Clinical correlation between automated vision screening under cycloplegia and retinoscopy in young children / Correlação clínica entre triagem visual automatizada sob cicloplegia e retinoscopia em crianças pequenas

ABSTRACT Purpose: To evaluate the clinical performance of the Spot Vision Screener and establish clinical correlations between automated screening and retinoscopy following induction of cycloplegia in preverbal children. Methods: In this prospective, cross-sectional study, children aged 6-36 months were evaluated using the Spot Vision Screener. A complete ophthalmologic examination, including cycloplegic refraction assessment, was performed, followed by repeat spot vision screening and retinoscopy in all cases to establish correlations regarding hypermetropia, myopia, and astigmatism following induction of induction cycloplegia. Results: The study included 185 children. The sensitivity of the automated screener after cycloplegia was 100% (95%CI: 85.18-100%), and specificity was 87.04% (95%CI: 80.87-91.79%). Positive and negative predictive values were 52.27% (42.36-62.01%) and 100%, respectively. Compared to retinoscopy, the Spot Vision Screener overestimated spherical values by 0.62 D (95%CI: 0.56-0.69) in the right eye and by 0.60 (95%CI: 0.54-0.66) in the left eye and cylindrical values by -0.38 D in the right eye (95%CI: -0.42--0.33) and by -0.39 D in the left eye (95%CI: -0.43--0.34). For overall spherical and cylindrical values, the difference was 0.61 D (95%CI: 0.57-0.65) and -0.38 D (95%CI: -0.41--0.35) in the left and right eyes, respectively. Conclusion: A substantial correlation was found between retinoscopy and objective data captured by the device. This shows that technology can be used in conjunction, reaching a more accurate diagnosis and identifying amblyopia risk factors as early as possible. Photoscreening may make a difference at the population level for early screening and intervention.

RESUMO Objetivo: Avaliar o desempenho clínico do Spot Vision Screener e estabelecer correlações clínicas entre a triagem automatizada e a retinoscopia após indução de cicloplegia em crianças pré-verbais. Métodos: Neste estudo transversal prospectivo, crianças de 6 a 36 meses foram avaliadas usando o Spot Vision Screener. O exame oftalmológico completo, incluindo refração cicloplégica, foi então realizado, seguido de repetição da triagem automatizada e retinoscopia em todos os casos, a fim de estabelecer correlações quanto à hipermetropia, miopia e astigmatismo após a indução de cicloplegia. Resultados: O estudo incluiu 185 crianças. A sensibilidade do dispositivo de triagem automática após cicloplegia foi de 100% (IC 95%: 85,18-100%) e a especificidade foi de 87,04% (IC 95%: 80,87-91,79%). Os valores preditivos positivos e negativos foram de 52,27% (42,36 - 62,01%) e 100%, respectivamente. Em comparação com a retinoscopia, o Spot Vision Screener superestimou os valores esféricos em 0,62 D (IC 95%: 0,56 - 0,69) no olho direito e em 0,60 (IC 95%: 0,54 - 0,66) no olho esquerdo e os valores cilíndricos em -0,38 D (IC 95%: -0,42 a -0,33) no olho direito e por -0,39 D (IC 95%: -0,43 a -0,34) no olho esquerdo. A diferença para os valores esféricos e cilíndricos de forma geral foi de 0,61 D (IC 95%: 0,57 - 0,65) e -0,38 D (IC 95%: -0,41 a -0,35), respectivamente. Conclusão: Foi encontrada correlação substancial entre a retinoscopia e os dados objetivos captados pelo dispositivo. Isso mostra que a tecnologia pode ser usada em conjunto, contribuindo para um diagnóstico mais preciso e identificando os fatores de risco de ambliopia o mais precocemente possível. A técnica automatizada pode fazer a diferença em nível populacional para triagem e intervenção precoce.

The Gimbalscope – A novel smartphone-assisted retinoscopy technique

The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured.

