A device to aid the teaching of retinoscopy in low-resource countries

Donovan, Laureen; Brian, Garry; Toit, Rènée du

doi:10.1136/bjo.2007.121699

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…12–19,44 In this latter respect, self-refracting spectacles offer a potential advantage over the Focometer, a self-adjusting focusable telescope reported previously to have accuracy similar to Adspecs in the measurement of spherical equivalent refractive error, 32 but which is not appropriate for use in refractive correction. Self-refracting glasses also avoid the potential complexity of training involved in the use of streak retinoscopy, 45 which also requires subjective refinement for optimum accuracy. 46 …”

Section: Discussionmentioning

confidence: 99%

The Child Self-Refraction Study

He¹,

Congdon²,

Mackenzie³

et al. 2011

Ophthalmology

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Objective To compare visual and refractive outcomes between self-refracting spectacles (Adaptive Eye-care, Ltd, Oxford, UK), noncycloplegic autorefraction, and cycloplegic subjective refraction. Design Cross-sectional study. Participants Chinese school-children aged 12 to 17 years. Methods Children with uncorrected visual acuity ≤6/12 in either eye underwent measurement of the logarithm of the minimum angle of resolution visual acuity, habitual correction, self-refraction without cycloplegia, autorefraction with and without cycloplegia, and subjective refraction with cycloplegia. Main Outcome Measures Proportion of children achieving corrected visual acuity ≥6/7.5 with each modality; difference in spherical equivalent refractive error between each of the modalities and cycloplegic subjective refractive error. Results Among 556 eligible children of consenting parents, 554 (99.6%) completed self-refraction (mean age, 13.8 years; 59.7% girls; 54.0% currently wearing glasses). The proportion of children with visual acuity ≥6/7.5 in the better eye with habitual correction, self-refraction, noncycloplegic autorefraction, and cycloplegic subjective refraction were 34.8%, 92.4%, 99.5% and 99.8%, respectively (self-refraction versus cycloplegic subjective refraction, P<0.001). The mean difference between cycloplegic subjective refraction and noncycloplegic autorefraction (which was more myopic) was significant (−0.328 diopter [D]; Wilcoxon signed-rank test P<0.001), whereas cycloplegic subjective refraction and self-refraction did not differ significantly (−0.009 D; Wilcoxon signed-rank test P = 0.33). Spherical equivalent differed by ≥1.0 D in either direction from cycloplegic subjective refraction more frequently among right eyes for self-refraction (11.2%) than noncycloplegic autorefraction (6.0%; P = 0.002). Self-refraction power that differed by ≥1.0 D from cycloplegic subjective refractive error (11.2%) was significantly associated with presenting without spectacles (P = 0.011) and with greater absolute power of both spherical (P = 0.025) and cylindrical (P = 0.022) refractive error. Conclusions Self-refraction seems to be less prone to accommodative inaccuracy than noncycloplegic autorefraction, another modality appropriate for use in areas where access to eye care providers is limited. Visual results seem to be comparable. Greater cylindrical power is associated with less accurate results; the adjustable glasses used in this study cannot correct astigmatism. Further studies of the practical applications of this modality are warranted. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

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Section: Discussionmentioning

confidence: 99%

The Child Self-Refraction Study

He¹,

Congdon²,

Mackenzie³

et al. 2011

Ophthalmology

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“…Automated refraction requires access to expensive machines, which must be adequately maintained and calibrated. Retinoscopy is a less expensive technology potentially suitable for use in the developing world,25 but the need for rigorous training has limited its use there. Accuracy of automated and retinoscopic refraction in children depends on paralysis of accommodation (the ability to focus on near objects) with cycloplegic drugs,26 which also dilate the pupil.…”

Section: Introductionmentioning

confidence: 99%

Self correction of refractive error among young people in rural China: results of cross sectional investigation

