 0.36 and -8.2 ± 0.71 diopter (D) (P < 0.001; control), and -0.15 ± 0.35 and -2.25 ± 0.54 D (P = 0.03; latanoprost). Conclusions:In the FD guinea pig model, latanoprost significantly reduces the development of myopia. Although further investigations into underlying mechanisms are needed, the results open the exciting possibility of a new line of myopia control therapy.

Purpose To assess the use of oral chloral hydrate (CH) sedation in uncooperative children to perform a precise cycloplegic retinoscopy and a thorough dilated fundus examination in an outpatient strabismus and nystagmus clinic. Patients and methods A prospective study was conducted on 114 uncooperative children (119 sedation episodes) who were attending the strabismus and nystagmus outpatient clinic at Menoufia University Hospital. Children were sedated by the first dose of CH (50 mg/kg). A second dose, half-strength of the first dose, was given if no adequate sedation occurred after 30 min. The degree of sedation was graded into five categories: excellent, good, fair, poor, and failure. All demographic characteristics, sedation success, failure, and adverse events were reported and statistically analyzed. Results The mean age of children was 23.38 months (range: 5.16–62.06), and their weight ranged from 6.5 to 22 kg. The total CH dose ranged from 325 to 1500 mg. A total of 78 sedation episodes were reported by a single dose, and 41 by two doses. The percentage of the grade of sedation in our 119 episodes was as follows: excellent (56.3%), good (9.2%), fair (28.6%), poor (2.5%), and failure (3.4%). The overall success of one dose was 65.5%, which increased to 96.6% by a second supplemental dose. The most common complication was vomiting (13.4%). Other complications included prolonged drowsiness (one case) and paradoxical agitation (two cases). Spearman correlation showed a significant positive correlation between the degree of sedation and the total dose of CH (r=0.603, P<0.001). Conclusion According to our study, the use of CH was found to have a high success rate with two doses, without major adverse events. [ABSTRACT FROM AUTHOR]

Purpose: Retinoscopy is a skill that requires the integration of procedural skill and declarative knowledge. Whilst the actual technique is simple, retinoscopy is a complex skill to acquire and is one that students often find challenging. This study compared the strategies that novices, third‐year students and experts use when performing retinoscopy, with the aim of identifying the key stages of learning that may enlighten teaching practice. Method: This study employed a protocol‐based approach in which the verbal protocols and cognitive strategies of novices, students and experts were recorded and then subjected to 'problem space' analysis. Results: Clear differences existed when the retinoscopy of novices, students and experts was directly compared using a standardised simulated task. Experts were more accurate in performance and used defined strategies to reach the goal. The presence of these strategies significantly predicted the accuracy of the retinoscopy result. Conclusion: This study highlights the importance of meta‐cognitive strategies and the need for an adequate theoretical foundation in skill acquisition. The underpinning knowledge provides a pedagogic tool that specifies activities which are beneficial to learning a clinical skill. [ABSTRACT FROM AUTHOR]

The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured. [ABSTRACT FROM AUTHOR]

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., Competing Interests: Conflict-of-interest statement: The authors declare no conflict of interest for this article and received no funding., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Purpose: To analyze the refractive shift during off-the-axis retinoscopy under cycloplegic drugs in myopic patients during ocular examination. Methods: Prospective cross-sectional study was carried out among 10 myopic patients having refractive errors of −3.00 D or less. All the subjects underwent cycloplegic refraction by a single examiner at 0°, 10°, and 20°. Descriptive data were analyzed as mean and standard deviation. Paired t-test was used to compare the mean differences between on-axis (0°) and off-axis (10° and 20°) retinoscopy. Result: The mean spherical equivalent refraction of 10 myopic patients showed an increase in myopic shift with approximately 7% and 18% for 10° and 20° of eccentricity, respectively. Similarly, the mean spherical equivalent measure on axis (0°) and off axis (10° and 20°) were -2.5495, −2.737, and −3.0265, respectively. The mean spherical equivalent differences between on-axis (0°) and off-axis (10° and 20°) showed statistically significant differences with P < 0.05. Conclusion: This study concluded that a greater degree of eccentricity will induce a greater amount of errors in retinoscopy.

