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Jacob David Schaafsma,1 Robert W Arnold2 1School of Medicine, University of Milan, Milan, Italy; 2Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USACorrespondence: Robert W Arnold, Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche Street &num;280, Anchorage, AK, 99508, USA, Tel +1(907)561-1917, Fax +1(907)563-5373, Email eyedoc@alaska.netBackground: 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.Keywords: sphero-cylinder, refraction, autorefraction, photoscreening, developmental delay

Abstract Purpose To evaluate objective and subjective refraction differences in healthy young adults. Methods Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. Results This study included 1,395 young adult participants. The average age was 22.17 years (range, 17–39, 84.8% males). The average SE was − 0.65 ± 1.19 diopter (D) compared with − 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p

Purpose: To evaluate objective and subjective refraction differences in healthy young adults. Methods: Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. Results: This study included 1,395 young adult participants. The average age was 22.17 years (range, 17–39, 84.8% males). The average SE was − 0.65 ± 1.19 diopter (D) compared with − 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p < 0.001). This difference was more common in older participants (p < 0.001). J0 and J45 value differences were not significant. The absolute SE value of subjective refraction was lower in the myopic (p < 0.001) and hyperopic (p < 0.001) patients. Conclusions: Young hyperopic participants tended to prefer "less plus" in subjective refraction compared with autorefraction. Young myopic participants tended to prefer "less minus" in subjective refraction compared with autorefraction. All participants, but mainly older participants, preferred slightly "less Cp" than that measured using autorefraction; The astigmatic axis did not differ significantly between the methods. [ABSTRACT FROM AUTHOR]

Abstract Purpose By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening. Methods Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland–Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A. Results The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P 0.05), but there were significant differences in the SE and DS (P

AIM: To compare the subjective refraction data with non-cycloplegic auto-refraction findings in the geriatric population above 60 years of age according to the different crystalline lens conditions. METHODS: This report is a part of the Tehran Geriatric Eye Study (TGES) that was conducted from January 2019 to January 2020 on elderly population 60 years of age and above in Tehran. The samples were selected by multi-stage stratified random cluster sampling. Of 3791 individual invitees, 3310 (response rate: 87.3%) participated in this study. All study participants underwent non-cycloplegic auto-refraction (auto-refractometer/keratometer Nidek ARK-510) and subjective refraction. RESULTS: Regarding the sphere, eyes with mixed cataract had the worst limits of agreement (LoA: -1.24 to 0.87) and the best agreement was related to the pseudophakic eyes (LoA: -0.83 to 0.54). The highest (0.27±0.31 D) and lowest (0.21±0.27 D) differences between the two methods regarding the cylinder power were observed in eyes with cortical cataract and normal eyes, respectively. The worst LoA between the two methods in measuring the cylinder power was related to the eyes with mixed cataract (LoA: -0.44 to 0.96). Regarding the J0 (horizontal/vertical components of astigmatism), the mean values of J0 obtained by auto-refraction were tended more toward against the rule direction in all crystalline lens conditions, and the two methods had the greatest difference in cortical cataract cases (0.05±0.17 D). Regarding the J45 (oblique components of astigmatism), the lowest (0±0.11 D) and highest (-0.01±0.12 D) differences were observed in normal eyes and eyes with cortical cataract, respectively. CONCLUSION: The auto-refractometer/keratometer Nidek ARK-510 results in the elderly with different phakic and pseudophakic conditions do not correspond well with subjective refraction findings. This discrepancy in spherical findings is more pronounced in individuals with mixed cataract than in other cases.

Purpose: To evaluate and compare the objective refractions obtained by autorefraction and aberrometry under different lighting conditions with an isofocal intraocular lens (Isopure, BVI medical, Liége, Belgium) compared to a monofocal control lens (Micropure, BVI medical, Liége, Belgium) with the same platform and material. Methods: Prospective, comparative and randomized study on patients undergoing cataract surgery and bilateral isofocal or monofocal IOL implantation. A total of 44 subjects were randomly assigned to either the isofocal group (n = 22) or the Micropure (n = 22). Manifest refraction (MR) was always performed under the same lighting conditions for all the patients. For objective refraction the autorefractor KR8800 and the aberrometer OPD-Scan III (Nidek Inc., Tokyo, Japan.) were used. For each eye included in the study, six result sets were collected: MR, AR (autorefraction measured with the autorefractor), WF-P and WF-M (Zernike-coefficients-based objective refraction, photopic and mesopic pupil size), OPD-C and OPD-M (autorefraction measured with the aberrometer in photopic and mesopic conditions). Results: The mean sphere for MR was 0.03 ± 0.32D for the Isopure group and 0.24 ± 0.22D for the monofocal group (p = 0.013). For the Isopure group, Friedman analysis showed statistically significant differences for sphere measured with WF-P (p = 0.035), WF-M (p = 0.018) and OPD-M (p = 0.000), and SE measured with OPD-M (p = 0.004). In the Micropure lens group, the Friedman analysis showed differences for all values studied (p < 0.05). Correlation coefficients showed that AR is the objective method with the strongest correlation values for all components of refraction for both groups. Conclusion: The modification of the surfaces of the isofocal lens does not have a negative impact on the refraction obtained by AR compared to a standard monofocal intraocular lens. [ABSTRACT FROM AUTHOR]