Refractive changes during off-the-axis retinoscopy in myopia

Purpose: To analyze the refractive shift during off?the?axis retinoscopy under cycloplegic drugs in myopic patients during ocular examination. Methods: Prospective cross?sectional study was carried out among 10 myopic patients having refractive errors of ?3.00 D or less. All the subjects underwent cycloplegic refraction by a single examiner at 0°, 10°, and 20°. Descriptive data were analyzed as mean and standard deviation. Paired t?test was used to compare the mean differences between on?axis (0°) and off?axis (10° and 20°) retinoscopy. Result: The mean spherical equivalent refraction of 10 myopic patients showed an increase in myopic shift with approximately 7% and 18% for 10° and 20° of eccentricity, respectively. Similarly, the mean spherical equivalent measure on axis (0°) and off axis (10° and 20°) were ?2.5495, ?2.737, and ?3.0265, respectively. The mean spherical equivalent differences between on?axis (0°) and off?axis (10° and 20°) showed statistically significant differences with P < 0.05. Conclusion: This study concluded that a greater degree of eccentricity will induce a greater amount of errors in retinoscopy

Comparação das medidas refratométricas através da utilização do Photoscreener 2win® e da retinoscopia manual em pré-escolares assintomáticos / Comparison of refractometric measurements using 2win® Photoscreener and manual retinoscopy in asymptomatic preschoolers

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e acurácia da refratometria obtida através do aparelho photoscreener 2WIN® como método de rastreio de ametropias com indicação de prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria em crianças assintomáticas, de origem extra-hospitalar, de 6 a 36 meses de idade, e determinar se a cicloplegia influencia a capacidade de rastreio do aparelho. Métodos: Cento e setenta e oito (178) de crianças com idades entre 6 e 36 meses tiveram sua refratometria mensurada pelo método padrão-ouro, a retinoscopia manual sob cicloplegia, e pelo método em teste, o photoscreener 2WIN®, antes e após a cicloplegia. Resultados: O photoscreener 2WIN® é capaz de identificar aqueles pacientes que deveriam receber prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria com sensibilidade de 100%, especificidade de 93,18% e acurácia de 93,26%, quando comparado a retinoscopia estática. Sob cicloplegia, o 2WIN® mantém sensibilidade de 100%, porém aumenta sua especificidade para 96,59% e a acurácia para 96,63%. Conclusão: O photoscreener 2WIN® se mostrou altamente sensível, específico e acurado para uso como equipamento de triagem daqueles pacientes de 6 a 36 meses que se beneficiariam do uso de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria, com discreto aumento da especificidade e acurácia quando aplicado em pacientes cicloplegiados.

ABSTRACT Objective: Evaluate the sensitivity, specificity e accuracy of the ocular refraction measured by the 2WIN® photoscreener as a screening method to identify children in need of spectacles prescription according to the criteria published by the Brazilian Society of Pediatric Ophthalmology (BSPO) in asymptomatic children, 6 to 36 months old, and determine the impact of cycloplegia in the sensitivity, specificity and accuracy of this method. Methods: One hundred seventy-eight (178) eyes of asymptomatic children between the ages of 6 and 36 months have been submitted to ocular refraction measurements by the gold-standard method, the manual retinoscopy under cycloplegia, and the method been tested, the 2WIN® photoscreening, both before and under cycloplegia. Results: The 2WIN® photoscreener before cycloplegia was able to identify those patients in need of spectacles prescription according to the criteria published by the BSPO with 100% sensitivity, 93.18% specificity and 93.26% accuracy, when compared to the manual retinoscopy under cycloplegia. The 2WIN® photoscreener under cycloplegia maintained a sensitivity of 100%, but increased specificity to 96.59% and accuracy to 96.63%. Conclusion: The 2WIN® photoscreener before cycloplegia showed high sensitivity, specificity, and accuracy in detection of patients in need of spectacles prescription according to the criteria published by the BSPO in the tested population, with minor increase in specificity and accuracy when the measurements were performed under cycloplegia.