Zhang¹,

Zhang²,

et al. 2011

BMJ

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Objective To compare outcomes between adjustable spectacles and conventional methods for refraction in young people.Design Cross sectional study.Setting Rural southern China.Participants 648 young people aged 12-18 (mean 14.9 (SD 0.98)), with uncorrected visual acuity ≤6/12 in either eye.Interventions All participants underwent self refraction without cycloplegia (paralysis of near focusing ability with topical eye drops), automated refraction without cycloplegia, and subjective refraction by an ophthalmologist with cycloplegia.Main outcome measures Uncorrected and corrected vision, improvement of vision (lines on a chart), and refractive error.Results Among the participants, 59% (384) were girls, 44% (288) wore spectacles, and 61% (393/648) had 2.00 dioptres or more of myopia in the right eye. All completed self refraction. The proportion with visual acuity ≥6/7.5 in the better eye was 5.2% (95% confidence interval 3.6% to 6.9%) for uncorrected vision, 30.2% (25.7% to 34.8%) for currently worn spectacles, 96.9% (95.5% to 98.3%) for self refraction, 98.4% (97.4% to 99.5%) for automated refraction, and 99.1% (98.3% to 99.9%) for subjective refraction (P=0.033 for self refraction v automated refraction, P=0.001 for self refraction v subjective refraction). Improvements over uncorrected vision in the better eye with self refraction and subjective refraction were within one line on the eye chart in 98% of participants. In logistic regression models, failure to achieve maximum recorded visual acuity of 6/7.5 in right eyes with self refraction was associated with greater absolute value of myopia/hyperopia (P<0.001), greater astigmatism (P=0.001), and not having previously worn spectacles (P=0.002), but not age or sex. Significant inaccuracies in power (≥1.00 dioptre) were less common in right eyes with self refraction than with automated refraction (5% v 11%, P<0.001).Conclusions Though visual acuity was slightly worse with self refraction than automated or subjective refraction, acuity was excellent in nearly all these young people with inadequately corrected refractive error at baseline. Inaccurate power was less common with self refraction than automated refraction. Self refraction could decrease the requirement for scarce trained personnel, expensive devices, and cycloplegia in children’s vision programmes in rural China.

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“…1. The human head manikin was made from a three-dimensional (3D) printing technology widely used in ophthalmology [18][19][20][21][22] with a hard resin material and behind the head, composed of 4 slots for replacement parts. Replacement parts designed for two optical half-eyeballs and slots for commercial trial lens placement for refractive adjustment.…”

Section: Innovation Phasementioning

confidence: 99%

Efficacy of Simulator-Based Direct Ophthalmoscopy Training using New Refractive Adjustment Fundoscopic Examination Simulator for Medical Students – ICEye Model: A Comparative Randomized Crossover Study

Chokchaitanasin,

Vongkulsiri,

Choontanom

2024

Preprint

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Background: The use of simulators for ophthalmology training is growing globally. However, all developed simulators have certain limits based on different circumstances. The study aims to assess the efficacy and satisfaction of the new refractive adjustment simulator "ICEyeModel" compared to a traditional simulator for direct ophthalmoscopy training in medical students. Methods: This is a comparative, randomized cross-over study. Our study enrolled fifty participants from a 6-year medical student training program at Phramongkutklao Hospital. They required a refreshment lecture on primary direct ophthalmoscopy usage and a short course on common retinal disease review. They were randomized into two training sequence groups: Training sequence 1 started with a traditional film photograph simulator followed by the ICEyeModel. Training sequence 2 started with the ICEyeModel, followed by a traditional simulator. Both groups were asked to complete a fundoscopic description test and satisfaction questionnaires. Results: Medical students training with the ICEye Model achieved significantly higher fundoscopic examination scores (14.42±2.34) compared to those training with traditional simulators (11.30±6.43), with p<0.001. For the ICEyeModel, 86% of participants can correctly adjust the direct ophthalmoscope power match to the refractive state from the trial lens placed in the simulator. ICEyeModel has a higher satisfaction score regarding picture quality, enhancing motivation and confidence than a traditional simulator. Conclusion: The ICEye Model is the first combination of fundoscopic examination training and refraction practicing simulators that significantly improves fundoscopic examination skills and increases medical students' motivation and confidence in practicing direct ophthalmoscopy. In the future, it can be used to practice with indirect ophthalmoscopes and retinoscopes.

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A device to aid the teaching of retinoscopy in low-resource countries

Cited by 8 publications

References 3 publications

The Child Self-Refraction Study

The Child Self-Refraction Study

Self correction of refractive error among young people in rural China: results of cross sectional investigation

Efficacy of Simulator-Based Direct Ophthalmoscopy Training using New Refractive Adjustment Fundoscopic Examination Simulator for Medical Students – ICEye Model: A Comparative Randomized Crossover Study

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