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Abstract
Purpose
To compare the measurements between manifest refraction and cycloplegic refraction using retinoscopy or an autorefractor in children and to investigate factors affecting the difference.
Methods
A total of 388 children with a mean age of 7.4 ± 3.6 years were examined using retinoscopy and a Grand Seiko GR-3500KA autorefractor before and after cycloplegia. We compared the difference in spherical and cylindrical components between refractions and analyzed the results according to gender, age, type of refractive error, amblyopia, strabismus, and neu-ro-developmental disorder. A difference in refractions of ±0.50 D or more was considered as a significant discrepancy.
Results
Before cycloplegia, the spherical portion of the refractive error via autorefractor measurement was more myopic than for the retinoscopic measurement in 47.2% of patients, and the cylindrical portion was greater in 37.1%. The spherical discrepancies were more common in children aged < 7 years, with hyperopia, or amblyopia (respectively, p = 0.002, p < 0.001, and p = 0.033). After cycloplegia, the spherical component of the refractive error by autorefraction differed from retinoscopic measurement in 29.4% of patients, and the cylindrical portion differed in 30.7%. However, the difference was not significant and there was no difference according to clinical features. More than half of the children with discrepancies in the spherical component between retinoscopic refractions before and after cycloplegia had a discrepancy between autorefraction and retinoscopic refraction before cycloplegia, and the two discrepancies had a significant correlation.
Conclusions
Auto-refraction after cycloplegia can estimate retinoscopic values partially. Nevertheless, 30% of the children still showed a discrepancy. The discrepancy of manifest refraction or autorefraction compared to retinoscopic refraction with cycloplegia should be considered in younger children, cases with hyperopia or amblyopia, and cases with a difference in autorefraction and retinoscopic refraction before cycloplegia.
References
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Figure 1.
Graph showing the correlation of the difference between retinoscopic MR and auto-MR, and the difference between retinoscopic MR and CR (linear regression analysis; R2 = 0.063, p < 0.001). MR = manifest refraction; auto-MR = autorefraction before cycloplegia; CR = retinoscopic cycloplegic refraction.
Table 1.
Proportion of eyes of disagreement between retinoscopic refractions before and after cycloplegia according to component
| Component | Same* | Different† |
|---|---|---|
| Sphere | 504 (64.9) | 272 (35.1) |
| Cylinder | 624 (80.4) | 152 (19.6) |
| Axis | 696 (89.7) | 80 (10.3) |
| Spherical equivalent | 494 (63.7) | 282 (36.3) |
Table 2.
Comparison of characteristics between same and different groups divided by the difference in sphere component between retinoscopic refractions before and after cycloplegia
| Overall (n = 388) | Same* (n = 252) | Different† (n = 136) | p-value | |
|---|---|---|---|---|
| Gender (male) | 180 (46.4) | 115 (45.6) | 65 (47.8) | 0.382‡ |
| Age (year) | 7.4 ± 3.6 | 7.9 ± 3.5 | 6.6 ± 3.5 | 0.001§ |
| <7 years | 210 (54.1) | 112 (44.4) | 98 (72.1) | <0.001‡ |
| ≥7 years | 178 (45.9) | 140 (55.6) | 38 (27.9) | |
| Type of refractive errors | <0.001‡ | |||
| Emmetropia | 85 (21.9) | 63 (25.0) | 22 (16.2) | |
| Hyperopia | 134 (34.5) | 60 (23.8) | 74 (54.4) | |
| Myopia | 138 (35.6) | 115 (45.6) | 23 (16.9) | |
| Astigmatism | 31 (8.0) | 14 (5.6) | 17 (12.5) | |
| Anisometropia | 77 (19.8) | 47 (18.7) | 30 (22.1) | 0.250‡ |
| Amblyopia | 29 (7.5) | 12 (4.8) | 17 (12.5) | 0.010‡ |
| Aniso:Strabismic:Combined | 17:6:6 | 8:2:2 | 9:4:4 | |
| Strabismus | 189 (48.7) | 129 (51.2) | 60 (44.1) | 0.214‡ |
| Exo:Eso:Vertical | 156:29:4 | 110:16:3 | 46:13:1 | |
| Neuro-developmental disorders | 38 (9.8) | 25 (9.9) | 13 (9.6) | 0.522‡ |
Table 3.