Purpose: To compare axial length (AL) and corneal radius (CR) measured with the Oculus Myopia Master and the Zeiss IOLMaster 700, and cycloplegic refractive error measured with the Myopia Master and the Huvitz Auto Ref/Keratometer (HRK‐8000A). Methods: The study included both eyes of 74 participants (16 male), with a mean (SD) age of 22.8 (3.7) years. The parameters indicated were measured under cycloplegia with these instruments: Myopia Master (AL, CR and refractive error), IOLMaster 700 (AL and CR) and HRK‐8000A (refractive error and CR). Bland–Altman plots with mixed effects 95% limits of agreement (LoA) and corresponding 95% confidence intervals were used to assess the agreement in ocular biometry between the Myopia Master and the IOLMaster 700, and for refractive error between the Myopia Master and the HRK‐8000A. Results: The analysis included 139 eyes, of which 52 were myopic (spherical equivalent refractive error, SER ≤ −0.50 D), 32 emmetropic and 55 hyperopic (SER ≥ 0.50 D). The 95% LoA for AL between the Myopia Master and IOLMaster 700 was −0.097 to 0.089 mm. There was no mean difference in AL [mean (SD) = −0.004 (0.047) mm, p = 0.34]. There was a significant difference in mean CR, with that measured with the Myopia Master being flatter than that found with the IOLMaster 700 [0.035 (0.028) mm, p < 0.001]. The 95% LoA for CR was −0.02 to 0.09 mm. Compared with HRK‐8000A, the Myopia Master measured a significantly more negative SER [−0.19 (0.33) D, p < 0.001], with 95% LoA of −0.86 to 0.46 D. Conclusion: The LoA for measurements of SER, CR and AL when comparing the Myopia Master with the HRK‐8000A and the IOLMaster 700 were wider than deemed acceptable for making direct comparisons. This indicates that the instruments cannot be used interchangeably in clinical practice or research. [ABSTRACT FROM AUTHOR]

Autorefraction is an objective way to determine the refractive error of the eye, without the need for feedback by the patient or a well-educated practitioner. To make refractive measurements more accessible in the background of the growing prevalence of myopia, a compact autorefractor was built, containing only few optical components and relying on double-pass imaging and the physical properties of the point-spread function and digital image processing instead. A method was developed to analyze spherical defocus as well as the defocus and angle of astigmatism. The device was tested using calibrator eye models in a range of ± 15 D spherical defocus and − 3 D astigmatic defocus. Reliable results could be achieved across the whole measurement range, with only a small increase in deviation toward high values of refractive errors, showing the feasibility of a PSF-based approach for a compact and low-cost solution for objective measurements of refractive error. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare central and peripheral refraction using an open view Shin-Nippon NVision-K 5001 autorefractor and an open view COAS-HD VR aberrometer in young children. Cycloplegic central and peripheral autorefraction was measured in the right eye of 123 children aged 8 to 16 years. Three measurements each were obtained with both Shin-Nippon NVision-K 5001 autorefractor and COAS-HD VR aberrometer along the horizontal visual field up to 30° (nasal and temporal) in 10° steps. The refraction from the autorefractor was compared with aberrometer refraction for pupil analysis diameters of 2.5-mm and 5.0-mm. The Shin-Nippon was 0.30 D more hyperopic than COAS-HD VR at 2.5-mm pupil and 0.50 D more hyperopic than COAS-HD VR at 5-mm pupil for central refraction. For both pupil sizes, the 95% limits of agreement were approximately 0.50 D for central refraction, and limits were wider in the nasal visual field compared to the temporal visual field. The mean difference for both J 0 and J 45 were within 0.15 D and the 95% limits of agreement within 0.90 D across the horizontal visual field. Defocus components were similar between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 2.5-mm pupil for most visual field angles. However, there was a significant difference in defocus component between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 5.0-mm pupil, wherein the autorefractor measured more hyperopia. The astigmatic components J 0 and J 45 were similar between instruments for both central and peripheral refraction. [ABSTRACT FROM AUTHOR]

The purpose of this article is to explore alternative ways of achieving optimal correction for myopic children who cannot cooperate to subjective manifest refraction (SR). The study included myopic children aged 9–12 years who underwent non-cycloplegic SR and autorefraction with and without cycloplegia using the Shin-Nippon Nvision-K 5001 autorefractor (AR) as well as non-cycloplegic autorefraction using the Topcon KR-800S AR. There were 21 children (mean age, 10.62 years) included. The spherical equivalent refractive error of SR was not significantly different from that of non-cycloplegic AR measurements, but it was significantly different from that of cycloplegic Shin-Nippon Nvision-K 5001 measurements (p < 0.001). Compared with SR, cycloplegic Shin-Nippon Nvision-K 5001 measured a less myopic refractive error (median: −2.44 D vs. −2.88 D, p < 0.001). For both ARs, the axis measurements and astigmatic dioptre values between SR and autorefraction were not significantly different. Compared with non-cycloplegic SR, cycloplegic measurements showed a lesser degree of myopic refractive error. There was no significant difference between SR and non-cycloplegic autorefraction. Therefore, the Topcon KR-800S and the Shin-Nippon Nvision-K 5001 ARs may be useful for prescribing glasses in myopic children who cannot cooperate during SR. However, caution should be taken with cylinders

