Comparison of Manifest Refraction and Cycloplegic Refraction Using Retinoscopy or an Autorefractor in Children

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 neuro-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 auto-refraction 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 auto-refraction 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 auto-refraction compared to retinoscopic refraction with cycloplegia should be considered in younger children, cases with hyperopia or amblyopia, and cases with a difference in auto-refraction and retinoscopic refraction before cycloplegia.

An Analysis of Correlation with Visual Acuity, Refractive Error and Corneal Astigmatism after Wearing of Reverse Geometry Lenses

PURPOSE: To evaluate correlations with refractive error, astigmatism and uncorrected visual acuity after Ortho-K LKTM lens wear. METHODS: Sixty-one eyes of 32 patients who had been wearing reverse geometry lenses for over 5 weeks were recruited. Uncorrected visual acuity, subjective refraction on retinoscopy, objective refraction measured by an autorefractometer, and corneal astigmatism were measured by corneal topography before, at 2 days, and 1, 3, and 5 weeks after lenses fitting. RESULTS: Uncorrected visual acuity improved from 0.12+/-0.10 to 0.95+/-0.15 after 5 weeks. Subjective refraction on retinoscopy and objective refraction measures with the autorefractometer were -3.52+/-1.65D and -4.06+/-1.73D, respectively before wearing the lenses. These decreased to -0.08+/-0.40D and -1.98+/-2.04D, respectively after 5 weeks. The astigmatism detected by corneal topography improved from 0.93+/-0.49 to 1.20+/-1.03 after 5 weeks. Uncorrected visual acuity was correlated with the refractive error measured by subjective refraction with retinoscopy rather than that by objective refraction with the autorefractometer. Corneal astigmatism measured by corneal topography correlated with the refraction detected by the autorefractometer. CONCLUSIONS: Subjective refraction by retinoscopy rather than refraction found objectively using the autorefractometer, was highly correlated with uncorrected visual acuity (r=0.77~0.87) which seems to be useful in evaluating myopia patients. The astigmatism determined by autorefractometer examination had high correlation with that determined by corneal topography (r=0.51~0.76). This result appears useful in decisions related to the decentering of lenses.