Self-refraction Accuracy with Adjustable Spectacles among Children in Ghana

Ilechie, Alex Azuka; Abokyi, Samuel; Owusu-Ansah, Andrew; Boadi-Kusi, Samuel Bert; Denkyira, Andrew Kofi; Abraham, Carl Halladay

doi:10.1097/opx.0000000000000561

Cited by 9 publications

(28 citation statements)

References 16 publications

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“…Previous studies have used other SR technologies such as the AdSpecs (Centre for Vision in the Developing World) and FocusSpecs (FocusSpecs LLC, Durham, NC). USee users achieved vision levels similar to those reported with previous approaches, including one study in Ghana (FocusSpecs) [ 21 ], and two AdSpecs studies from China [ 3 , 11 ]. Currently, we are unaware of any other portable, mechanical SR technologies that are able to provide refractive error correction beyond the –6 to +6 D range offered by USee.…”

Section: Discussionsupporting

confidence: 67%

Comparison of self-refraction using a simple device, USee, with manifest refraction in adults

Annadanam¹,

Varadaraj²,

Mudie³

et al. 2018

PLoS ONE

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BackgroundThe USee device is a new self-refraction tool that allows users to determine their own refractive error. We evaluated the ease of use of USee in adults, and compared the refractive error correction achieved with USee to clinical manifest refraction.MethodsSixty adults with uncorrected visual acuity <20/30 and spherical equivalent between –6.00 and +6.00 diopters completed manifest refraction and self-refraction.ResultsSubjects had a mean (±SD) age of 53.1 (±18.6) years, and 27 (45.0%) were male. Mean (±SD) spherical equivalent measured by manifest refraction and self-refraction were –0.90 D (±2.53) and –1.22 diopters (±2.42), respectively (p = 0.001). The proportion of subjects correctable to ≥20/30 in the better eye was higher for manifest refraction (96.7%) than self-refraction (83.3%, p = 0.005). Failure to achieve visual acuity ≥20/30 with self-refraction in right eyes was associated with increasing age (per year, OR: 1.05; 95% CI: 1.00–1.10) and higher cylindrical power (per diopter, OR: 7.26; 95% CI: 1.88–28.1). Subjectively, 95% of participants thought USee was easy to use, 85% thought self-refraction correction was better than being uncorrected, 57% thought vision with self-refraction correction was similar to their current corrective lenses, and 53% rated their vision as “very good” or “excellent” with self-refraction.ConclusionSelf-refraction provides acceptable refractive error correction in the majority of adults. Programs targeting resource-poor settings could potentially use USee to provide easy on-site refractive error correction.

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Section: Discussionsupporting

confidence: 67%

Comparison of self-refraction using a simple device, USee, with manifest refraction in adults

Annadanam¹,

Varadaraj²,

Mudie³

et al. 2018

PLoS ONE

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“…The 95 per cent LoA for the spherical equivalent error (Figure A) from the present study (± 1.10 D and ± 1.20 D, for rotated lens and rotated optotypes) can be compared to those of others studies (LoA = ± 1.43 D, LoA = ± 1.31 D and LoA = ± 1.56 D) with larger sample sizes (n = 203, n = 350 and n = 556 school children). The reported LoA from the current investigation are slightly lower, which results in good agreement of Alvarez‐based self‐refraction with already established subjective and objective procedures.…”

Section: Discussionsupporting

confidence: 48%

“…To account for unwanted accommodation, which is a known problem during subjective refraction, the study protocol required that measurement of the self‐assessed refraction for both procedures commenced from maximum positive power until the 0.0 logMAR (6/6) line of optotypes was visible (readable) for the first time. In contrast to the current study, other studies that assessed self‐refraction in school children used a cycloplegic agent in order to block accommodation . Since the current study protocol and the protocols from earlier studies are not comparable, it is uncertain if the present results would have been different if a cycloplegic agent would have been used.…”

Section: Discussionmentioning

confidence: 64%

“…Liquid‐filled glasses (AdSpecs, Adaptive Eyecare Ltd, Oxford, UK) can provide acceptable results in the assessment of the spherical equivalent refractive error M. Surveys by Gudlavalleti et al and Ilechie et al found a significant difference between refraction results for self‐assessed refraction using liquid‐filled glasses and cycloplegic subjective refraction (ΔM = −0.44 D, p < 0.001, t‐test), but 85.2 per cent of 203 school children reach a VA of better than 0.10 logMAR (6/7.5 Snellen notation). Other studies showed that 92 per cent of school children from Boston, USA and nearly 87 per cent from Chaoshan, China reached a monocular VA that was better than 0.10 logMAR (6/7.5) after self‐refraction and also while correcting the spherical equivalent refractive error.…”

mentioning

confidence: 99%

“…Current self‐adjustable spectacles, like liquid‐filled glasses (AdSpecs) or Alvarez lenses (FocusSpecs), provide a moderate agreement, when compared to conventional refraction techniques for the correction of the spherical refractive error (95 per cent limits of agreement [LoA]: ± 1.43 D, ± 1.31 D, ± 1.56 D). However, there are limitations while using liquid‐filled glasses, for example the correction and assessment of astigmatism .…”

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confidence: 99%

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Self‐assessment of refractive errors using a simple optical approach