Anterior chamber depth and axial length affect clinical performance of Spot Vision Screener / A profundidade da câmara anterior e o comprimento axial afetam o desempenho clínico do Spot Vision Screener

ABSTRACT Purpose: The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. Methods: A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. Results: Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). Conclusion: The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o efeito da profundidade da câmara anterior e do comprimento axial sobre o desempenho clínico do Spot Vision Screener, na deteção de fatores de risco para a ambliopia em crianças de 3 a 10 anos de idade. Métodos: Um total de 300 olhos de 150 pacientes de 3-10 anos de idade foram prospectivamente testados com o Spot Vision Screener (firmware: 3.0.02.32, software: 3.0.04.06) e com autorefratómetro padrão (Nidek ARK-1). Todas as medições de profundidade e comprimento axial da câmara anterior dos pacientes foram realizadas através de Nidek AL Scan. A sensibilidade e especificidade para a deteção de erros refrativos significativos foram determinadas de acordo com os critérios de referência da Associação Americana de Oftalmologia e Estrabismo Pediátricos. A análise da Correlação de Pearson foi utilizada para avaliar a correlação entre os resultados do Spot Vision e a profundidade ou comprimento axial da câmara anterior dos pacientes. Resultados: Em comparação com os resultados do autorefratómetro padrão, a sensibilidade do Spot foi de 59% e a especificidade de 94%. As diferenças entre os equivalentes esféricos do autorefratómetro cicloplégico e o Spot Vision Screener foram correlacionados negativamente com a profundidade (r=-0,48; p<0,001) e o comprimento axial (r=-0,45; p<0,001) da câmara anterior dos casos. Conclusão: O Spot Vision Screener possui uma sensibilidade moderada e uma especificidade elevada utilizando os critérios da Associação Americana de Oftalmologia Pediátrica e Estrabismo; a profundidade da câmara anterior e o comprimento axial dos pacientes afetam os resultados do Spot Vision.

Estimation Dynamic Distance Direct Ophthalmoscopy (eDDDO): A novel, objective method for the quantitative assessment of accommodation in young children

Purpose: To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children. Methods: In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner. Results: For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45). Conclusion: eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities.

La queratometría como variable predictora de la ametropía: un estudio diagnóstico en la población escolarizada de 5 a 19 años de la ciudad de pereira

Objetivo: determinar la relación entre la curvatura corneal y los defectos de refracción en la población estudiantil de 5 a 19 años de la ciudad de Pereira en el año 2014. Materiales y métodos: el tipo de estudio es observacional correlacional descriptivo. Se indica el modelo de regresión lineal simple entre la queratometría y la retinoscopía. Se evaluó el error refractivo en 915 estudiantes de Pereira mediante retinoscopía estática y queratometría. Resultados: el valor cilíndrico obtenido para el ojo derecho (OD) oscila entre -0,12 y -5,50 dpt, mientras que para el ojo izquierdo (OI), el valor oscila entre -0,12 y -6,12 dpt. El 86,6% del meridiano eje (ME) del OD está entre 38,00 y 43,88 dpt, en tanto que el 87,2% del ME del OI se encuentra entre 32,00 y 43,88 dpt. La ametropía positiva para el OD está entre 0,25 y 8,00 dpt; para el OI en 0,25 y 7,50dpt. La ametropía negativa está en 6,00 para el OD y 6,50 dpt para el OI como valores máximos. En relación a la curvatura corneal y a las ametropías, el OD muestra una correlación de Pearson negativa, de -0,21 (p=0.0001). En el OI la correlación de Pearson también es negativa, de -0,20 (p=0.0001). Por lo tanto, la relación encontrada entre estas dos variables es tan solo del 5,1% y un 4,7% para OD y OI, respectivamente. Conclusiones: la relación entre la curvatura corneal y los errores de refracción según este modelo solo explica un porcentaje insignificante que no tiene importancia clínica, es del 4,9% en promedio del valor obtenido en el error refractivo en ambos ojos. Por ello, no es posible hacer una predicción de los errores refractivos con base en el radio de la curvatura corneal.