Sabrina N Mukash,1 David L Kayembe,1 Jean-Claude Mwanza1,2 1Department of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo; 2Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Sabrina N MukashDepartment of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of CongoTel +243 816917089Email mukashsaby@gmail.comObjective: To assess the agreement between retinoscopy and autorefractometry and between subjective refraction and both retinoscopy and autorefractometry in Congolese children.Patients and Methods: Fifty-four children (6– 17 years old) were enrolled consecutively in this cross-sectional study. Refraction was evaluated before and after cycloplegia (1% cyclopentolate) with retinoscopy and autorefractometry. Readings were compared (paired t-test) and agreement assessed with Bland–Altman plots. Subjective refraction was compared with the two methods to determine which one provides better reference estimates for subjective refraction.Results: Under cycloplegia, the spherical power was comparable between retinoscopy and autorefractometry (1.12 ± 1.37 D vs 1.22 ± 1.06D, P = 0.70), cylinder power was significantly more myopic on retinoscopy than autorefractometry (0.80 ± 1.10D vs − 0.62 ± 0.66, P = 0.019), and SE was greater on autorefractometry than retinoscopy (0.91 ± 1.10D vs 0.72 ± 1.00D, P = 0.014). Retinoscopy and autorefractometry overestimated the power of spherical (P = 0.022 and 0.002, respectively) and cylindrical components (all P < 0.001). There was an agreement between retinoscopy and autorefractometry in measuring spherical (bias: 0.09 ± 0.16D; limit of agreement, LoA: − 0.40 to 0.22D) and cylindrical power (bias: − 0.18 ± 0.20D; LoA: − 0.57 to 0.21D). Subjective refraction agreed with cycloplegic retinoscopy for determining SE power (bias: 0.11D; LoA: − 0.51 to 0.73D).Conclusion: Retinoscopy and autorefractometry can be used interchangeably in children for determining the power of spherical and cylindrical components. Cycloplegic retinoscopy is better than autorefractometry to obtain SE reference values for subjective refraction in children.Keywords: retinoscopy, autorefractometry, subjective refraction, agreement

Purpose: To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation.Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4–12 weeks after surgery.66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D).Using modern formulas, or even AI formulas, for IOL calculation in children’s eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this.Methods: To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation.Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4–12 weeks after surgery.66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D).Using modern formulas, or even AI formulas, for IOL calculation in children’s eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this.Results: To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation.Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4–12 weeks after surgery.66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D).Using modern formulas, or even AI formulas, for IOL calculation in children’s eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this.Conclusion: To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation.Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4–12 weeks after surgery.66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D).Using modern formulas, or even AI formulas, for IOL calculation in children’s eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this. [ABSTRACT FROM AUTHOR]

This study explored whether retinoscopy (RET) provides comparable results of relative peripheral refraction (RPR) to open–field autorefractometry (AR) in myopic subjects. Peripheral refraction was measured in 20 myopic and 20 control adult subjects. Both central and peripheral refraction (20° nasal and temporal eccentricity) were measured using RET and open-field AR. Differences in the median central spherical equivalent (SE), median RPR, and median J45/J180 power vectors between the RET and AR techniques were analyzed. Moreover, Bland – Altman plots were used to assess the agreement between RET and AR methods for RPR measurements in MG. For MG, the median RPR values were positive (hyperopic shift), and no significant differences were observed between the RET and AR techniques with respect to RPR measurement. In addition, we did not observe any significant differences in the RPR values between the nasal and temporal eccentricities for either the RET or AR technique for myopic subjects. There was also a significant correlation and agreement between the RET and AR technique for RPR measurements. With respect to central refraction, the median SE was slightly more positive for the RET than for the AR technique. Inside the CG, we also found significant correlation between the RET and AR technique for RPR measurements, and we observed a myopic shift in peripheral eccentricities. Our results show that retinoscopy may be a useful tool for objective measurements of RPR in myopic subjects and may be used interchangeably with the open-field AR method in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate peripapillary-RNFL thickness in myopia by Cirrus OCT among north Indian population by spherical equivalent (SE), age, gender, and axial length (AL).Methods: This was a cross-sectional study held during 2019-2020. Patients aged 18-60 years underwent ophthalmic examination including retinoscopy, AL, and OCT RNFL thickness. Persons with previous ocular surgery or ocular ailment other than refractive error were excluded. The peripapillary-RNFL thickness was noted and compared by demographic determinants.Results: We examined 300 eyes of 300 persons (mean age: 30.75 ± 8.57 years; 144 males/156 females). Among them, 224 were myopes and 76 were emmetropes (EM). The mean SE was - 3.3 ± 0.4D (range: -11.0D to + 0.37D). The mean AL was 24.61 ± 1.92 mm (22.1-29.5). Overall temporal, nasal, superior, inferior, and mean peripapillary-RNFL thickness was 66.31 ± 7.58, 78.57 ± 16.00, 120.63 ± 11.69, 116.60 ± 15.80, and 95.50 ± 10.84 μm, respectively. Temporal, nasal, superior, inferior, and mean peripapillary-RNFL thickness was 73.97 ± 8.36, 94.84 ± 7.63, 127.96 ± 8.96, 136.89 ± 6.53, and 108.34 ± 6.28 μm, respectively, in EM eyes as compared to 63.71 ± 6.18, 73.05 ± 14.24, 118.21 ± 11.53, 109.71 ± 11.50, and 91.14 ± 8.31 μm, respectively, in myopic eyes (P < 0.001). Association of peripapillary-RNFL thickness with myopia and its different grades was P < 0.001. Association of mean peripapillary-RNFL thickness with age was P > 0.005 and gender was P = 0.168. Correlation between SE and RNFL thickness was positive and significant. Correlation between AL and RNFL thickness was negative but statistically significant. Association of AL with SE was P < 0.001.Conclusion: We provide normative peripapillary-RNFL thickness in the north Indian population in order to help in screening for myopia with comorbidity such as glaucoma based on RNFL thickness. [ABSTRACT FROM AUTHOR]

