Journal of Pediatric Ophthalmology and Strabismus

Original Article Supplemental Data

A Comparison of Three Different Photoscreeners in Children

Kuddusi Teberik, MD; Mehmet Tahir Eski, MD; Murat Kaya, MD; Handan Ankarali, PhD

Abstract

Purpose:

To compare the results obtained from three non-cycloplegic handheld photorefractometers with cycloplegic autorefractometry (Topcon KR-8100; Topcon Corporation, Tokyo, Japan) measurement in children.

Methods:

The refractive status of 238 eyes in 119 healthy children was assessed. The values acquired using photorefraction with the non-cycloplegic PlusoptiX A12 (Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (Righton, Tokyo, Japan), and Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) devices were compared with those obtained from the cycloplegic Topcon KR-8100. The agreement between the measurements was assessed using the intraclass correlation coefficient.

Results:

The mean age was 10.1 ± 3.2 years (range: 6 to 17 years). The mean spherical value for the right eyes was 0.38 diopters (D) (range: −4.50 to 6.25 D) for the Plusoptix A12; 0.45 D (range: −4.50 to 6.25 D) for the Spot Vision Screener; −1.15 D (range: −8.75 to 6.50 D) for the Retinomax K-plus 3; and 0.62 (range: −4.50 to 6.00) for the Topcon KR-8100. The mean spherical equivalent value for the right eyes was 0.41 D (range: −4.50 to 7.90 D) for the Plusoptix A12; 0.18 D (range: −4.75 to 6.13 D) for the Spot Vision Screener; −1.30 D (range: −10.50 to 6.38 D) for the Retinomax K-plus 3; and 0.67 D (range: −4.00 to 6.00 D) for the Topcon KR-8100 (for the right eyes).

Conclusions:

The photorefractometer method was beneficial in the measurement of refractive errors of school-aged children. The PlusoptiX A12 photorefractometer method may eliminate the need for cycloplegia in the detection of refractive errors in children.

[J Pediatr Ophthalmol Strabismus. 2018;55(5):306-311.]

Abstract

Purpose:

To compare the results obtained from three non-cycloplegic handheld photorefractometers with cycloplegic autorefractometry (Topcon KR-8100; Topcon Corporation, Tokyo, Japan) measurement in children.

Methods:

The refractive status of 238 eyes in 119 healthy children was assessed. The values acquired using photorefraction with the non-cycloplegic PlusoptiX A12 (Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (Righton, Tokyo, Japan), and Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) devices were compared with those obtained from the cycloplegic Topcon KR-8100. The agreement between the measurements was assessed using the intraclass correlation coefficient.

Results:

The mean age was 10.1 ± 3.2 years (range: 6 to 17 years). The mean spherical value for the right eyes was 0.38 diopters (D) (range: −4.50 to 6.25 D) for the Plusoptix A12; 0.45 D (range: −4.50 to 6.25 D) for the Spot Vision Screener; −1.15 D (range: −8.75 to 6.50 D) for the Retinomax K-plus 3; and 0.62 (range: −4.50 to 6.00) for the Topcon KR-8100. The mean spherical equivalent value for the right eyes was 0.41 D (range: −4.50 to 7.90 D) for the Plusoptix A12; 0.18 D (range: −4.75 to 6.13 D) for the Spot Vision Screener; −1.30 D (range: −10.50 to 6.38 D) for the Retinomax K-plus 3; and 0.67 D (range: −4.00 to 6.00 D) for the Topcon KR-8100 (for the right eyes).

Conclusions:

The photorefractometer method was beneficial in the measurement of refractive errors of school-aged children. The PlusoptiX A12 photorefractometer method may eliminate the need for cycloplegia in the detection of refractive errors in children.

[J Pediatr Ophthalmol Strabismus. 2018;55(5):306-311.]

