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The accuracy of non-cycloplegic auto refractor versus retinoscopy in a pediatric population

1 May 2004


Purpose: Auto refractor and retinoscopy are both routinely utilized objective refractive techniques for pediatric vision care. There are certain clinical settings for which cycloplegia is not feasible such as vision screenings and humanitarian eye care clinics. The purpose of this project was to determine the accuracy ofthe auto refractor compared to retinoscopy under non-cycloplegic conditions, such as occur in vision screenings and triage-level eye care clinics.

Methods: Seventy-five children were included in the study. Each child had auto refractor and retinoscopy performed on both eyes prior to instillation of 1 drop of 1% Tropicamide. After 20 minutes, auto refractor and retinoscopy were performed again for comparison. Cycloplegic retinoscopy was the standard to which all findings were compared.

Results: Of the 75 right eyes measured by the auto refractor prior to cycloplegia (NCAR), the average finding was 1.35D more minus then the standard, cycloplegic retinoscopy (CR). NCAR on the 75 left eyes were 1.15D more minus than CR. When non-cycloplegic retinoscopy (NCR) was performed on the same 75 right eyes, they were found to be only 0.47D more minus than CR, while the 75 left eyes were found to be only 0.25D more minus. The case specific range of discrepancy from CR values was up to 6.00D for NCAR and up to 2.50D for NCR. Cycloplegic auto refractor (CAR) results showed the right eye to be only 0.20D more minus, and the left eye CAR results were 0.28D more plus than CR. Comparison between CAR and CR showed no significant difference between means.

Conclusions: This study illustrates that non-cycloplegic auto refraction is not an accurate refractive measure in children due to poor accommodative control. Distance retinoscopy performed with appropriate fogging technique is the most accurate objective measure to prescribe from in the vast majority of cases.


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