To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences. Cross-sectional, retrospective study. Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye. Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least –0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models. Differences between noncycloplegic and cycloplegic autorefraction measurements. The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18–1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18–1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10–1.36) and those with hyperopia (OR range, 4.20–13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild–moderate–high myopia or moderate–high hyperopia. Three quarters of school-aged individuals had < 1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the necessity of cycloplegia for epidemiological studies of refraction in Chinese young adults (aged 17–22 years) with dark irises, and to compare the cycloplegic effects of 1% cyclopentolate and 0.5% tropicamide in them. Methods A total of 300 young adults (108 males and 192 females) aged 17 to 22 years (mean 19.03 ± 1.01) were recruited from Tianjin Medical University from November 2019 to January 2020. Participants were randomly divided into two groups. In the cyclopentolate group, two drops of 1% cyclopentolate eye drop were administrated (one drop every 5 min), followed by autorefraction and subjective refraction 30 to 45 min later. In the tropicamide group, four drops of 1% Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) eye drop were given (one drop every 5 min), followed by autorefraction and subjective refraction 20 to 30 min later. The participants and the examiners were masked to the medication. Distance visual acuity, intraocular pressure (IOP), non-cycloplegic and cycloplegic autorefraction (Topcon KR-800, Topcon Co. Tokyo, Japan), non-cycloplegic and cycloplegic subjective refraction and ocular biometry (Lenstar LS-900) were performed. Results The values of spherical equivalent (SE) and sphere component were significantly different before and after cycloplegia in the cyclopentolate group and the tropicamide group (p 0.05). In each group, no significant difference was found between autorefraction and subjective refraction after cycloplegia (p > 0.05). We also found that more positive or less negative cycloplegic refraction was associated with the higher difference in SE in each group. Conclusions Cycloplegic refractions were generally more positive or less negative than non-cycloplegic refractions. It is necessary to perform cycloplegia for Chinese young adults with dark irises to obtain accurate refractive errors. We suggest that cycloplegic autorefraction using tropicamide may be considered as a reliable method for epidemiological studies of refraction in Chinese young adults with dark irises. Trial registration The study was registered on September 7, 2019 (Registration number: ChiCTR1900025774 ).

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AIM: To evaluate the effectiveness of Grand Seiko Ref/Keratometer WAM-5500 compared to Topcon KR800 autorefractor in detecting refractive error in large scale vision screening for Chinese school age children with the WHO criteria. METHODS: A total of 886 participants were enrolled with mean age of 9.49±1.88y from Tianjin, China. Spherical equivalent (SE) was obtained from un-cycloplegic autorefraction and cycloplegic autorefraction. Topcon KR 800 (Topcon) and Grand Seiko WAM-5500 (WAM) autorefractors were used. Bland-Altman Plot and regression were generated to compare their performance. The overall effectiveness of detecting early stage refractive error was analyzed with receiver operating characteristic (ROC) curves. RESULTS: The mean SE was -0.98±1.81 diopter (D) and the prevalence of myopia was 48.9% defined by WHO criteria according to the result of cycloplegic autorefraction. The mean SE of un-cycloplegic autorefraction with Topcon and WAM were -1.21±1.65 and -1.20±1.68 D respectively. There was a strong linear agreement between result obtained from WAM and cycloplegic autorefraction with an R2 of 0.8318. Bland-Altman plot indicated a moderate agreement of cylinder values between the two methods. The sensitivity and specificity for detecting hyperopia were 90.52% and 83.51%; for detecting myopia were 95.60% and 90.24%; for detecting astigmatism were 79.40% and 90.21%; for detecting high myopia were 98.16% and 98.91% respectively. CONCLUSION: These findings suggest that both Grand Seiko and Topcon autorefractor can be used in large-scale vision screening for detecting refractive error in Chinese population. Grand Seiko gives relatively better performance in detecting myopia, hyperopia, and high myopia for school age children.

Autorefraction is an objective way to determine the refractive error of the eye, without the need for feedback by the patient or a well-educated practitioner. To make refractive measurements more accessible in the background of the growing prevalence of myopia, a compact autorefractor was built, containing only few optical components and relying on double-pass imaging and the physical properties of the point-spread function and digital image processing instead. A method was developed to analyze spherical defocus as well as the defocus and angle of astigmatism. The device was tested using calibrator eye models in a range of ± 15 D spherical defocus and −3 D astigmatic defocus. Reliable results could be achieved across the whole measurement range, with only a small increase in deviation toward high values of refractive errors, showing the feasibility of a PSF-based approach for a compact and low-cost solution for objective measurements of refractive error.

Background: To evaluate the necessity of cycloplegia for epidemiological studies of refraction in Chinese young adults (aged 17-22 years) with dark irises, and to compare the cycloplegic effects of 1% cyclopentolate and 0.5% tropicamide in them.Methods: A total of 300 young adults (108 males and 192 females) aged 17 to 22 years (mean 19.03 ± 1.01) were recruited from Tianjin Medical University from November 2019 to January 2020. Participants were randomly divided into two groups. In the cyclopentolate group, two drops of 1% cyclopentolate eye drop were administrated (one drop every 5 min), followed by autorefraction and subjective refraction 30 to 45 min later. In the tropicamide group, four drops of 1% Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) eye drop were given (one drop every 5 min), followed by autorefraction and subjective refraction 20 to 30 min later. The participants and the examiners were masked to the medication. Distance visual acuity, intraocular pressure (IOP), non-cycloplegic and cycloplegic autorefraction (Topcon KR-800, Topcon Co. Tokyo, Japan), non-cycloplegic and cycloplegic subjective refraction and ocular biometry (Lenstar LS-900) were performed.Results: The values of spherical equivalent (SE) and sphere component were significantly different before and after cycloplegia in the cyclopentolate group and the tropicamide group (p < 0.05). The mean difference between noncycloplegic and cycloplegic autorefraction SE was 0.39 D (±0.66 D) in the cyclopentolate group and 0.39 D (±0.34 D) in the tropicamide group. There was no significant difference in the change of SE and sphere component after cycloplegia between the cyclopentolate group and the tropicamide group (p > 0.05). In each group, no significant difference was found between autorefraction and subjective refraction after cycloplegia (p > 0.05). We also found that more positive or less negative cycloplegic refraction was associated with the higher difference in SE in each group.Conclusions: Cycloplegic refractions were generally more positive or less negative than non-cycloplegic refractions. It is necessary to perform cycloplegia for Chinese young adults with dark irises to obtain accurate refractive errors. We suggest that cycloplegic autorefraction using tropicamide may be considered as a reliable method for epidemiological studies of refraction in Chinese young adults with dark irises.Trial Registration: The study was registered on September 7, 2019 (Registration number: ChiCTR1900025774 ). [ABSTRACT FROM AUTHOR]