BACKGROUND: Handheld autorefractometers are now widely used for screening refractive errors in children. The purpose of the study was to compare the refractive measurements from table-mounted, handheld autorefractometers and retinoscopy in children. MATERIAL AND METHODS: Measurements in children with poor visual acuity and/or strabismus were obtained with the handheld 2WIN and the table-mounted Nidek ARK-1 refractometers and retinoscopy after the instillation of 0.5% atropine. Data on the sphere, spherical equivalent (SE), and cylindrical vectors at 0 degrees (J0) and 45 degrees (J45) were analysed. RESULTS: Data were collected from 57 children (mean age, 4.3 years ± 2.0 years). The 2WIN refractometer measured statistically significantly lower SE mean values than the Nidek ARK-1 or retinoscopy (1.67 ± 1.48 D, 2.96 ± 1.95 D, 2.92 ± 1.93 D, respectively). The 95% LOA was the narrowest for sphere, SE, J0, and J45 vector for Nidek ARK-1 refractometer and retinoscopy. The difference between the measurements of 2WIN and retinoscopy and 2WIN and Nidek ARK-1 was more pronounced in higher refractive values for sphere, SE, J0, and J45. CONCLUSION: The table-mounted autorefractor provided a reading more similar to that of streak retinoscopy than to that of the handheld autorefractor. The differences between the 2WIN and the other two methods were more pronounced in the higher refractive values, so careful interpretation of the autorefraction results would be advised, especially in children with higher refractive values who are at most significant risk for amblyopia. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the accuracy and effectiveness of noncycloplegic and cycloplegic autorefraction using two types of autorefractors (ARs) compared with retinoscopy in children and adolescents. Methods: This cross-sectional study included 308 students (6–17 years old) from eastern Taiwan. Noncycloplegic and cycloplegic refractive measurements were obtained using open-field AR (Shin-Nippon NVision-K 5001), closed-field AR (Topcon KR-800), and cycloplegic retinoscopy. Three optical components emerged from the measurements: spherical equivalent (M) and two Jackson cross-cylinder values (J0 and J45). Agreement between both ARs and retinoscopy was evaluated using intraclass correlation coefficient. Measurement discrepancies from retinoscopy among different ARs and cycloplegic status were compared using repeated measures ANOVA and receiver operating characteristic curve analysis. Results: Compared with retinoscopy, measurements obtained before and after cycloplegia with both ARs showed excellent reliability for evaluating M and J0 and fair to good results for J45. More myopic results were obtained using KR-800 before cycloplegia; more hyperopic results were obtained using KR-800 and NVision-K 5001 after cycloplegia(all p