Objective: The purpose of this research was to determine the relationship between corneal curvature and refractive errors in schooled population between the ages of 5 to 19 in the city of Pereira in 2014. Materials and Methods: This is a descriptive correlational observational study, in which the simple linear regression model between keratometry and retinoscopy is indicated. Through static retinoscopy and keratometry, refractive error was evaluated in 915 students of Pereira. Results: The cylindrical value obtained for the RE (right eye) oscillates between -0.12 and -5.50 dpt and for the LI (left eye) -0.12 and -6.12 dpt, where 86.6% of the Axis (ME in Spanish) RE is between 38.00 and 43.88dpt, while 87.2% of Axis LE is between 32.00 and 43.88dpt. The positive ametropia for the RE is between 0.25 and 8.00dpt, for the LE 0.25 and 7.50dpt, the negative in RE 6.00 and OI 6.50dpt as maximum values. In relation to corneal curvature and ametropias, the RE shows a negative Pearson correlation of -0.21 (p = 0.0001). In the LE the Pearson correlation is also negative, of -0.20 (p = 0.0001). Therefore, the relationship found between these two variables is only 5.1% and 4.7% for RE and LE respectively. Conclusions: The relationship between corneal curvature and refractive errors according to this model only explains an insignificant percentage that does not have clinical importance, it is a 4.9% on average of the value obtained in the refractive error in both eyes, therefore, it does not allow a prediction of refractive errors based on the radius of corneal curvature.

Objetivo. O objetivo desta pesquisa foi determinar a relação entre a curvatura da córnea e erros de refração na população estudantil de 5 a 19 anos de idade na cidade de Pereira em 2014. Materiais e Métodos. 0 tipo de estudo é descritivo correlacional observacional, no qual o modelo de regressão linear simples entre ceratometria e retinoscopia é indicado. Por meio de retinoscopia estática e ceratometria, o erro refrativo foi avaliado em 915 estudantes de Pereira. Resultados. O valor cilíndrico obtido para o OD (olho direito) é entre -0,12 e -5,50dpt e para o OI (olho esquerdo) e -0,12dpt e -6,12, onde 86,6% do Meridiano Eje (ME) OD está entre 38,00 e 43,88dpt, enquanto que 87,2% do ME 01 está entre 32,00 e 43,88dpt. A ametropia positiva para o OD está entre 0,25 e 8,00dpt, para o OI 0,25 e 7,50dpt, a ametropia negativa em OD 6,00 e OI 6,50dpt como valores máximos. Em relação à curvatura corneana e ametropias, o OD mostra uma correlação negativa de Pearson de -0,21 (p = 0,0001). No OI, a correlação de Pearson também é negativa, de -0,20 (p = 0,0001). Portanto, a relação encontrada entre essas duas variáveis é de apenas 5,1% e 4,7% para OD e OI, respectivamente. Conclusões. A relação entre a curvatura corneana e os erros refra-tivos de acordo com este modelo explica apenas uma percentagem insignificante de nenhuma importância clínica, é de 4,9%, em média, do valor obtido no erro refrativo em ambos os olhos, de modo que, não permite fazer uma previsão de erros refrativos com base no raio da curvatura corneana.

Repeatability of ARK-30 in a pediatric population

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.

Variant myopia: A new presentation?

Purpose: Variant myopia (VM) presents as a discrepancy of >1 diopter (D) between subjective and objective refraction, without the presence of any accommodative dysfunction. The purpose of this study is to create a clinical profile of VM. Methods: Fourteen eyes of 12 VM patients who had a discrepancy of >1D between retinoscopy and subjective acceptance under both cycloplegic and noncycloplegic conditions were included in the study. Fourteen eyes of 14 age- and refractive error-matched participants served as controls. Potential participants underwent a comprehensive orthoptic examination followed by retinoscopy (Ret), closed-field autorefractor (CA), subjective acceptance (SA), choroidal and retinal thickness, ocular biometry, and higher order spherical aberrations measurements. Results: In the VM eyes, a statistically and clinically significant difference was noted between the Ret and CA and Ret and SA under both cycloplegic and noncycloplegic conditions (multivariate repeated measures analysis of variance, P < 0.0001). A statistically significant difference was observed between the VM eyes, non-VM eyes, and controls for choroidal thickness in all the quadrants (Univariate ANOVA P < 0.05). The VM eyes had thinner choroids (197.21 � 13.04 ?) compared to the non-VM eyes (249.25 � 53.70 ?) and refractive error-matched controls (264.62 � 12.53 ?). No statistically significant differences between groups in root mean square of total higher order aberrations and spherical aberration were observed. Conclusion: Accommodative etiology does not play a role in the refractive discrepancy seen in individuals with the variant myopic presentation. These individuals have thinner choroids in the eye with variant myopic presentation compared to the fellow eyes and controls. Hypotheses and clinical implications of variant myopia are discussed.