Objective: To evaluate time of maximum cycloplegia in myopic children with brown irises and to study differences between refractive error after maximum cycloplegia measured by retinoscopy and autorefraction. Materials and Methods: The present study was a prospective descriptive study included myopic children with brown irises aged 5 to 14 years. Cycloplegic refraction was performed using cyclopentolate 1%, three times, ten minutes apart. Refractive error was measured by autorefraction before and at 30, 40, 50, 60, 70, and 80 minutes after the first instillation of cyclopentolate. Finally, retinoscopy was performed by a single examiner at 80 minutes. Time of maximum cycloplegia was determined from the time point at which the 95% confidence interval of the differences between the mean spherical equivalent (SE) at each point and its final value at 80 minutes was reached and remained within the equivalence limit (±0.25 D). Difference between SE of retinoscopy and autorefraction was evaluated. Results: Sixty-eight children were recruited. The mean age was 10.5 years (SD 2.4). Thirty-seven children were male (54%). The time of maximum cycloplegia was 30 minutes after the first instillation of cyclopentolate. At 80 minutes, the degree of myopia measured by autorefraction was significantly higher compared to those measured by retinoscopy (p<0.001, mean difference 0.26 D). Conclusion: Time of maximum cycloplegia in myopic children with brown irises was 30 minutes after the first instillation of cyclopentolate. Even when the maximum cycloplegia was reached, the degree of myopia measured by autorefraction was higher than that measured by retinoscopy. [ABSTRACT FROM AUTHOR]

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The main aim of this study was to compare refraction measurements with and without cycloplegia from two refractors devices, (TRK-2P autorefractometer (TRK-2P) and wavefront-based refraction Visionix 130 (VX130)) in children and adolescents. This descriptive observational study included 20 myopic eyes and 40 hyperopic eyes measured in two different Spanish hospitals. Cycloplegia was carried out by three drops of cyclopentolate hydrochloride 1% (Colircusí cycloplegic, Alcon Healthcare S.A., Barcelona). The mean age of the myopia group was 12.40 ± 3.48 years; for the hyperopia group, the mean age was 7.37 ± 2.47 years. In the myopia group, autorefraction and wavefront-based refraction did not show clinically significant differences in any components between with and without cycloplegia. The hyperopia group showed statistical and clinically significant differences in sphere and SE components between relaxed and non-relaxed states of accommodation, although the cylindrical components were not clinically different. In this study, we considered a value of ≥0.50D as a clinically significant difference in refraction. Therefore, both devices were capable of obtaining accurate refractions without cyclopegia in myopia children, although they did not avoid instrument myopia and accommodation involved in hyperopia children. Moreover, both refractometers could be useful for astigmatism monitoring in children without the need for cycloplegic drops.

Purpose: To determine repeatability and agreement of the ARK-30 handheld autorefractor with retinoscopy under cycloplegic and noncycloplegic conditions in children. Methods: Three consecutive autorefractor measurements (with and without cycloplegia) and retinoscopy were performed and compared in 30 randomized eyes of 30 children (mean age of 6.7 ± 2.7 years with spherical equivalent [SE] refraction from ‒4.01 to +7.38 D) in a cross-section and masked study. Bland–Altman analysis of autorefractor measurements (with and without cycloplegia) and agreement with retinoscopy were calculated with conventional notation (sphere [Sph] and cylinder [Cyl]) and vector notation (SE, J0, and J45coefficients). Results: ARK-30 measurements without cycloplegia were lower than under cycloplegic conditions (Sph: ‒0.52 ± 2.37 D vs + 0.86 ± 2.60 D, P < 0.01; Cyl: ‒0.83 ± 0.80 D versus ‒0.78 ± 0.77 D, P = 0.37; and SE: ‒0.94 ± 2.19 D vs + 0.47 ± 2.44 D, P < 0.01, respectively) and statistically different (P < 0.03) from retinoscopy (Shp: +0.83 ± 2.66 D; Cyl: ‒0.71 ± 0.87 D; SE: +0.51 ± 2.49 D). Without statistical differences were in J0and J45coefficients. Cyloplegic autorefraction measures were not found to be statistically significantly different to retinoscopy measures. ARK-30 under cycloplegia shows better repeatability with lower limits of agreement (LoA) in Sph (LoA: ‒0.66 to +0.69 D), and SE (LoA: ‒0.66 to +0.65 D) than without cycloplegia (LoA: ‒1.45 to +1.77 D, and ‒1.38 to +1.74 D, respectively). Conclusion: Under noncycloplegic conditions, ARK-30 autorefractor has low repeatability and a tendency toward minus over correction in children. However, repeatability and agreement with retinoscopy under cycloplegic conditions allow use of ARK-30 in children to estimate refraction but not to substitute gold standard retinoscopic refraction.