Leube

Kraft

Ohlendorf

et al. 2018

Clinical and Experimental Optometry

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BackgroundThis explorative study investigated procedures for the self‐assessment of spherocylindrical refractive errors.MethodsEighteen participants with a mean age of 34.0 ± 8.8 years were enrolled. Adjustable Alvarez lenses were mounted in a rotatable ring holder and two procedures were tested for the self‐adjustment: (1) rotation of the lens in three meridians: 0°, 60° and 120° and (2) rotation of the optotypes in the same meridians. Starting from maximum positive power, the participants were required to decrease the power of the Alvarez lens until the optotypes (0.0 logMAR) appeared to be clear the first time. Best‐corrected visual acuity (BVA) was measured using a psychophysical staircase procedure. Bland–Altmann analysis was carried out in order to calculate the limits of agreement between the self‐refraction method and the standard subjective refraction.ResultsUsing procedure 1, 77 per cent of the subjects achieved a VA ≥ 0.1 logMAR (6/7.5) and the same was true for 88 per cent of the subjects using procedure 2. Using procedure 1, a significantly worse BVA was found, when compared to subjective refraction (ΔVA = −0.15 logMAR, F3,140 = 7.11, p = 0.046, median test). Analysis of variance (ANOVA) analysis showed a significant influence of the refraction method on the oblique astigmatism component J45 but not for the spherical equivalent M and the straight astigmatism component J0 (M: F3,140 = 0.532, p = 0.661; J0: F3,140 = 0.056, p = 0.983; J45: F3,140 = 13.97, p < 0.001; ANOVA). The limits of agreement for the spherical equivalent error M were ± 1.10 D and ± 1.20 D and for the astigmatic components J0 ± 0.78 D and ± 0.59 D and for J45 ± 0.62 D and ± 0.54 D, for procedure 1 and procedure 2, respectively.ConclusionsFixed adjustable Alvarez lenses and rotatable stimuli can provide a fast and precise self‐assessment method to measure the spherocylindrical error of the eye.

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Refractive Accuracy and Visual Outcome by Self-Refraction Using Adjustable-Focus Spectacles in Young Children

Zhao,

Wen,

Nasrazadani

et al. 2023

JAMA Ophthalmol

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ImportanceUncorrected refractive error is the most common cause of vision impairment in children. Most children 12 years or older can achieve visual acuity (VA) of 20/25 or better by self-refraction using adjustable-focus spectacles, but data on younger children are lacking.ObjectiveTo assess refractive accuracy, corrected VA, and factors associated with not achieving VA of 20/25 or better among children aged 5 to 11 years performing self-refraction with Adspecs adjustable-focus spectacles (Adaptive Eyecare), compared with noncycloplegic autorefraction and cycloplegic refraction.Design, Setting, and ParticipantsThis was a cross-sectional noninferiority trial conducted from September 2, 2015, to December 14, 2017. The study setting was an academic pediatric eye clinic. Children aged 5 to 11 years with uncorrected VA of 20/40 or worse in 1 or both eyes and without systemic or ocular conditions preventing best-corrected VA of 20/25 or better were enrolled. Children who had best-corrected VA worse than 20/25 were excluded. Study data were analyzed from September 2017 to June 2023.ExposuresChildren were taught to self-refract with adjustable-focus spectacles.Main Outcomes and MeasuresSpherical equivalent refractive error (using self-refraction, noncycloplegic autorefraction, and cycloplegic refraction) and VA (uncorrected and using self-refraction, noncycloplegic autorefraction, and cycloplegic refraction) for study eyes were evaluated. Potential predictors of failure to achieve VA of 20/25 or better with self-refraction were assessed using logistic regression.ResultsA total of 127 consecutive children were enrolled. After exclusions, 112 children (median [IQR] age, 9.0 [8.0-10.3] years; 52 boys [46.4%]) were included in the study. Mean (SD) spherical equivalent refractive power was −2.00 (1.52) diopters (D) for self-refraction, −2.32 (1.43) D for noncycloplegic autorefraction, and −1.67 (1.49) D for cycloplegic refraction. Mean (SD) difference in refractive power between self-refraction and noncycloplegic autorefraction was 0.32 (1.11) D (97.5% 1-sided CI, 0.11 to ∞ D; P &lt; .001) and between self-refraction and cycloplegic refraction was −0.33 (1.15) D (97.5% 1-sided CI, −0.54 to ∞ D; P = .77). The proportion of children with corrected VA of 20/25 or better was 79.5% (89 of 112) with self-refraction, 85.7% (96 of 112) with noncycloplegic autorefraction, and 79.5% (89 of 112) with cycloplegic refraction (self-refraction vs noncycloplegic autorefraction: McNemar P value = .27; self-refraction vs cycloplegic refraction: McNemar P value &gt; .99). Those failing to achieve best-corrected VA of 20/25 or better with self-refraction had higher astigmatism (odds ratio [OR], 10.6; 95% CI, 3.1-36.4; P &lt; .001) and younger age (OR, 1.5; 95% CI, 1.1-2.2; P = .02).Conclusions and RelevanceSelf-refraction among children aged 5 to 11 years may result in more myopic power than cycloplegic refraction but not necessarily to a clinically relevant degree. Although the proportion of children achieving VA of 20/25 or better with self-refraction using adjustable-focus spectacles did not differ from cycloplegic refraction, it was less likely among younger children and those with higher astigmatism.

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Self-refraction Accuracy with Adjustable Spectacles among Children in Ghana

Abstract: Self-refraction offers acceptable visual and refractive results for young people in a rural setting in Ghana, although myopic inaccuracy in the more negative direction occurred in some children.

Cited by 9 publications

References 16 publications

Comparison of self-refraction using a simple device, USee, with manifest refraction in adults

Comparison of self-refraction using a simple device, USee, with manifest refraction in adults

Self‐assessment of refractive errors using a simple optical approach

Refractive Accuracy and Visual Outcome by Self-Refraction Using Adjustable-Focus Spectacles in Young Children

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