Background: The viability of using objective refraction techniques in the geriatric population for on-site nursing home care was assessed. The results of the three objective methods of refraction, manual retinoscopy, and two commercially available infrared autorefactors (handheld Nikon Retinomax and the table mounted Nidek), were compared.
Methods: One hundred and eighteen eyes from patients in area senior centers were initially evaluated ophthalmically. The pupil size, media opacities, and macular appearance were graded following template guides. The eyes were then refracted manually and using the two autorefractors. Autorefractor measurements were repeated per manufacturer's instructions. LogMAR visual acuity was recorded with the manual and the autorefractor corrections; as well as with the patient's initial spectacle prescription if applicable.
Results: Visual acuity with the Nidek autorefraction corrections was on average one line better than with the Retinomax autorefraction corrections. There was, however, no statistical significance in visual acuity when evaluating the three methods of refraction in eyes with opacities of Grade 2 or more, or in the category of small pupils ( < 2.5mm). The mean dioptric difference between all three methods of refraction was less than 0.25D in all categories. A total of twenty-eight eyes was rejected due to the instruments' inability to yield a refraction or because of missing visual acuities. The Nidek autorefractor had the most rejected measurements with eighteen eyes, the Retinomax had three rejections, and retinoscopy had none; the remaining rejections were due to missing visual acuities.
Conclusion: The results suggested that all three methods of refraction yield similar equivalent sphere results. The refractive error corrections obtained from the Retinomax did, however, on average provide one line less visual acuity, but of the two autorefractors it had significantly less rejected measurements than the table mounted Nidek. Ease of measurement for the practitioner and the patient, as well as its portability make the Retinomax a viable option for the geriatric population.
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