Proportion of eyes of disagreement between retinoscopic refraction and autorefraction before cycloplegia according to component
| Component | Same* | Different† |
|---|---|---|
| Sphere | 410 (52.8) | 366 (47.2) |
| Cylinder | 488 (62.9) | 288 (37.1) |
| Axis | 332 (42.8) | 444 (57.2) |
| Spherical equivalent | 368 (47.4) | 408 (52.6) |
Table 4.
Comparison of characteristics between same and different groups divided by the difference in sphere component between retinoscopic refraction and autorefraction before cycloplegia
| Overall (n = 388) | Same* (n = 205) | Different† (n = 183) | p-value | |
|---|---|---|---|---|
| Gender (male) | 180 (46.4) | 101 (49.3) | 79 (43.2) | 0.136‡ |
| Age (year) | 7.4 ± 3.6 | 7.9 ± 3.5 | 6.9 ± 3.6 | 0.005§ |
| <7 years | 210 (54.1) | 96 (46.8) | 114 (62.3) | 0.002‡ |
| ≥7 years | 178 (45.9) | 109 (53.2) | 69 (37.7) | |
| Type of refractive errors | <0.001‡ | |||
| Emmetropia | 85 (21.9) | 49 (23.9) | 36 (19.7) | |
| Hyperopia | 134 (34.5) | 53 (25.9) | 81 (44.3) | |
| Myopia | 138 (35.6) | 90 (43.9) | 48 (26.2) | |
| Astigmatism | 31 (8.0) | 13 (6.3) | 18 (9.8) | |
| Anisometropia | 77 (19.8) | 35 (17.1) | 42 (23.0) | 0.093‡ |
| Amblyopia | 29 (7.5) | 9 (4.4) | 20 (10.9) | 0.033‡ |
| Aniso:Strabismic:Combined | 17:6:6 | 4:2:3 | 13:4:3 | |
| Strabismus | 189 (48.7) | 100 (48.8) | 89 (48.6) | 0.095‡ |
| Exo:Eso:Vertical | 156:29:4 | 89:10:1 | 67:19:3 | |
| Neuro-developmental disorders | 38 (9.8) | 25 (12.2) | 13 (7.1) | 0.069‡ |
Table 5.
Proportion of eyes of disagreement between retinoscopic refraction and autorefraction after cycloplegia according to component
| Component | Same* | Different† |
|---|---|---|
| Sphere | 548 (70.6) | 228 (29.4) |
| Cylinder | 538 (69.3) | 238 (30.7) |
| Axis | 380 (49.0) | 396 (51.0) |
| Spherical equivalent | 524 (67.5) | 252 (32.5) |
Table 6.
Comparison of characteristics between same and different groups divided by the difference in sphere component between retinoscopic refraction and autorefraction after cycloplegia
| Overall (n = 388) | Same* (n = 274) | Different† (n = 114) | p-value | |
|---|---|---|---|---|
| Gender (male) | 180 (46.4) | 126 (46.0%) | 54 (47.4) | 0.445‡ |
| Age (year) | 7.4 ± 3.6 | 7.6 ± 3.6 | 7.1 ± 3.6 | 0.227§ |
| <7 years | 210 (54.1) | 139 (50.7) | 71 (62.3) | 0.069‡ |
| ≥7 years | 178 (45.9) | 135 (49.3) | 43 (37.7) | |
| Type of refractive errors | 0.075‡ | |||
| Emmetropia | 85 (21.9) | 62 (22.6) | 23 (20.2) | |
| Hyperopia | 134 (34.5) | 84 (30.7) | 50 (43.9) | |
| Myopia | 138 (35.6) | 105 (38.3) | 33 (28.9) | |
| Astigmatism | 31 (8.0) | 23 (8.4) | 8 (7.0) | |
| Anisometropia | 77 (19.8) | 57 (20.8) | 20 (17.5) | 0.250‡ |
| Amblyopia | 29 (7.5) | 20 (7.3) | 9 (7.9) | 0.299‡ |
| Aniso:Strabismic:Combined | 17:6:6 | 13:4:3 | 4:2:3 | |
| Strabismus | 189 (48.7) | 137 (50.0) | 52 (45.6) | 0.288‡ |
| Exo:Eso:Vertical | 156:29:4 | 117:17:3 | 39:12:1 | |
| Neuro-developmental disorders | 38 (9.8) | 27 (9.8) | 11 (9.6) | 0.564‡ |
Table 7.
Linear regression analysis for the spherical and cylindrical components of autorefraction before and after cycloplegia against those of retinoscopic refraction with cycloplegia
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