Importance: Increased myopic shift was found to be associated with 1 year of overminus spectacle treatment for children with intermittent exotropia (IXT). Persistence of myopic shift after discontinuing overminus spectacles is unknown., Objective: To compare refractive error change over 3 years in children with IXT originally treated with overminus vs nonoverminus spectacles., Design, Setting, and Participants: This study was an 18-month extension of the Trial of Overminus Spectacle Therapy for Intermittent Exotropia cohort, which previously randomized children aged 3 to 10 years with IXT and baseline spherical equivalent refractive error (SER) between -6.00 diopters (D) and 1.00 D to overminus spectacles (-2.50 D for 12 months, -1.25 D for 3 months, and nonoverminus for 3 months) or nonoverminus spectacles. Children were recruited from 56 sites from July 2010 to February 2022. Data were analyzed from February 2022 to January 2024., Interventions: After trial completion at 18 months, participants were followed up at 24 and 36 months. Treatment was at investigator discretion from 18 to 36 months., Main Outcomes and Measures: Change in SER (cycloplegic retinoscopy) from baseline to 36 months., Results: Of 386 children in the Trial of Overminus Spectacle Therapy for Intermittent Exotropia, 223 (57.8%) consented to 18 months of additional follow-up, including 124 of 196 (63.3%) in the overminus treatment group and 99 of 190 (52.1%) in the nonoverminus treatment group. Of 205 children who completed 36-month follow-up, 116 (56.6%) were female, and the mean (SD) age at randomization was 6.2 (2.1) years. Mean (SD) SER change from baseline to 36 months was greater in the overminus group (-0.74 [1.00] D) compared with the nonoverminus group (-0.44 [0.85] D; adjusted difference, -0.36 D; 95% CI, -0.59 to -0.12; P = .003), with 30 of 112 (26.8%) in the overminus group having more than 1 D of myopic shift compared with 14 of 91 (15%) in the nonoverminus group (risk ratio, 1.8; 95% CI, 1.0-3.0). From 12 to 36 months, mean (SD) myopic shift was -0.34 (0.67) D and -0.36 (0.66) D in the overminus and nonoverminus groups, respectively (adjusted difference, -0.001 D; 95% CI, -0.18 to 0.18; P = .99)., Conclusions and Relevance: The greater myopic shift observed after 1 year of -2.50-D overminus lens treatment remained at 3 years. Both groups had similar myopic shift during the 2-year period after treatment weaning and cessation. The risk of myopic shift should be discussed with parents when considering overminus lens treatment., Trial Registration: ClinicalTrials.gov Identifier: NCT02807350.

PURPOSE: School eye screening program is an integrated part of SarvaShikshyaAbhiyan. Distance visual acuity was the only tool used in such school eye screening for making referrals. We aim to evaluate the referral rate when only distance visual acuity was used as the screening tool versus using retinoscopy. METHODS: School children were earlier screened using distant visual acuity as the sole criteria. They were again examined as per the guidelines recommended by State of Alaska and American Academy of Pediatrics, and the results of the two examinations were compared. Microsoft Excel 2007 was used for the statistical analysis. RESULTS: Earlier 384 school children of class first to fourth (aged 6-10 years) had been screened using distant visual acuity. Of them, 87 (22.6%) were referred. The rest 297 (male 183 61.6%) students with a mean age of 7.8 years (standard deviation ± 1.23) were again examined and 42/384 (11%) were detected as having visual anomaly that were false negative/or missed during the initial screening. Refractive errors were detected in 33/42 (78.6%) students by retinoscopy. Retinoscopy showed the highest sensitivity (78.6%) and negative predictive value (96.6%) to detect all types of refractive error among all types of tests. Of 42 pair of eyes, 36 right eyes and 39 left eyes had refractive errors, mostly astigmatic, or hyperopic, which were missed earlier. CONCLUSION: Only distance visual acuity failed to detect hyperopia and astigmatism properly. Introduction of retinoscopy would increase the validity of school eye screening. [ABSTRACT FROM AUTHOR]

