Refraction in Children: A Comparison Between "Naive" Refraction to the Plusoptix A12 Portable Auto-Refractometer and Refraction at the Fixed Auto-Refractometer in Cycloplegia: About 52 Cases
International Journal of Ophthalmology & Visual Science
Volume 3, Issue 4, December 2018, Pages: 47-54
Received: Oct. 25, 2018; Accepted: Nov. 10, 2018; Published: Dec. 24, 2018
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Said Iferkhass, Ophthalmology Department, Military Hospital My Ismail, Meknes, Morocco
Fatine Elalami, Ophthalmology Department, Military Hospital My Ismail, Meknes, Morocco
Nihad Elhalouat, Ophthalmology Department, Military Hospital My Ismail, Meknes, Morocco
Anas Bouassal, Ophthalmology Department, Military Hospital My Ismail, Meknes, Morocco
Aziz Elouafi, Ophthalmology Department, Military Hospital My Ismail, Meknes, Morocco
Abdelkader Laktaoui, Ophthalmology Department, Military Hospital My Ismail, Meknes, Morocco
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The aim of our work is to compare the values obtained by the last generation portable auto-refractometer PlusoptixA12 without dilation to those provided by an automatic refractometer with cycloplegia: Canon (RK-F2), in children, in order to have an idea about its strengths and limitations. Our work is a Cross-sectional study conducted from June to November 2016, about 52 children (104 eyes), aged from 3 to 16 years. Each child had a measure of refraction with the Plusoptix (without cycloplegy). After that, three instillations of cyclopentolate hydrochloride were carried out (T0, T5, and T10 min). We retake the refraction after 45 minutes using a fixed auto-refractometer. The average spherical equivalent was 1.46 ± 1.10 for refraction with Plusoptix versus 1.94 ± 1.40 for cycloplegic auto-refraction with a statistically significant difference (average difference -0.48D ± 1.06 (P <0.001). The difference between the average spherical refraction was -0.42 ± 1.03; P <0.001). In the hyperopic group, the average difference between the two refractive methods was -0.61 ± 1.03 compared to 0.23 ± 0.59 for myopic patients. For cylinders, the difference of the average power between the two devices was -0.14 ± 0.38 (P <0.001). There was no statistical significance between the two instruments for the cylindrical axis (p: 0.087). In the light of results obtained, the Plusoptix can be used as an interesting method of screening for ametropia. But it is not a precise way for studying refraction in strabic and amblyopic population. Its results are more reliable for the myopic and astigmatic subgroups than hyperopic ones.
Refraction, Plusoptix, Cycloplegia, Child
To cite this article
Said Iferkhass, Fatine Elalami, Nihad Elhalouat, Anas Bouassal, Aziz Elouafi, Abdelkader Laktaoui, Refraction in Children: A Comparison Between "Naive" Refraction to the Plusoptix A12 Portable Auto-Refractometer and Refraction at the Fixed Auto-Refractometer in Cycloplegia: About 52 Cases, International Journal of Ophthalmology & Visual Science. Vol. 3, No. 4, 2018, pp. 47-54. doi: 10.11648/j.ijovs.20180304.11
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Howland HC. Photorefraction of eyes: history and future prospects. Optom Vis Sci 2009; 86:603-606.
Matta NS, Arnold RW, Singman EL, Silbert DI. Comparison between the Plusoptix and MTI photoscreeners. Arch Ophthalmol 2009; 127:1591-1595.
Choong YF, Chen AH, Goh PP. A comparison of autore-fraction and subjective refraction with and without cy-cloplegia in primary school children. Am J Ophthalmol 2006; 142:68-74.
Lai YH, Tseng HY, Hsu HT, Chang SJ, Wang HZ. Un-corrected visual acuity and noncycloplegic autorefrac-tion predict significant refractive errors in taiwanese preschool children. Ophthalmology. 2013.120:271-276.
Fogel-Levin et al, A comparison of Plusoptix A12 measurements with cycloplegic refraction Israel. 2016.
Ayse YK1, Onder U, Suheyla K. Accuracy of Plusoptix S04 in children and teens. Can J Ophthalmol. 2011 Apr; 46 (2):153-7.
Payerols A 1 , Eliaou C 1 , Trezeguet V 1 , Villain M 2 , Daien V 3 Payerols et al. Accuracy of Plusoptix A09 distance refraction in pediatric myopia and hyperopia BMC Ophthalmology [01 Jun. 2016, 16:72.
Xiao-Ran Yan, Wan-Zhen Jiao, Zhi-Wei Li, Wen-Wen Xu, Feng-Jiao Li, Li-Hua Wang. Performance of the Plusoptix A09 Photoscreener in Detecting Amblyopia Risk Factors in Chinese Children Attending an Eye Clinic PLoS ONE10 (6): e0126052.
Dahlmann-Noor AH, Comyn O, Kostakis V, Misra A, Gupta N, Heath J, et al. Plusoptix Vision Screener: the accuracy and repeatability of refractive measurements using a new autorefractor. Br J Ophthalmol. 2009. 93: 346–349. pmid:19001013.
Brian W. Arthur, MD, FRCSC, a Rehan Riyaz, MD, b Sylvia Rodriguez, MD, a and Jonathan Wong, MD Field testing of the plusoptiX S04 photoscreener. J AAPOS 2009; 13:51-57.
Mae Millcent W. Petrseim, Carrie E. Papa, M. Edward Wilson, Edward W. Cheeseman, Bethany J. Wolf, Jennifer D. Davidson, and Rupal H. Trivedi. Photoscreeners in the Pediatric Eye Office: Compared testability and Refractions on High-Risk Children Am J Ophthalmol. 2014 Nov; 158 (5): 932–938.
Mirzajani, Heirani, Jafarzadehpur and Haghani. A comparison of photorefractor and retinoscopy 2012 Iran.
Ali Akbar Saber Moghaddam, 1 Abbas Kargozar, 1 Mehran Zarei-Ghanavati, 1 Marzieh Najjaran, 2 Vahideh Nozari, 2 Mohammad Taghi Shakeri3. Screening for amblyopia risk factors in pre-verbal children using the Plusoptix photoscreener: a cross-sectional population-based study. Br J Ophthalmol 2012; 96:83e86.
Erdurmus M, Yagci R, Karadag R, Durmus M. A comparison of photo-refraction and retinoscopy in children. JAAPOS. 2007; 11:606–11.
Paff T, Oudesluys-Murphy AM, Wolterbeek R, et al. Screening for refractive errors in children: the Plusop-tiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy. J AAPOS 2010; 14:478-483.
Choi M, Weiss S, Schaeffel F, et al. Laboratory, clini -cal, and kindergarten test of a new eccentric infra-red photorefractor (PowerRefractor). Optom Vis Sci 2000; 77:537-548.
L. M. Gilmartin. Comparison of the Plusoptix S04 binocular autorefractor withcycloplegic refraction performed by an ophthalmologist British and Irish Orthoptic Journal 2010; 7: 59–61.
Demirci G, Arslan B, Özsütçü M, Eliaçık M, Gulkilik G. Comparison of photorefraction, autorefractometry and retinoscopy in children. Int Ophthalmol 2014; 34:739-46.
Schimitzek T, Lagreze WA.. Accuracy of a new photo-refractometer in young and adult patients. Graefes Arch Clin Exp Ophthalmol 2005; 243:637-45.
Donahue SP, Arthur B, Neely DE, Arnold RW, Silbert D, Ruben JB; AAPOS Vision Screening Committee. Guidelines for automated preschool vision screening: a 10-year, evidence-based update. J AAPOS 2013; 17:4-8.
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