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.

Tribal Odisha Eye Disease Study # 4: Accuracy and utility of photorefraction for refractive error correction in tribal Odisha (India) school screening

Purpose: To compare the photorefraction system (Welch Allyn Spot™) performance with subjective refraction in school sight program in one Odisha (India) tribal district. Methods: In a cross-sectional study school students, aged 5–15 years, referred after the preliminary screening by trained school teachers received photoscreening and subjective correction. The photoscreener was compared to subjective refraction in the range of +2D to ?7.5D. Statistical analysis included Friedman nonparametric test, Wilcoxon signed-rank test, linear regression, and Bland–Altman plotting. Results: The photoscreener was used in 5990 children. This analysis included 443 children (187 males, 256 females, and the mean age was 12.43 ± 2.5 years) who received both photorefraction and subjective correction, and vision improved to 6/6 in either eye. The median spherical equivalent (SE) with spot photorefraction was 0.00 D (minimum ?5.0D; maximum +1.6 D), and with subjective correction was 0.00D (minimum ?6.00 D; maximum +1.5 D). The difference in the SE between the two methods was statistically significant (P < 0.001) using Friedman nonparametric test; it was not significant for J 45 and J 180 (P = 0.39 and P = 0.17, respectively). There was a good correlation in linear regression analysis (R2 = 0.84) and Bland–Altman showed a good agreement between photorefraction and subjective correction in the tested range. Conclusion: Photorefraction may be recommended for autorefraction in school screening with reasonable accuracy if verified with a satisfactory subjective correction. The added advantages include its speed, need of less expensive eye care personnel, ability to refract both eyes together, and examination possibility in the native surrounding.

Reliability and Usefulness of Refractive Measurements by PlusoptiX S09 in Children

PURPOSE: To compare the refractive measurements obtained using a photorefractor (PlusoptiX S09, PlusoptiX GmbH, Germany) with those obtained using cycloplegic refraction in children. METHODS: We assessed the refractive status of 268 eyes in 134 children. The values acquired via photorefraction with a PlusoptiX S09 device were compared with those obtained by cycloplegic retinoscopy. Hyperopia (> or =+3.5 D), myopia (> or =-3.0 D), with the rule or against the rule astigmatism (> or =-1.5 D), and oblique astigmatism (> or =-1.0 D) were set as diagnostic criteria for refractive amblyopia risk factors (RARFs). The difference in the detection of RARFs by the two methods was the main outcome measure. RESULTS: The average spherical refractive power was -0.81 +/- 1.68 D for PlusoptiX S09 versus -0.26 +/- 2.00 D for cycloplegic retinoscopy (average difference -0.54 +/- 0.61 D; p < 0.001). The average spherical equivalent was -1.20 +/- 1.62 D for PlusoptiX S09 versus -0.64 +/- 1.94 D for cycloplegic retinoscopy (average difference -0.56 +/- 0.62 D; p < 0.001). The average cylinder power was -0.79 +/- 0.93 D for PlusoptiX S09 versus -0.76 +/- 0.94 D for cycloplegic retinoscopy (average difference -0.03 +/- 0.33 D; p = 0.135). Even though cycloplegic retinoscopy is considered the gold standard, the sensitivity and specificity for detecting RARFs with the PlusoptiX S09 were 88.0% and 96.3%, respectively. CONCLUSIONS: PlusoptiX S09 is a relatively useful method for detecting RARFs, but the device tends toward myopic shift compared to cycloplegic refraction, and hyperopia is underestimated.

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.

Comparision between Manifest vs. Cycloplegic Photore fraction with MTI Photoscreener in Prematurity

Amblyopia and strabismus are common in eyes of prematurity and the need for early detection of amblyopia and amblyogenic factors is widely recognized. So, we performed refraction in premature infants at the 6 months of age to evaluate the incidence and degree of myopia and the changes of refractive errors according to the development, disease course and photocoagulation therapy of retinopathy of prematurity[ROP]. It is the purpose of this study to evaluate the effectiveness of MTI[medical Technology, Inc]photoscreener by comparing the sensitivity and specificity between refractive errors determined by manifest photorefraction and cycloplegic photorefraction in 6-month-old premature infants in Sung-Ae General Hospital. Pass or fail screening data from photograph of 32 non-dilated and dilated premature infant were calculated by two masked observers, compared with the results of cycloplegic retinoscopy, and the statical analysis was carried out. In the cases of cycloplegic photorefraction, Ten eyes of myopia, 4 eyes of emetropia, and 50 eyes of hyperopia were found, and 21 eyes of astigmatism above 1.5D were also detected. Overall statistical analysis of sensitivity and specificity rate were 71.7% and 69.5%in manifest photorefraction, 87.5% and of 75%in cycloplegic photorefraction, respectively. In non-cycloplegic photorefraction, sensitivity of myopia and hyperopia were 92.8%, 65%, but in cycloplegic photorefraction, sensitivity of myopia and hyperopia were 75%, 100%, respectively. The outcomes of our study suggest that MTI photoscreener in cycloplegic photorefraction was more reliable than non-cycloplegic photorefraction. Myopia under 1D turned to hyperopia in cycloplegic photorefraction, so the sensitivity of that was not to be reliable, but the sensitivity of hyperopia was high. Thus, the authors can readily recommand this cycloplegic photorefraction in uncooperable infants to evalute the refractive error conveniently.

Polaroid Photoscreening for Amblyogenic Factors

We investigate the effect of a new photoscreening camera designed to detect amblyogenic factors including strabismus, asymmetric and abnormal refractive errors and media opacities. The photoscreener uses eccentric photorefraction principles and provides two meridian photographs of the retinal reflex. Pass/fail screening data from photograph of 58 nondilated children, determined by two masked observers, were compared with data from complete ophthalmologic examinations. Photoscreener had a sensitivity rate of 92.0%, a specificity rate of 72.2%, a positive predictive value of 94.8%, a negative predictive value of 61.9% and overall agreement rate of 90.5%. The new two-flash photoscreenig camera, which uses high-speed polaroid film, is an accurate and reliable method of detecting amblyogenic factors in undilated children, and the camera promise as a useful mass screening tool.

Research of double-cranny eccentric photorefraction device / 医疗卫生装备

In order to improve the performance of the photorefraction device,shorten the detection time and improve the accuracy of measuring,the theory of a new kind of double-cranny eccentric photorefraction device is described.Some features and key point of technology are emphatically pointed out.A method is put forward to determine the ocular diopter by image processing.

Refraction by Photo refraction

Photorefraction was performed in 96 cases(191 eyes) after instillation of tropicamide and cyclopentolate for the purpose of screening procedure. And then refraction was also carried out by retinoscope. From this comparison study, phtorefraction provided data which were very close to those obtained from the conventional retinoscopy.