AIM: To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). METHODS: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

• To measure precise refractive and keratometric measurements are mandatory in refractive surgery. • Many devices have been used to examine refractive status and corneal curvature. • Use of wavefront aberrometer-derived objective refractive measurements remain controversial. • Wavefront devices using the dynamic skiascopy method are not compatible with table-top autorefractometer. This study aimed to compare objective refractive errors and keratometry measurements obtained using the Nidek OPD-Scan II aberrometer/topographer and Topcon KR 8900 autorefractokeratometer. The right eye medical records of 176 patients aged 18-35 years who were admitted to our clinic as refractive surgery candidates were tested for refractive status and keratometry measurements with a Nidek OPD-Scan II aberrometer/topographer and a standard table-top autorefractokeratometer (Topcon KR 8900) before and after the induction of cycloplegia. Patients who had undergone any eye surgery and had hereditary, ectatic, or acquired corneal pathology were excluded. Refractive data were compared as spheres, cylinders, spherical equivalents, and power vectors before and after the induction of cycloplegia. Flat and steep keratometry (K1-K2) readings were recorded in diopters (D) and axis degrees, respectively, for each eye. The spherical, cylindrical, spherical equivalence, J0-J45 vector values and K1-K2 readings (D, axis) between the two devices were statistically significant before and after the induction of cycloplegia (p<0.05). Bland-Altman analysis identified mean differences (95%CI of limits of agreement) of 0.77 (-0,57 to 2,11) in sphere, 0.74 (-0,54 to 2,01) in spherical equivalent, -0,07 (-0,41 to 0,26) in J0 vector, 0,06 (-0,31 to 0,43) in J45 vector, -0,16 (-0,66 to 0,33) in K1, -0,23 (-0,79 to 0,33) in K2 values before induction of cycloplegia. The refractive and keratometry results of the Nidek OPD Scan II system and Topcon KR 8900 standard table-top autorefractokeratometer are not interchangeable in healthy adult population before and after induction of cycloplegia. [ABSTRACT FROM AUTHOR]

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Background: To assess agreement between accommodative lag by monocular estimation method (MEM) retinoscopy and Nott retinoscopy compared to open-field autorefraction using spherical equivalent versus power in the 180 meridian for both children and adults.Methods: Twenty-six children aged 7-16 years (mean: 9.9 ± 2.3) and 27 adults aged 22-29 years (mean: 24.2 ± 1.7) participated. Accommodative lag was measured by examiners with autorefraction and separate examiners using MEM and Nott retinoscopy while subjects viewed 6/18 letters at 33 cm. Five measures of autorefraction were averaged with vector analysis and both power in the 180 meridian and spherical equivalent was determined. Two-factor repeated measures analysis of variance and the mean difference and 95 per cent limits of agreement were calculated.Results: Mean (standard deviation) lag for each technique was: MEM = 0.69 (0.52) D, Nott = 0.62 (0.51) D, autorefraction in 180 = 0.66 (0.50) D and autorefraction spherical equivalent = 0.60 (0.46) D. Lag did not vary across techniques (p = 0.48), but children did have smaller lags than adults (p < 0.001) and greater amounts of uncorrected astigmatism (0.61 ± 0.09 D versus 0.42 ± 0.08 D, p = 0.02). There was no significant interaction between age group and technique (p = 0.74). Mean differences between techniques were small, ranging from -0.14 to +0.06 D. Ninety-five per cent limits of agreement ranged from ±0.80 to ±1.33 around the mean with the narrowest ranges found for comparisons made to autorefraction in 180. Limits of agreement were also narrowest in children as compared to adults with similar mean differences between age groups.Conclusions: This study demonstrates the mean agreement between autorefraction and retinoscopic techniques is centred on zero (no bias) in both children and adults. The range of agreement becomes narrower when autorefraction power in the 180 is calculated, even for a sample of subjects with moderately small amounts of uncorrected astigmatism. [ABSTRACT FROM AUTHOR]

Purpose: To compare refractive assessment results obtained with an aberrometer, an autorefractor, and manual subjective refraction (SR) in a healthy population with optimal visual potential. Methods: Sixty adults aged 18–59 years with visual acuity of 20/25 or better, no media opacity, and no known corneal or retinal abnormalities were recruited during the course of routine eye examination. Refractive error in both eyes of each patient was assessed by 3 methods: manual SR, a Nidek 530-A autorefractor (AR), and a Nidek OPD-II Scan wavefront aberrometer (OPD). The order of testing was randomized. One technician collected all OPD and AR measurements, and 1 optometrist performed manual SR. Refractive measurements were converted from spherocylindrical prescriptions to power vectors and compared between methods by 2-factor repeated measures and Bland–Altman analysis. Results: Analysis of the power vectors followed by a log transformation showed no significant difference in refractive results between AR, OPD, and SR (P = .63). Bland–Altman analysis identified mean differences (95% CI of limits of agreement) of −0.06 (−0.67 to 0.55) for OPD vs SR, 0.001 (−0.522 to 0.524) for AR vs SR, and 0.06 (−0.541 to 0.662) for AR vs OPD. Conclusion: Agreement between all refractive assessments was comparable to previously reported agreement between repeated measures of SR. Agreement between AR and SR was slightly stronger than between OPD and SR. Although both the OPD and AR results, in general, showed a high level of agreement with SR, results beyond ±0.50D (5.8% for AR, 10% for OPD) would discourage prescribing spectacles directly from either instrument.

Purpose: To determine the accuracy of photorefraction and autorefraction as compared to cycloautorefraction and to detect the repeatability of photorefraction. Methods: This diagnostic study included the right eyes of 86 children aged 7-12 years. Refractive status was measured using photorefraction (PlusoptiX SO4, GmbH, Nürnberg, Germany) and autorefraction (Topcon RM800, USA) with and without cycloplegia. Photorefraction for each eye was performed three times to assess repeatability. Results: The overall agreement between photorefraction and cycloautorefraction was over 81% for all refractive errors. Photorefractometry had acceptable sensitivity and specificity for myopia and astigmatism. There was no statistically significant difference considering myopia and astigmatism in all comparisons, while the difference was significant for hyperopia using both amblyogenic (P = 0.006) and nonamblyogenic criteria (P = 0.001). A myopic shift of 1.21 diopter (D) and 1.58 D occurred with photorefraction in nonamblyogenic and amblyogenic hyperopia, respectively. Using revised cut-off points of + 1.12 D and + 2.6 D instead of + 2.00 D and + 3.50 D improved the sensitivity of photorefractometry to 84.62% and 69.23%, respectively. The repeatability of photorefraction for measurement of myopia, astigmatism and hyperopia was acceptable (intra-cluster correlation [ICC]: 0.98, 0.94 and 0.77, respectively). Autorefraction results were significantly different from cycloautorefraction in hyperopia (P < 0.0001), but comparable in myopia and astigmatism. Also, noncycloglegic autorefraction results were similar to photorefraction in this study. Conclusion: Although photorefraction was accurate for measurement of myopia and astigmatism, its sensitivity for hyperopia was low which could be improved by considering revised cut-off points. Considering cut-off points, photorefraction can be used as a screening method.