Comparing the effect of conventional method of retinoscopic refraction with computerized automated refraction in various refractive error patients

Introduction: Refractive error is the most common visual impairment seen worldwide. This is one of the main cause for which patients come to ophthalmologist. This can occur at any age of the patient. Automated refractometer has become popularised method for doing refraction because of the busy practise of ophthalmologist and due to heavy patients load in screening camps. It is an easy method to learn, to operate and also time saving procedure. Patients are also very comfortable with it because of this easy procedure done in short time. But Streak retinoscopy which is considered as a Gold standard technique for refraction, has some difficulties like time consuming, dilatation of pupil and discomfort to the patient. Aim: Comparing the effect of the conventional method of refraction with computerized automated refraction in various refractive error patients. Materials and methods: It was an observational, cross-sectional study done in a 50 refractive error patients who attend Department of Ophthalmology OPD. Results: According to the statistical analysis done to compare the refraction values of the auto refractometer and streak retinoscopy with the patient's acceptance value, results came as streak Deepikadevi SN, Sundararajan D, Namitha Bhuvaneshwari K, Murali Krishnan. Comparing the effect of conventional method of retinoscopic refraction with computerized automated refraction in various refractive error patients. IAIM, 2017; 4(10): 105-110. Page 106 retinoscopy values had no significant difference with the patient's acceptance value. This study also shows males were more affected by refractive errors than females and the mean age of affection in myopia was 19- 20 years and hypermetropia is 33-36 years. Conclusion: Since reteak retinoscopy values are accepted well by the patients, it is the better method for refrection than auto refractometer

Oil Droplet Cataract: Cause of Decreased Vision of Unknown Etiology

PURPOSE: To report cases of oil droplet cataract, one cause of decreased vision of unknown etiology. METHODS: We performed a retrospective chart review analysis of patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity and diagnosed with oil droplet cataract. Clinical features including history, result of ophthalmologic examinations, and clinical course were evaluated. RESULTS: Among the patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity, 6 patients were diagnosed with oil droplet cataract. The patients ranged from 38 to 63 years of age and their best corrected visual acuities at their first visits were between 0.1 and 0.7. Ophthalmologic examinations including neuro-ophthalmologic tests were normal except for changes in lens nucleus and peculiar fundus reflexes were observed using retinoscopy in all patients. Five eyes of 4 patients underwent cataract surgery and all 5 eyes achieved the best corrected visual acuity of 1.0 or higher. CONCLUSIONS: Oil droplet cataract is a cause of decreased visual acuity of unknown etiology that can be missed. The disease abnormalities are difficult to observe because only subtle changes in lens nucleus are apparent on slit lamp examination; however characteristic fundus reflexes can be identified using retinoscopy. Ophthalmologists should thoroughly understand the oil droplet cataract and diagnose it in the early stages to avoid misdiagnosis and unnecessary costs.

Comparison of the Refractive Measurements with Hand-held Autorefractometer, Table-mounted Autorefractometer and Cycloplegic Retinoscopy in Children

PURPOSE: To evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy. METHODS: Included in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 +/- 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared. RESULTS: The mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of +/-2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0degrees and 45degrees; keratometer values respectively. CONCLUSIONS: The refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.

Comparison of the Refractive Measurements with Hand-held Autorefractometer, Table-mounted Autorefractometer and Cycloplegic Retinoscopy in Children

PURPOSE: To evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy. METHODS: Included in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 +/- 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared. RESULTS: The mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of +/-2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0degrees and 45degrees; keratometer values respectively. CONCLUSIONS: The refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.

