Ellipsoid Spectacle Comparison of Plusoptix, Retinomax and 2WIN Autorefractors

Abstract

Background: Handheld devices can automatically give an estimate of refraction. The established method for refraction comparison using spherical equivalent (M) and J0, J45 vector transformations by Bland-Altman analysis is too complex for non-eye doctors involved with vision screening and remote vision clinics. Therefore, a simpler comparison technique was developed. Methods: Based on the spectacle limit to resolve grade A 1 logMAR, B 3 logMAR and C 6 logMAR blur, J0, J45, and M are combined into the Alaska Blind Child Discovery (ABCD) composite ellipsoid GRADE system. Pediatric eye patients had confirmatory examination after dry refraction with three portable autorefractors: Plusoptix, 2WIN and Retinomax. The refractions were then compared using both Bland-Altman and ABCD composite. Performance to detect AAPOS amblyopia risk factors was also assessed. Results: A total of 202 children, mean age seven years, 28% high spectacle need and 43% AAPOS 2013 amblyopia risk factors showed high correlation with cycloplegic refraction (intraclass correlation 0.49 to 0.90) for sphere, J0 and J45 spectacle components. Plusoptix had more (10%) inconclusives due to patients out-of-range. The Retinomax was unable to screen some younger children and was less reliable for sphere but gave more precise astigmatism estimates. The proportion of autorefractions expected to give GRADE A/B highneed patients acuity improvement to 20/40 would be 41% for Plusoptix, 39% for 2WIN and 65% for Retinomax. Sensitivity/specificity for amblyopia risk factor detection was 80%/83% for Plusoptix, 72%/88% for 2WIN and 84%/73% for Retinomax. Conclusion:The simplified spectacle comparison resembled Bland-Altman and could assist lay vision screeners and non-eye doctors attempting remote spectacle donation worldwide.

Comparative Validation of PlusoptiX and AI-Optic Photoscreeners in Children with High Amblyopia Risk Factor Prevalence

“…REFRACTIVE COMPARISON: The accuracy of each device’s photoscreen estimation of refraction was compared to actual refraction using the ABCD ellipsoid method. 24 Of the 200 patients, 134 had sphero-cylinder estimates in both AI Optics and PlusoptiX for comparison. ABCD ellipsoid mean (±S.D) for PlusoptiX right eye 2.20±1.5 and left eye 2.34±1.6 differed from AI Optics right eye (3.15±2.3) and left eye (3.63±2.6) using Student’s t -test with right eye (t(266) = 4.0 and left eye t(266) = 4.9 both being significant (p<0.001).…”

“…The ability of each device to estimate age-based sphero-cylinder refractive error is compared using the ABCD ellipsoid method. 24 The ABCD ellipsoid is derived as an oval-solid region on a 3 dimensional plot with J0 (x-axis), J45 (y-axis) and M spherical equivalent (z-axis) the displacement between two sphero-cylinder refractions leading to a single measure related to the degree of blur produced by the refractive difference. 48 The following are observations regarding advantages and disadvantages of each device when screening cooperative and developmentally delayed children.…”

“…The Plusoptix family of photoscreeners (S04, s08, s09, s-12, s-16) has had extensive validation compared with eye chart visual acuity, 6,7 digital flash cameras, [7][8][9] the MTI photoscreener, 9,10 the iScreen, 9,[11][12][13] Suresight, 9,14-16 compared with SPOT, 12,13,[17][18][19][20][21] 2WIN, 17,[21][22][23][24][25][26] GoCheck Kids, 13 blinq, 25,26 with Retinomax 9,23,24,27,28 and table-top autorefractors, 22,29 community screening 30,31 and examination. 28,[32][33][34][35][36][37][38][39][40][41][42][43][44] The refractive accuracy has been compared.…”

Multifaceted Amblyopia Screening with blinq, 2WIN, and PDI Check

“…The refractive estimate of the 2WIN was compared with actual refraction using Bland–Altman 26 and the new ABCD composite ellipsoid 27 methods. Each device was then validated using various uniform and adapted gold-standard exams.…”

2021 instrument referral criteria for PlusoptiX, SPOT, and 2WIN targeting AAPOS 2021 guidelines

“…To better assess the different cohorts, the autorefractor results were compared to the refined retinoscopy using conventional J0 and J45 cylinder vector transformations 18 and spherical equivalent. In addition, each device was compared with the corresponding refined retinoscopy by the ABCD Composite ellipsoid simple continuous and graded metric; 19 a perfect spectacle match scores 0.0 while mild spectacle A-Grade mis-match resulting in a 1 line acuity blur scores 1.0, a 3-line B-Grade blur scores 2.0, and a 6-line C-grade blur scores 3.0.…”