Aim: To compare the subjective refraction data with non-cycloplegic auto-refraction findings in the geriatric population above 60 years of age according to the different crystalline lens conditions., Methods: This report is a part of the Tehran Geriatric Eye Study (TGES) that was conducted from January 2019 to January 2020 on elderly population 60 years of age and above in Tehran. The samples were selected by multi-stage stratified random cluster sampling. Of 3791 individual invitees, 3310 (response rate: 87.3%) participated in this study. All study participants underwent non-cycloplegic auto-refraction (auto-refractometer/keratometer Nidek ARK-510) and subjective refraction., Results: Regarding the sphere, eyes with mixed cataract had the worst limits of agreement (LoA: -1.24 to 0.87) and the best agreement was related to the pseudophakic eyes (LoA: -0.83 to 0.54). The highest (0.27±0.31 D) and lowest (0.21±0.27 D) differences between the two methods regarding the cylinder power were observed in eyes with cortical cataract and normal eyes, respectively. The worst LoA between the two methods in measuring the cylinder power was related to the eyes with mixed cataract (LoA: -0.44 to 0.96). Regarding the J 0 (horizontal/vertical components of astigmatism), the mean values of J 0 obtained by auto-refraction were tended more toward against the rule direction in all crystalline lens conditions, and the two methods had the greatest difference in cortical cataract cases (0.05±0.17 D). Regarding the J 45 (oblique components of astigmatism), the lowest (0±0.11 D) and highest (-0.01±0.12 D) differences were observed in normal eyes and eyes with cortical cataract, respectively., Conclusion: The auto-refractometer/keratometer Nidek ARK-510 results in the elderly with different phakic and pseudophakic conditions do not correspond well with subjective refraction findings. This discrepancy in spherical findings is more pronounced in individuals with mixed cataract than in other cases., (International Journal of Ophthalmology Press.)

Copyright of Journal of Optometry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To determine repeatability and agreement of the ARK-30 handheld autorefractor with retinoscopy under cycloplegic and noncycloplegic conditions in children.Methods: Three consecutive autorefractor measurements (with and without cycloplegia) and retinoscopy were performed and compared in 30 randomized eyes of 30 children (mean age of 6.7 ± 2.7 years with spherical equivalent [SE] refraction from ‒4.01 to +7.38 D) in a cross-section and masked study. Bland-Altman analysis of autorefractor measurements (with and without cycloplegia) and agreement with retinoscopy were calculated with conventional notation (sphere [Sph] and cylinder [Cyl]) and vector notation (SE, J0, and J45coefficients).Results: ARK-30 measurements without cycloplegia were lower than under cycloplegic conditions (Sph: ‒0.52 ± 2.37 D vs + 0.86 ± 2.60 D, P < 0.01; Cyl: ‒0.83 ± 0.80 D versus ‒0.78 ± 0.77 D, P = 0.37; and SE: ‒0.94 ± 2.19 D vs + 0.47 ± 2.44 D, P < 0.01, respectively) and statistically different (P < 0.03) from retinoscopy (Shp: +0.83 ± 2.66 D; Cyl: ‒0.71 ± 0.87 D; SE: +0.51 ± 2.49 D). Without statistical differences were in J0and J45coefficients. Cyloplegic autorefraction measures were not found to be statistically significantly different to retinoscopy measures. ARK-30 under cycloplegia shows better repeatability with lower limits of agreement (LoA) in Sph (LoA: ‒0.66 to +0.69 D), and SE (LoA: ‒0.66 to +0.65 D) than without cycloplegia (LoA: ‒1.45 to +1.77 D, and ‒1.38 to +1.74 D, respectively).Conclusion: Under noncycloplegic conditions, ARK-30 autorefractor has low repeatability and a tendency toward minus over correction in children. However, repeatability and agreement with retinoscopy under cycloplegic conditions allow use of ARK-30 in children to estimate refraction but not to substitute gold standard retinoscopic refraction. [ABSTRACT FROM AUTHOR]

Purpose: Childhood accommodation interferes with accurate diagnosis of the latent refractive errors. Dynamic retinoscopy offers accurate measurements of accommodative response, while an autorefractometer can predict the accommodative system activation in children. A correlation of the accommodative effort with the dynamic refraction has been investigated in emmetropic children, before and after cycloplegia. Methods: A prospective clinical study of accommodative effort in 149 emmetropic children, in the age group 3–16 years, has been conducted using TOPCON AR RM-8000B autorefractor. Dynamic refraction was performed by monocular estimation method before and after cycloplegia, using the retinoscope mirror light as target. Retinoscopic reflex produced ‘with the motion’ was corrected with positive spherical lenses, and that ‘against the motion’ was corrected with negative spherical lenses, to achieve neutralization. Results: Mean accommodative effort measured for 149 children included in the study was −0.63 ± 0.69 D and dynamic refraction was −0.07 ± 0.44 D before cycloplegia, while the mean was + 0.52 D after cycloplegia, irrespective of the method used. Autorefractor measured −0.17 D of accommodative effort per unit change in dynamic refraction before cycloplegia and +0.90 D after cycloplegia. Conclusions: The performance of TOPCON AR RM-8000B autorefractor was comparable to dynamic retinoscopy. Presence of many children, and in turn, large number of accommodative response data in 11–13 and 14–15 years group is probably linked to prolonged reading/writing. The accuracy and the agreement of the actual accommodative measurements revealed after cycloplegia.

