Screening of infants for significant refractive error using videorefraction

Abstract

Isotropic photorefraction has been suggested as a suitable method for screening infants for refractive error. Recently published data suggested that reasonable consistency with retinoscopy results might be achieved using cycloplegic videophotorefraction (VPR) for spherical refractive error but that results might be unreliable for astigmatic errors. Non-cycloplegic VPR did not appear to produce results consistent with retinoscopy. A practical idea of how many children might be identified using this technique and how many missed was needed by personnel designing screening projects. Hence the VPR was tested by screening a population of 247 infants for significant refractive error, and comparing the results with cycloplegic retinoscopy. Sensitivity and specificity scores were calculated for a range of test levels of ametropia. Without cycloplegia, sensitivity of VPR was poor. With cycloplegia the situation was much improved, with sensitivity for hyperopia +4.00 D or over of 83.3% and specificity of 90.6%. Sensitivity for astigmatism of 1 D or greater (84.6%) was high but specificity was poor (45.6%). Acceptable sensitivity was achieved for identifying children in this age group at risk of developing squint and amblyopia due to refractive error, providing cycloplegia was used.

Clinical evaluation of an eccentric infrared photorefractor: the PowerRefractor

“…Vision testing and the determination of refractive errors in infants and young children are not trivial tasks and the examination requires skilled personnel (Bolger et al 1991). As information about refractive status, together with information about strabismus and media opacities, can be used to identify children at risk of developing amblyopia, photorefractors have emerged as a simple method of large scale screening in a preschool population (Atkinson et al 1984; Abrahamsson et al 1986; Day 1986; Weseman & Rassow 1987; Hodi 1994; Donahue et al 2000). The apparatus can be used successfully by ophthalmologically unskilled personnel with special training.…”

Messgenauigkeit des Autorefraktometers Power-Refractor in der klinischen Praxis - eine vergleichende Studie*

“…Die in der Literatur angegebene Präzision der Photorefraktion liegt unter der anderer Autorefraktometer ( [25] und [32], zitiert nach [15], sowie [29]). Wird auf Zykloplegie verzichtet, nimmt die Genauigkeit weiter ab [18,19].…”

Can the Brückner Test be Used as a Rapid Screening Test to Detect Amblyogenic Factors in Developing Countries?

“…3 Approaches to detect amblyopia early include preschool and school vision screening for amblyogenic refractive or strabismic factors. [4][5][6][7][8][9] Although there are potential benefits from screening for amblyopia in children, difficulties persist in screening for amblyopia on a population basis. These include: 1) the low prevalence of amblyopia on a population basis; 2) difficulties in accurately measuring vision in children; 3) absence of a single "best test" to screen for amblyopia; and 4) lack of adequately qualified pediatric ophthalmology personnel to screen the entire child population.…”