Introduction

Amblyopia may cause an inevitable loss of vision unless it is detected and treated during childhood.1 Correct measurement of the refractive defect is important in terms of the prevention of amblyopia. Various methods are used for this purpose, such as photorefractometers, handheld autorefractometers, cycloplegic retinoscopy, and visual-evoked responses.2

The gold standard for diagnosing refractive errors in children is cycloplegic refraction.3 However, pediatric refractive problems can be difficult to assess, even for an experienced ophthalmologist, and solutions are limited to applied screening processes.4–6 Moreover, the use of cycloplegic drops may predispose the child to unwanted side effects. Autorefraction is a faster method and frequently used as a reference in subjective refractions in optometric and ophthalmologic practice for spectacle prescription; however, it requires significant collaboration and for this reason is not practical for some children.3,5

Photorefraction is a technique that simplifies the screening of amblyopia even in young children, which can detect refractive errors without cycloplegia.7 It is also suitable for the detection of refractive error in patients with physical and mental disabilities. Patients do not have to put their heads close to devices or feel threatened by the examiner. However, accommodation has a significant effect on the measurement of refractive error, especially in school-aged children.

In this study, we compared the results obtained without cycloplegia from three handheld photorefractometers with cycloplegic measurement in children. Another purpose was to investigate whether the refractometer method meets the needs for cycloplegia in the measurement of refractive errors.

Patients and Methods

The study was completed between November and December 2016. Approval for the study was obtained from the ethics committee. The study was conducted in line with the tenets of the Declaration of Helsinki. Parental consent was also obtained before proceeding. A total of 119 healthy children were consecutively admitted to the outpatient clinic and were examined using four different methods.

Children with sensitivity to cycloplegic agents, manifest slippage, media opacity, or retinal abnormalities and those with refractive errors beyond the limits defined by the manufacturer (spherical equivalent from −7.50 to +5.00 diopters [D]), and children uncooperative with photorefraction measurement and retinoscopy were excluded from the study. Those without additional eye pathology other than a refractive disorder were included in the study.

The refraction examinations of the participants were performed without cycloplegia using the PlusoptiX A12 (Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (Righton, Tokyo, Japan), and Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY). Cyclopentolate 1% (Cycloplegin; Abdi Ibrahim, Istanbul, Turkey) for cycloplegia was administered to both eyes of each patient. This application was repeated 5 minutes later. The pupillary light reaction of the participants was checked 45 minutes after the last administration. After complete cycloplegia was achieved in all of the patients' eyes, evaluation was performed using the Topcon KR-8100 (Topcon Corporation, Tokyo, Japan).

The measurements were repeated at least twice, and the average values of the results obtained were recorded for use in the study. The sphere, cylinder, axis, and spherical equivalent values obtained from all of the photorefractors were compared statistically with the values obtained from the Topcon KR-8100. The spherical equivalent was obtained by adding half of the spherical dioptric value to the cylindrical dioptric value.

Statistical Analysis

Descriptive values of the obtained measurements were calculated as the mean ± standard deviation and categorized. The agreement between the measurements was assessed using intraclass correlation coefficient (ICC) and the 95% confidence interval of this coefficient, and the P values indicating statistical significance levels were given. In addition, a Bland–Altman graph was used when this harmony was examined graphically. An alpha value of 0.05 was considered significant, and the Statistical Package for the Social Sciences (version 18; SPSS, Inc., Chicago, IL) and Medcalc (trial version; Ostend, Belgium) programs were used in the calculations.

Results

Of 119 patients studied, 61 (51.3%) were female and patient ages ranged from 6 to 17 years (mean: 10.1 ± 3.2 years).

Tables 12 summarize the non-cycloplegic mean sphere, cylinder, axis, and spherical equivalent measurements for the right and left eyes.

Mean ± SD Sphere, Cylinder, and Spherical Equivalents in the Right Eyesa

Table 1:

Mean ± SD Sphere, Cylinder, and Spherical Equivalents in the Right Eyes

Mean ± SD Sphere, Cylinder, and Spherical Equivalents in the Left Eyesa

Table 2:

Mean ± SD Sphere, Cylinder, and Spherical Equivalents in the Left Eyes

For the PlusoptiX A12, 25 (21%) and 30 (25%) of the eyes (right and left, respectively) were myopic, 78 (65.5%) and 73 (61.3%) were hyperopic, and 16 (13.4%) and 16 (13.4%) were plano. Astigmatism was found in 102 (85.7%) and 98 (82.3%) of the eyes (right and left, respectively), and 34 (28.5%) of these eyes had a cylinder of more than 1.00 D.