Purpose: To study the need of post mydriatic test (PMT) in children with mild to moderate compound myopic astigmatism. Materials and Methods: The children having mild to moderate compound myopic astigmatism presenting to the pediatric ophthalmology department underwent subjective refraction before, immediately after cycloplegia and 3 days after cycloplegia. The refractive error was analyzed using two-tailed paired t test by dividing the refractive-errors into sphere, cylinder and axis. Spherical equivalent was analyzed separately. Result: Eighty four eyes of 42 children aged 3 to16 years (Mean 9.6, SD 3.2) were included. Mean sphere was -0.9 diopter sphere (DS) (± 1.9) without cycloplegia and -0.4 DS (± 2.0) with cycloplegia compared to -0.9 DS (± 1.8) in the PMT. Mean cylinder was -1.3 diopter cylinder (DC) (± 1.2) without cycloplegia and -1.0 DC (± 1.5) with cycloplegia compared to -1.14 DC (± 1.3) in PMT. Mean spherical equivalent was -1.5 DS (± 1.6) without cycloplegia and -0.9 DS (± 1.8) with cycloplegia compared to -1.5 DS (± 1.6) in PMT. For spherical equivalent, the correlation coefficient (r) between non-cycloplegic refraction and cycloplegic refraction; non-cycloplegic refraction and PMT; cycloplegic refraction and PMT was 0.9. However, in comparison to cycloplegic refraction, PMT was closer to non-cycloplegic refraction and differed by only 0.01 DS (± 0.9) in sphere and 0.2 D (± 0.7) in cylinder. Conclusion: PMT is not warranted in children with compound myopic astigmatism.

Purpose: 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. [ABSTRACT FROM AUTHOR]

AIM:To evaluate the accuracy of spherical equivalent (SE) estimates of a double-pass system and to compare it with retinoscopy, subjective refraction and a table-mounted autorefractor.METHODS: Non-cycloplegic refraction was performed on 125 eyes of 65 healthy adults (age 23.5±3.0 years) from October 2010 to January 2011 using retinoscopy, subjective refraction, autorefraction (Auto kerato-refractometerTOPCON KR-8100, Japan) and a double-pass system (Optical Quality Analysis System, OQAS, Visiometrics S.L., Spain). Nine consecutive measurements with the double-pass system were performed on a subgroup of 22 eyes to assess repeatability. To evaluate the trueness of the OQAS instrument, the SE laboratory bias between the double-pass system and the other techniques was calculated.RESULTS:The SE mean coefficient of repeatability obtained was 0.22D. Significant correlations could be established between the OQAS and the SE obtained with retinoscopy (r=0.956, Pr=0.955, Pr=0.957, PPCONCLUSION: The double-pass system provides accurate and reliable estimates of the SE that can be used for clinical studies. This technique can determine the correct focus position to assess the ocular optical quality. However, it has a relatively small measuring range in comparison with autorefractors (-8.00 to +5.00D), and requires prior information on the refractive state of the patient.

We propose a method to estimate "fudge factor" in the selection of IOL power for post-myopic LASIK patients undergoing cataract surgery by considering the difference between subjective refraction (SR) and autorefraction (AR) and to also compare the predictability of two popular regression formulae: SRK-T and Haigis. [ABSTRACT FROM AUTHOR]

Contact lens wear is known to induce change in both the cornea and refractive state. Often a shift towards increased myopia is noted. Historically investigations into the effects of contact lenses onrefractive state have often been incomplete in terms of statistical analysis whereby nearest equivalent sphere is used or the spherical, cylindrical and axis components are analyzed in isolation. The aim ofthis study was to investigate the short-term effects of silicone hydrogel contact lenses on refractive behaviour. Seven volunteers agreed to wear a silicone hydrogel lens on one eye for a period of thirty minutes. Prior to lens wear, after ten minutes of lens wear and after thirty minutes of lens wear 50 autorefractor measurements were taken of refractive state from each subject. Data were analyzed using multivariate statistical methods. Scatter plots and other multivariate statistics are used to show how lens wear influences refractive behaviour. The results of this study show that silicone hydrogel contact lenses do influence refractive behaviour in both a spherical as well as an antistigmatic (astigmatism) fashion. (S Afr Optom 2012 71(2) 78-85)

Background:  Refractive error is the most common cause of decreased visual acuity. Refractive measurement in adults consists of cycloplegic (objective) and manifest (subjective) refraction. Although the effectiveness of autorefraction is a crucial factor, there needs to be more information on its accuracy and precision on each autorefractor compared with subjective measurement in Thai patients., Objective:  To compare the accuracy and precision of the two autorefractors' findings in Rajavithi Hospital, OptoChek Plus, and TOMEY Auto Refractometer RC-5000, with each other and with those of the subjective method., Materials & Methods:  An observational study was conducted at the Ophthalmology clinic in Rajavithi Hospital from March 1, 2021, to March 31, 2022. All subjects were tested using the two autorefractors (OptoChek Plus and TOMEY Auto Refractometer RC-5000) and subjective refraction. One eye per subject was included in the study., Results:  Forty-eight patients (48 eyes) were enrolled in the study. The difference between spherical powers obtained by OptoChek and subjective refraction was not significantly different; however, there was a significant difference between those calculated by Tomey and the subjective method (p=0.77, p=0.04 respectively). The variations between cylindrical powers arrived at by the two autorefraction techniques and those calculated by the subjective method were significantly different (OptoChek and Tomey p-=0.01, p-value<0.001, respectively). In addition, 95% of the limit of agreement (95% of LOA) was low in the cylindrical measurement of each autorefractor compared with subjective refraction. (84.61%, 86.36%, respectively). No statistically significant difference between the spherical equivalent calculated by the two autorefractors and that of subjective refraction was observed in the present study (OptoChek: p-value=0.26 and Tomey: p-value=0.77)., Conclusions:  There was a clinically significant difference between the cylindrical power calculated by the two autorefractors and those obtained from subjective refraction. Patients with high astigmatism should be monitored closely when measured by autorefractors, as there can be a slightly lower agreement between objective and subjective refraction., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kemchoknatee et al.)