Objective: Comparing refractive values determined by two photorefractory devices (Plusoptix® A09, GmbH, Nuremberg, Germany and SureSight®, Welch Allyn Co, New York, USA) with refractive values obtained by skiascope after cycloplegia with 1% cyclopentolate hydrochloride in healthy children. Methods: Cases aged between 48 and 132 months were evaluated for this cross-sectional study. Cases with no ophthalmic pathology in both eyes and uncorrected visual acuity of 1.0 were included in the study. In all cases, refractive measurements were performed first with Plusoptix® and then with SureSight®. After providing cycloplegia with 1% cyclopentolate hydrochloride, skiascopy was performed. The correlation between the measurements obtained was evaluated with the Pearson correlation coefficient, and the compatibility was evaluated with the Bland-Altman analysis. Results: The mean spherical values of 52 subjects measured by cycloplegic skiascopy, Plusoptix® and SureSight® were 0.88±2.07 dioptry (D), 0.69±1.78D and 1.64±1.06D, respectively; mean of cylindrical measurements are -0.73±0.68D, -0.92±0.67D and -0.83±0.70D, respectively. Comparing Plusoptix® with skiascopy, SureSight® with skiascopy, Plusoptix® with SureSight® measurements, a high positive correlation was found between spherical values (r=0.861, r=0.736, r=0.721, respectively); a positive correlation was also found between cylindrical values (r=0.602, r=0.675, r=0.901, respectively). Skiascopic spherical and cylindrical measurements with Plusoptix®, and skiascopic spherical and cylindrical measurements with SureSight® were found to be compatible with each other (within 95% confidence interval, lower limit: -2.65, upper limit: 1.89; lower limit: -1.35, upper limit: 0.95; lower limit: -3.56, upper limit: 2.06; lower limit: -1.20, upper limit: 0.98). Spherical and cylindrical measurements obtained with Plusoptix® and SureSight® were found to be consistent with each other (within 95% confidence interval, lower limit: -3.39, upper limit: 1.49; lower limit: -0.67, upper limit: 0.51). Conclusion: It was concluded that the results of these three measurements in childhood were compatible with each other. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the refractive error of the uncooperative infants and children with the new method of retinoscopy called the tele-lens ("Mirza") retinoscopy. In the "Mirza" tele-lens retinoscopy, the examiner placed the trial lenses in 1/3 distance between the tested eye person and peephole of the retinoscope (22.2 cm far from the spectacle plane). First, the optical calculations were done to find the correction factors for this new method of retinoscopy. Second, the dry standard and "Mirza" tele-lens retinoscopy were performed in 78 eyes from 39 children aged 7–12 years with good cooperation and next, the procedure was repeated using cyclopentolate drops and then the results of the two methods were compared, and at the end, the dry "Mirza" tele-lens retinoscopy was done in the 60 eyes of 31 uncooperative infants with a mean age of 21.85 ± 8.79 months for evaluating the feasibility of the "Mirza" tele-lens retinoscopy procedure. The intraclass correlation coefficient (ICC) and Bland–Altman plot for assessment of agreement between the findings of two retinoscopic methods in dry and cyclo conditions were used. The comparison between the dry standard and "Mirza" tele-lens retinoscopic results with means of 1.39 ± 1.43 and1.36 ± 1.39, respectively were not statistically significant (p > 0.05). Besides, comparing the mean cycloplegic results of two methods (standard vs. "Mirza" tele-lens), the difference was not statistically significant (2.37 ± 1.44 vs. 2.41 ± 1.37) (p > 0.05). Moreover, Two-way repeated measures ANOVA revealed no significant retinoscopy method × use of drops interaction (P = 0.103) in comparing two methods of the standard and "Mirza" tele-lens retinoscopy. ICC results indicated high agreement between two methods in both dry (ICC = 0.993) and cyclo (ICC = 0.989) conditions. The "Mirza" tele-lens retinoscopy method can be performed with satisfactory results in infants and children who do not cooperate for the standard procedure of measuring the refractive errors. [ABSTRACT FROM AUTHOR]

To assess differences in a new objective metric obtained with a double-pass technique between a group with accommodation insufficiency (AI) and a control group and to explore the diagnostic capabilities of this new tool in comparison to conventional procedures. Retrospective cross-sectional case-control phase 1 study. Two groups with ages ranging from 8 to 18 years were recruited: AI and control group. The diagnostic criterion of AI was based on monocular accommodative amplitude (AA), 2 D below Hofstetter's calculation for minimum AA, and monocular accommodative facility (MAF), failing with minus lens and cut-off at ≤ 6 cycles per minute. Accommodative response with a double pass device (HD Analyzer, Visiometrics) was measured, performing an evaluation from +1.00 D to −3.50D (−0.5D steps), offering the width of the profile at 50% (WP) in minutes of arc. Differences were found between groups for the AA, MAF and MEM retinoscopy (p < 0.0001, p < 0.001, p = 0.037). The discriminative capacity of MEM retinoscopy for AI diagnosis was significant and the cut-off that maximized the sensitivity and specificity was > 0.5 D. Considering WP 50% in different points, the discriminative AI diagnosis capacities for the points of 2.0 D and 2.50 D were significant (ROC-AUC 0.78; p = 0.03 and p = 0.02). Double-pass system metric differed between patients with AI and control group, therefore the aim of a Phase I study was achieved. Further steps with higher sample sizes are required to evidence if the system really provides any advantage versus conventional methods in the diagnosis of AI. [ABSTRACT FROM AUTHOR]