Estado refractivo en niños de un año de edad / Refractive condition of one-year old children

Objetivo: caracterizar epidemiológicamente el estado refractivo examinado de los niños preescolares de un año de edad que acudieron a consulta de Oftalmología del Policlínico Pedro Esperón, Bauta, en el período 2010-2011. Métodos: se realizó un estudio observacional, descriptivo y transversal del estado refractivo explorado a los niños de un año de edad que acudieron a consulta de Oftalmología del Policlínico Pedro Esperón, Bauta, en el período 2010-2011. El universo estuvo constituido por 113 niños, total que acudieron al chequeo de círculo infantil en el periodo en estudio. La muestra fue de 98 chicos para un total de 196 ojos a los que se les realizó examen oftalmológico completo incluyendo la retinoscopía, se distribuyeron por género, color de la piel y antecedentes familiares, los ojos se clasificaron según ametropías y grado de severidad. Resultados: el género femenino (54,08 por ciento) y el color blanco de la piel (51,01 porciento) resultaron predominantes en la población estudiada. El 60,2 por ciento tenía el antecedente familiar de ametropía. Se obtuvo que el 91,8 por ciento de ojos amétropes. La hipermetropía fue la más frecuente en el 64,45 por ciento. De las ametropías estudiadas prevaleció su forma leve (66,08 por ciento). Conclusiones: el comportamiento del estado refractivo observado, estuvo dentro de las cifras esperadas en relación a los reportes internacionales referidos al tema

Objectives: to epidemically characterize the screened refractive condition of one-year old preschool children, who had been seen at the Ophthalmology service of Pedro Esperon policlinic located in Bauta, from 2010 to 2011. Methods: a descriptive, cross-sectional and observational study of the screened refractive condition of one-year old children, who went to the ophthalmological service of the above-mentioned hospital in the said period. The universe of study was 113 children, that is, the total number of children who went to the check-up program for the day care centers in the study period. The selected sample was made up of 98 kids representing 196 eyes. They were applied a complete ophthalmological test including retinoscopy; they were distributed by gender, race and family history whereas the eyes were classified according to the ametropies and level of severity of the lesion. Results: females (54.8 percent) and Caucasians (51.01 percent) were predominant. Family history of ametropia was present in 60.2 percent. It was found that there were 91.8 percent of ametropic eyes. Hypermetropia was the most frequent in 64.45 percent. Of the studied ametropies, the mild form prevailed (66.8 percent). Conclusions: the behaviour of the observed refractive conditions was within the expected limits according to the international reports on this topic

Precisão da retinoscopia sem lentes neutralizadoras na hipermetropia experimental de olho artificial / Accuracy limits of retinoscopy without neutralising lenses for evaluation of experimental hypermetropia in a model eye

OBJETIVO: Avaliar a acurácia e a precisão da retinoscopia sem lentes neutralizadoras na hipermetropia experimental de olho artificial. MÉTODOS: Observação da projeção da faixa do retinoscópio em olho artificial preparado para apresentar hipermetropias de +1,00 D a +8,00 D. A movimentação da faixa é feita simultaneamente com a variação da sua largura, deslocando a luva do retinoscópio até a obtenção da neutralização do movimento. O retinoscópio foi preparado para dois modos de medida: com escala milimétrica sob a luva e com acoplamento a potenciômetro ligado a multímetro de leitura digital em ohms (Ù). Oito médicos oftalmologistas realizaram 1200 retinoscopias em cada modo de medida, num total de 2400. Calculou-se a média e o desvio padrão das observações. Para comparar os resultados em mm e em ohms (Ù) calculou-se o coeficiente de variação (CV) a partir dos desvios padrão das observações em cada modo. RESULTADOS: Pelos modos descritos foi possível estimar hipermetropias até +4,00 dioptrias. CONCLUSÃO: A acurácia e a reprodutibilidade experimentais foram boas na identificação de hipermetropias até +4 ,00 D.

OBJECTIVE: Evaluate accuracy and reproducibility of streak retinoscopy without neutralising lenses in experimental hyperopia of an artificial eye. METHODS: Observe a Welsh Allynretinoscope streak through the pupil of an artificial eye prepared do show hyperopia from +1,00 D to +8,00 D. The streak was moved while varying its width by sliding the sleeve upwards until neutralisation point. The retinoscope was fitted either with a millimetre scale under the sleeve or with a multimetre connected to a rheostat driven by a spool snugly fastened around the sleeve. Multimetre readings were taken in ohms (Ù). Eight ophthalmologists performed 1200 in each mode totalysing 2400 readings. Average and standard deviation of the readings in each mode were determined, as well as the variation coefficient in order to allow comparison of results in millimetre and Ù. RESULTS: Based on the proposed method it was possible to estimate hyperopia up to +4,00 D. CONCLUSION: Accuracy and reproducibility in experimental hyperopia of an artificial eye was feasible up to +4,00 D.

Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children.

Aim: To describe and compare dynamic distance direct ophthalmoscopy (DDDO) with dynamic retinoscopy (DR) in assessment of accommodation in children. Materials and Methods: This prospective observational study had four components. Component 1: to understand the characteristic digital images of DDDO. Component 2: to compare DDDO with DR for detection of accommodative defects in children (1–16 years). Component 3: to compare DDDO with DR for the detection of completeness of pharmacologically induced cycloplegia in children (5–16 years) and Component 4: to assess which one of the two techniques was more sensitive to detect onset of cycloplegia after instillation of 1% cyclopentolate eye drops. Results: Component 1: image analysis of DDDO on two subjects (7 years and 35 years) demonstrated superior pupillary crescent that progressively disappeared with increasing accommodation. Concurrently an inferior crescent appeared that became bigger in size with increasing accommodation. Component 2: the prevalence of defects in accommodation was 3.3% (33/1000 children). Three had unilateral accommodation failure. Sensitivity of DDDO was 94%, specificity 100%, positive predictive value 100%, negative predictive value 99%, and clinical agreement (kappa) 0.97. Component 3: in the detection of completeness of pharmacologically induced cycloplegia (n=30), the sensitivity of DDDO was 94%, specificity 96%, positive predictive value 97%, negative predictive value 93% and kappa 0.9. DR had two false positives. DDDO had one false negative. Component 4: DDDO detected onset of pharmacologically induced cycloplegia 5 min earlier than DR (n=5). Conclusion: DDDO is a novel, simple, clinical and reliable method to assess accommodation in young children. This test can assess the accommodative response of both eyes simultaneously.

Evaluación de la reproducibilidad de la retinoscopia dinámica monocular de Merchán / Evaluation of the reproducibility of the Merchán monocular dynamic retinoscopy

Objetivo: Evaluar la reproducibilidad de la retinoscopia dinámica monocular y su nivel de acuerdo con la retinoscopia estática binocular y monocular, retinoscopia de Nott y Método Estimado Monocular (MEM). Métodos: Se determinó la reproducibilidad entre los evaluadores y entre los métodos por medio del coeficiente de correlación intraclase (CCI) y se establecieron los límites de acuerdo de Bland y Altman.Resultados: Se evaluaron 126 personas entre 5 y 39 años y se encontró una baja reproducibilidad interexaminador de la retinoscopia dinámica monocular en ambos ojos CCI ojo derecho: 0.49 (IC95% 0.36; 0.51); ojo izquierdo 0.51 (IC95% 0.38; 0.59). El límite de acuerdo entre evaluadores fue ±1.25 D. Al evaluar la reproducibilidad entre la retinoscopia dinámica monocular y la estática se observó que la mayor reproducibilidad se obtuvo con la estática binocular y monocular y, en visión próxima, entre el método estimado monocular y la retinoscopia de Nott. Conclusiones: La retinoscopia dinámica monocular no es una prueba reproducible y presenta diferencias clínicas significativas para determinar el estado refractivo, en cuanto a poder dióptrico y tipo de ametropía, por tanto, no se puede considerar dentro de la batería de exámenes aplicados para determinar diagnósticos y correcciones refractivas tanto en la visión lejana como en la visión próxima.

Objective: To assess the reproducibility of monocular dynamic retinoscopy and its level of agreement with binocular static retinoscopy, the Nott retinoscopy, and the Monocular Estimated Method (MEM). Materials and methods: The reproducibility was determined among evaluators and among the methods through the intraclass coefficient of correlation (ICC) and set the limits of agreement of Bland and Altman. Results: A total of 126 subjects between 5 and 39 years of age were evaluated and low inter-rater reproducibility of the monocular dynamic retinoscopy was found in both eyes: ICC right eye: 0.49 (IC 95% 0.36; 0.61) left eye 0.51 (IC 95% 0.38; 0.59). The limit of agreement between evaluators was ±1.25D. In assessing reproducibility between the monocular dynamic retinoscopy and the static retinoscopy, it was observed that the greatest reproducibility was obtained with the binocular and monocular static retinoscopy and in near vision between the estimated method monocular and Nott retinoscopy. Conclusions: Monocular dynamic retinoscopy is not a reproducible test and presents clinical differences meaningful to determine the refractive state, regarding power dial and type of ametropy; therefore, it could not be considered within the battery of tests used to determine diagnoses and refractive corrections both in distant vision and in near vision.