Objectives: Objective of this study is to investigate whether there is any effect of accommodation on Autoref reading before and after cycloplegia and to check out which age and type of refractive error is more effected by accommodation. Methods: An informed consent was obtained describing the detail of study and its implication. Therefore the subject was assured of their confidentially of information and outcome. Four groups were selected and effect of accommodation on patients autoref reading were measured. Autorefractor reading was noted before and after cycloplegia. Autoref reading was taken without cycloplegia in different age groups and then by using cyclopentolate to relax the accommodation and by repeating the autoref reading to find out difference in reading before and after cycloplegia. 110 patients of age group 3 to 60 were assessed by that method. Results: Accommodation affects different age groups except old age. Accommodation effects on refractive error more in age 3-15 years because accommodation is stronger in children. There was significant difference between morning and evening amplitude of accommodation as p<0.005. Conclusions: Accommodation affects different age group and the effect is maximum between 3-15 years and decreases with increasing age. Autoref overestimate myopia and under estimate hyperopia without cycloplegia. By using cycloplegia exact refractive error can be measured. [ABSTRACT FROM AUTHOR]

Background : To evaluate the potential use of the Buckner test to detect significant refractive errors in infants and children. Methods: In this prospective study Bruckner test was performed, in children upto 15 years of age, with direct ophthalmoscope and position and size of pupillary crescent was noted. Subsequently, non-cycloplegic and cycloplegic auto-refraction was performed using auto-refracto-meter. Children were classified according to errors of refraction, Emmetropic, Myopic and Hyperopic. Results: Total 102 children were included, 56 males and 46 females with mean age of 8.38 years. Results of Bruckner test, revealed 50 (49.0%) right eyes hyperopic and 35(34.3%) myopic, 53 (51.9%) left eyes were hyperopic and 36 (35.2%) myopic. Cycloplegic auto-refraction revealed significant hyperopia in 48 and 50 right and left eyes respectively. Significant Myopia was detected in 30 and 27 right and left eyes. The sensitivity and specificity of Bruckner test to detect refractive errors in children was found to be 97% and 79% respectively. Conclusion: The Bruckner test has potential usefulness, reasonable accuracy, timeliness and simplicity as a screening test to detect refractive errors in children. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Optometry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). Methods: This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. Results: The difference of mean spherical measurement was +0.98D ± 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D ± 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being -0.09D ± 0.43, and the J45 of +0.04D ± 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r² = 0.067, r² = 0.078, r² = 0.018 and r² = 0.015, respectively, all of which point to a low correlation between the AR and the MR. Conclusion: Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used. [ABSTRACT FROM AUTHOR]

Autorefraction is an objective way to determine the refractive error of the eye, without the need for feedback by the patient or a well-educated practitioner. To make refractive measurements more accessible in the background of the growing prevalence of myopia, a compact autorefractor was built, containing only few optical components and relying on double-pass imaging and the physical properties of the point-spread function and digital image processing instead. A method was developed to analyze spherical defocus as well as the defocus and angle of astigmatism. The device was tested using calibrator eye models in a range of ± 15 D spherical defocus and -3 D astigmatic defocus. Reliable results could be achieved across the whole measurement range, with only a small increase in deviation toward high values of refractive errors, showing the feasibility of a PSF-based approach for a compact and low-cost solution for objective measurements of refractive error.

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Purpose To investigate the age range for which cycloplegia provides additional information compared with non-cycloplegic refraction in teenagers and young adults. Methods Data for 1295 subjects (704 female; 591 male) from the Twins Eye Study in Tasmania ( TEST) and the Brisbane Adolescent Twin Study (mean age: 19.65 ± 3.56, range: 13-26 years) were included. For all participants, cycloplegia was induced by instillation of either one drop of 1% cyclopentolate (13-14 years) or one drop of 1% tropicamide (15-26 years). Pre- and postcycloplegic refractive errors for both eyes were measured using a Humphrey-598 automated refractor and spherical equivalents of refractive error were calculated. Generalized Estimating Equations ( GEE) were used to model the spherical equivalent refraction ( SER) for each eye against age (by year) and axial length (in the given eye). Results The mean group difference between pre- and postcycloplegic SER (post minus pre) was 0.17 ± 0.52 D and 0.12 ± 0.51 D for the right and left eyes, respectively, indicating that postcycloplegic refraction was generally more hyperopic/less myopic. The mean difference between pre- and postcycloplegic SER decreased from 0.36 ± 0.41 D in the 13-year-olds to 0.06 ± 0.50 D in people aged 25 years. After adjusting for family-relatedness, the difference between pre- and postcycloplegia SER was significant in all age groups up until the age of 20 years. Conclusions Non-cycloplegic autorefraction can result in group mean SER differences of greater myopia than cycloplegic autorefraction and occurs in teenagers (13-19 years of age), but not in adults 20-26 years. These data suggest that cycloplegia is not required in population estimates of refractive error for young adults once they reach approximately 20 years of age. [ABSTRACT FROM AUTHOR]