For the Spot Vision Screener, 28 (23.5%) and 30 (25.2%) of the eyes (right and left, respectively) were myopic, 80 (67.2%) and 77 (64.7%) were hyperopic, and 11 (9.2%) and 12 (10%) were plano. Astigmatism was found in 108 (90.7%) and 105 (88.2%) of the eyes (right and left, respectively), and 54 (45.3%) of these eyes had a cylinder of more than 1.00 D.

For the Retinomax K-plus 3, a myopic spherical equivalent value was found in 92 (77.3%) and 92 (71.4%) of the eyes (right and left, respectively), 20 (16.8%) and 92 (22.6%) were hyperopic, and 7 (5.8%) and 7 (5.8%) were plano, respectively. Astigmatism was diagnosed in 67 (56.3%) and 62 (52.1%) of the eyes (right and left, respectively), and 32 (26.8%) of these eyes had a cylinder value of more than 1.00 D.

For the KR-8100, 12 (10%) and 22 (18.4%) of the eyes (right and left, respectively) were myopic, 71 (59.6%) and 74 (62.1%) were hyperopic, and 36 (30.2%) and 23 (19.3%) were plano. Astigmatism was found in 50 (42%) and 41 (34.4%) of the eyes (right and left, respectively), and 58 (48.7%) of these eyes had a cylinder value of more than 1.00 D.

When the results in Table 1 were evaluated, Retinomax K-plus 3 results for the sphere measurements were significantly higher than measurements of the other devices (P = .0001). The Spot Vision Screener averages for the cylinder measurements were significantly higher than those of the other devices (P = .0001). Spot Vision Screener results for the axis measurements were significantly higher than the results measured on the other devices (P = .0001). The Retinomax K-plus 3 average for spherical equivalent was significantly higher than the measurements of the other devices (P = .0001).

When the results in Table 2 were evaluated, the Retinomax K-plus 3 results for sphere measurements were significantly higher than those of the other devices (P = .0001). The Spot Vision Screener results for the cylinder measurements were significantly higher than those of the other devices (P = .001). The PlusoptiX A12 and Spot Vision Screener results for axis were significantly higher than those of the other devices (P = .0001). The Retinomax K-plus 3 results for spherical equivalence were significantly higher than those of the other devices (P = .0001).

ICCs between the cycloplegic measurements obtained from the Topcon KR-8100, PlusoptiX A12, Spot Vision Screener, and Retinomax K-plus 3 and the confidence interval are summarized in Table 3 for all patients. The highest compliance was statistically significant with the cycloplegic Topcon KR-8100 measurements in both right and left measurements of the PlusoptiX A12 device. However, the level of integration was moderate. Moreover, the Spot Vision Screener showed a statistically significant agreement with cycloplegic Topcon KR-8100 measurements in the right spherical, right cylinder, and left spherical equivalent measurements, but the degree of these consistencies was moderate. In addition, the Retinomax K-plus 3 was compatible with cycloplegic Topcon KR-8100 measurements for the right cylinder measurement. No statistically significant correlation was found in the other conditions. According to these results, it can be said that the PlusoptiX A12 device, which is compatible with the Topcon KR-8100 in all of the measurements, is preferable in cases where cycloplegia was not performed. Tables AB (available in the online version of this article) break down the ICCs by age group and Table C (available in the online version of this article) compares the results. Bland–Altman graphs also evaluated the compatibility between the devices, and are collectively shown in Figures AF (available in the online version of this article). When the graphs are examined, it can be seen that the results of the measurements of the three different devices in the study were compatible with each other. The differences between the measurement results (bias) were distributed randomly to averages of the measurement.