Retinoscopia com luz em faixa em cães fácicos, afácicos e pseudofácicos / Streak retinoscopy in phakic, aphakic, and pseudophakic dogs

Avaliou-se o erro refracional em 40 cães submetidos ou não à facectomia por facoemulsificação, por meio de retinoscopia com luz em faixa. Distribuídos em quatro grupos de 10 animais cada, foram designados por cães fácicos, cães afácicos (CA), cães pseudofácicos com implante de duas lentes intra-oculares em piggyback (PP) e cães pseudofácicos com implante de uma lente intra-ocular veterinária de 41D (PL). As avaliações foram realizadas por ceratometria, ecobiometria ultra-sônica e retinoscopia. A média da curvatura corneana foi de 40,46±2,44D. O poder dióptrico obtido por retinoscopia foi de 18,50D no grupo CA, 5,25D no grupo PP e 2,00D no grupo PL. A retinoscopia com luz em faixa constituiu um método eficaz para avaliar a refração ocular em cães, mas foi dificultada quando da presença de opacidade de meios oculares. Todos os animais apresentaram-se hipermétropes, em diferentes graus; o astigmatismo ceratométrico cirurgicamente induzido foi discreto.

The refraction error in dogs submitted or not to phakectmy, by phakoemulsification by streak retinoscopy was evaluated. Forty dogs were distributed in four groups of 10 animals each, and were designated by phakic, aphakic (AD), pseudo-phakic with two piggyback intraocular lenses (PD), and pseudo-phakic with one intraocular 41D veterinary lens implant (LD). The evaluation was performed by keratometry, ultrasonic echobiometry, and retinoscopy. The mean corneal curvature was 40.46±2.44D. The dioptric power obtained by retinoscopy was 18.50D in AD group, 5.25D in PD group, and 2.00D in LD group. The retinoscopy was an efficient method to evaluate ocular refraction in dogs, but was more complex in ocular opacity presence. All animals presented different levels of hypermetropy, and the surgically induced astigmatism was discrete.

Refração por retinoscopia com luz em faixa em cães / Refraction by streak retinoscopy in dogs

A refração ocular por retinoscopia com luz em faixa em 10 cães normais, sem raça definida, demonstrou que a maioria dos animais, independentemente do porte, apresentou tendência à hipermetropia, além de anisometropia e astigmatismo.

Ocular refraction by streak retinoscopy performed in 10 mixed breed dogs showed that most of the animals, independently of size, had a tendency to hypermetropia, anisometropia, and astigmatism.

The effect of cyclopentolate cycloplegic on the refraction measurement in adult guinea pigs / 眼科

Objective To investigate the effect of cyclopentolate cycloplegic on the refraction measurement in adult guinea pigs. Design Experimental study.Participants 24 eyes of 12(10 weeks) adult guinea pigs.Methods 12 animals were randomly examined thrice by streak retinoscopy pre and post mydriasis.1%cyclopentolate hydrochloride was topically administrated to the eye every five minutes for three times.Main Outcome Measures The eye refraction of guinea pigs included the scope,cylinder and the equivalent power.Results The average refraction of guinea pigs in pre-mydriasis and post-mydriasis were 1.92?0.79 D and 2.08?0.79 D respectively. The average refraction that included the scope,cylinder and the equivalent power all showed no significant difference between pre and post mydriasis.The effect of mydriasis and measure time points on the refraction that included the scope,cylinder and the equivalent scope showed no significant difference either.Conclusions The effect of 1%cyclopentolate cycloplegic on adult guinea pigs in refraction is limited.The refraction of adult guinea pig can be measured naturally without cyclopentolate cycloplegic administrated.