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in All Patientsa

Table 3:

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in All Patients

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in the 6 to 10 Years Age Groupa

Table A:

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in the 6 to 10 Years Age Group

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in the 11 to 17 Years Age Groupa

Table B:

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in the 11 to 17 Years Age Group

Comparison of Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements

Table C:

Comparison of Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements

(A–C) Bland–Altman plots showing agreement between the devices for the right spherical equivalent.

Figure A.

(A–C) Bland–Altman plots showing agreement between the devices for the right spherical equivalent.

(A–C) Bland–Altman plots showing agreement between the devices for the right cylinder measurements.

Figure B.

(A–C) Bland–Altman plots showing agreement between the devices for the right cylinder measurements.

(A–C) Bland–Altman plots showing agreement between the devices for the right spherical equivalent measurements.

Figure C.

(A–C) Bland–Altman plots showing agreement between the devices for the right spherical equivalent measurements.

(A–C) Bland–Altman plots showing agreement between the devices for the left spherical measurements.

Figure D.

(A–C) Bland–Altman plots showing agreement between the devices for the left spherical measurements.

(A–C) Bland–Altman plots showing agreement between the devices for the left cylinder measurements.

Figure E.

(A–C) Bland–Altman plots showing agreement between the devices for the left cylinder measurements.

(A–C) Bland–Altman plots showing agreement between the devices for the left spherical equivalent measurements.

Figure F.

(A–C) Bland–Altman plots showing agreement between the devices for the left spherical equivalent measurements.

Discussion

This is the first study to compare the refraction measurement values obtained using the Retinomax K-plus 3 and new versions of the Spot Vision Screener (version 2.0.16) and Plusoptix A12 in school-aged children with the Topcon KR-8100. Photorefraction provides remote measurement of the refractive error by analyzing the transitivity of the reflected light from the fundus.8 Commercially available photorefractive devices have been used for several years. The vision screener was easy to use and convenient in more than 90% of young patients.9 We were able to complete ophthalmologic examinations for all of the children tested.

Early detection and treatment of amblyopia results in better outcomes and reduces the prevalence and severity of this disorder in children. Handheld autorefractors will be useful in addition to probable use in clinical treatment and to detect abnormal refractive errors.10–12 Unlike other studies, we examined the compatibility of these new generation devices with the Topcon KR-8100. In our study, the Plusoptix A12 showed a statistically significant agreement with the Topcon KR-8100 in both right and left eye measurements. However, the level of integration was moderate. Furthermore, the Spot Vision Screener showed a statistically significant agreement with the Topcon KR-8100 for right spherical, right cylinder, and left spherical equivalent measurements. However, the degree of this harmony was also moderate. We also found that, in our study, the Retinomax K-plus 3 correlated with the right cylinder measurements with the Topcon KR-8100. No statistically significant correlation was found in the other conditions. According to these results, we can say that the PlusoptiX A12, which is compatible with the Topcon KR-8100 in all of the measurements, is preferable in cases where cycloplegic autorefractometry was not performed. Bland–Altman graphs have also been studied for compatibility between the devices, and the results of the measurements of the three different devices in the study were found to be compatible with each other.

Fogel-Levin et al.13 found a statistically significant difference between the PlusoptiX A12 and cycloplegic refraction in all of the refraction measurements, but the differences had no clinical significance. In addition, the Pearson's correlation test was positive and showed a good correlation of the PlusoptiX A12 with cycloplegic refraction in all subgroups, as shown by previous studies with earlier versions of the PlusoptiX.14–16

Payerols et al.17 found that the spherical equivalent value with non-cycloplegic Plusoptix A09 refraction is closer to that of cycloplegic autorefraction than noncycloplegic autorefraction. The Plusoptix A09 underestimated the hyperopia of 0.73 D and slightly overestimated the myopia of 0.05 D. They reported that the Plusoptix A09 could be used for screening with higher accuracy in myopic than hyperopic children.

Yilmaz et al.18 found that the ICC was 0.902 for the Retinomax K-plus 3 and 0.918 for the Plusoptix A09. Both devices showed a high agreement between repeated measurements. In addition, the inter-device 95% limits of agreement ranges were 3.70 D for retinoscopy–Retinomax and 3.60 D for retinoscopy–Plusoptix in spherical refractive errors. The inter-device 95% limits of agreement ranges were 1.80 D for retinoscopy–Retinomax and 1.50 D for retinoscopy–Plusoptix in cylindrical refractive errors. There was no significant difference between devices according to one-way analysis of variance. Yilmaz et al. 18 reported that the Plusoptix A09 and Retinomax K-plus 3 agree well with cycloplegic retinoscopy and, although both devices may be used for screening children between 4 and 12 years old, the Plusoptix A09 may eliminate the need for cycloplegia for the detection of refractive errors in children.

Mirzajani et al.19 compared the Plusoptix S08 and retinoscopy, and reported that there was good consistency between the results of the Plusoptix S08 without using cycloplegic agents and those of cycloplegic retinoscopy.

Tuncer et al.20 compared the Retinomax and retinoscopy in 127 patients (mean age: 96.7 months) and found no significant difference between the devices in the spherical, cylindrical, and spherical equivalent of the refractive errors. They added that the Retinomax might be used successfully as a screening tool. In a similar study, Ying et al.21 compared noncycloplegic retinoscopy, Retinomax, and SureSight Vision Screener (Welch Allyn Medical Products) for preschool vision screening and reported that all of the devices had similar and high accuracy in detecting vision disorders in preschoolers across all types of screeners and ages of children. Akil et al.22 found good agreement between the Retinomax K-plus 3 with cycloplegia and cycloplegic retinoscopy. In the same study, when Bland–Altman analysis was performed to compare the spherical equivalent values before and after cycloplegia was measured with the Retinomax K-plus 3, Canon RK-F1, and cycloplegic retinoscopy, almost all of the differences between the measurements remained within the range of ±2 standard deviations, on average.22

Harvey et al.23 reported that the Retinomax provided an average of approximately 0.25 D less negative or more positive measures of refractive error than retinoscopy. They also compared their data to other reports and found that the Retinomax was concordant with retinoscopy and subjective refinement in young children, to the degree that is comparable with other autorefractors (Humphrey 500 and Nidek AR-1000). Wesemann and Dick24 showed that the accuracy of measurement of handheld autorefractor in children during cycloplegia was high. In contrast, Prabakaran et al.25 showed that spherical equivalent from a handheld autorefractor was significantly more negative compared to that of streak retinoscopy. Moreover, the handheld autorefractor significantly overestimated the amount of astigmatism. The current study found a good agreement between the Retinomax K-plus 3 after cycloplegia and cycloplegic retinoscopy.25

The photorefractometer method was found to be beneficial in the measurement of refractive errors of school-aged children. However, its disadvantages are a limited measurable refractive error range and being affected by mydriatic pupils. The PlusoptiX A12 photorefractometer may eliminate the need for cycloplegia in the detection of refractive errors in children. Further studies examining more cases with an extreme range of refractive errors may be needed to confirm the outcomes of this study.

References

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  16. Paff T, Oudesluys-Murphy AM, Wolterbeek R, et al. Screening for refractive errors in children: the plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy. J AAPOS. 2010;14:478–483. doi:10.1016/j.jaapos.2010.09.015 [CrossRef]
  17. Payerols A, Eliaou C, Trezeguet V, Villain M, Daien V. Accuracy of PlusOptix A09 distance refraction in pediatric myopia and hyperopia. BMC Ophthalmol. 2016;16:72. doi:10.1186/s12886-016-0247-8 [CrossRef]
  18. Yilmaz I, Ozkaya A, Alkin Z, Ozbengi S, Yazici AT, Demirok A. Comparison of the Plusoptix A09 and Retinomax K-Plus 3 with retinoscopy in children. J Pediatr Ophthalmol Strabismus. 2015;52:37–42. doi:10.3928/01913913-20141230-06 [CrossRef]
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  20. Tuncer I, Zengin MO, Karahan E. Comparison of the Retinomax hand-held autorefractor versus table-top autorefractor and retinoscopy. Int J Ophthalmol. 2014;7:491–495.
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  23. Harvey EM, Miller JM, Wagner LK, Dobson V. Reproducibility and accuracy of measurements with a hand-held autorefractor in children. Br J Ophthalmol. 1997;81:941–948. doi:10.1136/bjo.81.11.941 [CrossRef]
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  25. Prabakaran S, Dirani M, Chia A, et al. Cycloplegic refraction in preschool children: comparisons between the hand-held autorefractor, table-mounted autorefractor and retinoscopy. Ophthalmic Physiol Opt. 2009;29:422–426. doi:10.1111/j.1475-1313.2008.00616.x [CrossRef]

Mean ± SD Sphere, Cylinder, and Spherical Equivalents in the Right Eyesa

ParameterPlusoptiX A12Spot Vision ScreenerRetinomax K-plus 3Topcon KR-8100P
Sphere (D)0.38 ± 1.250.45 ± 1.25−1.15 ± 1.770.62 ± 1.35.0001
Cylinder (D)−0.45 ± 0.52−0.62 ± 0.66−0.40 ± 0.59−0.29 ± 0.86.0001
Axis (degrees)64.61 ± 62.0885.33 ± 71.1143.89 ± 56.9963.45 ± 67.55.0001
SE (D)0.41 ± 1.270.18 ± 1.37−1.30 ± 1.900.67 ± 1.50.0001

Mean ± SD Sphere, Cylinder, and Spherical Equivalents in the Left Eyesa

ParameterPlusoptiX A12Spot Vision ScreenerRetinomax K-plus 3Topcon KR-8100P
Sphere (D)0.38 ± 1.220.36 ± 1.28−1.05 ± 1.830.71 ± 1.44.0001
Cylinder (D)−0.45 ± 0.67−0.56 ± 0.71−0.31 ± 0.63−0.32 ± 0.84.001
Axis (degrees)65.83 ± 62.3168.89 ± 64.4844.19 ± 61.2145.38 ± 62.19.0001
SE (D)0.12 ± 1.220.13 ± 1.34−1.19 ± 1.840.62 ± 1.72.0001

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in All Patientsa

ParameterAppraised DevicesRight MeasurementsPLeft MeasurementsP
SphericalPlusoptiX A120.274 (−0.042 to 0.494).0410.262 (−0.052 to 0.479).048
Spot Vision Screener0.453 (0.215 to 0.619).0010.206 (−0.140 to 0.447).105
Retinomax K-plus 3−0.336 (−0.918 to 0.070).942−0.248 (−0.792 to 0.131).885
CylinderPlusoptiX A120.346 (0.061 to 0.545).0110.420 (0.167 to 0.596).002
Spot Vision Screener0.260 (−0.067 to 0.477).0500.164 (−0.200 to 0.418).165
Retinomax K-plus 30.361 (0.083 to 0.555).0080.191 (−0.161 to 0.437).124
AxisPlusoptiX A120.277 (−0.038 to 0.497).0390.300 (−0.005 to 0.512).027
Spot Vision Screener0.139 (−0.236 to 0.400).2080.142 (−0.232 to 0.403).203
Retinomax K-plus 30.115 (−0.271 to 0.384).2530.181 (−0.176 to 0.429).140
SEPlusoptiX A120.278 (−0.036 to 0.498).0380.266 (−0.054 to 0.489).047
Spot Vision Screener−0.042 (−0.375 to 0.333).4070.263 (−0.060 to 0.486).049
Retinomax K-plus 3−0.479 (−1.123 to 0.030).983−0.152 (−0.655 to 0.198).779

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in the 6 to 10 Years Age Groupa

ParameterAppraised DeviceRight MeasurementsPLeft MeasurementsP
SphericalPlusoptiX A120.592 (0.347 to 0.745).0010.366 (0.014 to 0.604).029
Spot Vision Screener0.372 (0.005 to 0.608).0260.460 (0.136 to 0.663).005
Retinomax K-plus 3−0.281 (−1.05 to 0.200).849−0.301 (−1.083 to 0.187).864
CylinderPlusoptiX A120.332 (0.068 to 0.583).0410.433 (0.093 to 0.646).009
Spot Vision Screener0.429 (0.079 to 0.641).0110.467 (0.147 to 0.667).004
Retinomax K-plus 30.495 (0.192 to 0.685).0020.528 (0.244 to 0.705).001
AxisPlusoptiX A120.285 (−0.144 to 0.554).0800.287 (−0.141 to 0.555).079
Spot Vision Screener0.330 (0.071 to 0.582).0470.343 (0.049 to 0.591).039
Retinomax K-plus 30.308 (−0.107 to 0.568).0620.084 (−0.466 to 0.428).357
SEPlusoptiX A120.039 (−0.539 to 0.400).4340.332 (0.069 to 0.583).046
Spot Vision Screener0.462 (0.138 to 0.664).0050.361 (0.023 to 0.601).031
Retinomax K-plus 3−0.645 (−1.633 to −0.027).981−0.205 (−0.928 to 0.248).782

Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements in the 11 to 17 Years Age Groupa

ParameterAppraised DeviceRight MeasurementsPLeft MeasurementsP
SphericalPlusoptiX A120.145 (−0.520 to 0.519).296−0.021 (−0.814 to 0.427).528
Spot Vision Screener0.136 (−0.534 to 0.515).307−0.020 (−0.812 to 0.427).526
Retinomax K-plus 3−0.446 (−1.569 to 0.188).896−0.187 (−1.110 to 0.333).721
CylinderPlusoptiX A12−0.518 (−1.69 to 0.147).9230.355 (−0.147 to 0.637).067
Spot Vision Screener−0.330 (−1.364 to 0.253).8350.251 (−0.331 to 0.579).161
Retinomax K-plus 3−0.156 (−1.054 to 0.351).6900.322 (−0.205 to 0.619).092
AxisPlusoptiX A12−0.166 (−1.071 to 0.345).700−0.169 (−1.077 to 0.343).073
Spot Vision Screener0.142 (−0.524 to 0.518).2990.213 (−0.399 to 0.558).206
Retinomax K-plus 3−0.302 (−1.314 to 0.268).8170.341 (−0.171 to 0.630).077
SEPlusoptiX A120.048 (−0.691 to 0.465).4330.153 (−0.505 to 0.524).284
Spot Vision Screener−0.013 (−0.754 to 0.445).4820.108 (−0.585 to 0.499).348
Retinomax K-plus 3−0.174 (−1.087 to 0.3400).709−0.073 (−0.906 to 0.932).594

Comparison of Levels of Agreement of Using the 3 Different Measuring Instruments With Cycloplegic Autokeratorefractometer in the Right and Left Measurements

ParameterAppraised DeviceRight MeasurementsLeft Measurements


All Patients6 to 10 Years11 to 17 YearsAll Patients6 to 10 Years11 to 17 Years
SphericalPlusoptiX A12YesYesNoYesYesNo
Spot Vision ScreenerYesYesNoNoYesNo
Retinomax K-plus 3NoNoNoNoNoNo
CylinderPlusoptiX A12YesYesNoYesYesNo
Spot Vision ScreenerYesYesNoNoYesNo
Retinomax K-plus 3YesYesNoNoYesNo
AxisPlusoptiX A12YesNoNoYesNoNo
Spot Vision ScreenerNoYesNoNoYesNo
Retinomax K-plus 3NoNoNoNoNoNo
SEPlusoptiX A12YesNoNoYesYesNo
Spot Vision ScreenerNoYesNoYesYesNo
Retinomax K-plus 3NoNoNoNoNoNo
Authors

From Düzce University Faculty of Medicine, Düzce, Turkey.

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Kuddusi Teberik, MD, Orhangazi Mah., Konuralp 500 Cd., No., 125/7, 81450, Düzce, Turkey. E-mail: kuddusiteberik@yahoo.com

Received: May 29, 2017
Accepted: October 19, 2017
Posted Online: May 29, 2018

10.3928/01913913-20180405-03

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