Testability of the Retinomax Autorefractor and IOLMaster in Preschool Children

Abstract

Purpose-To determine the testability of Retinomax and IOLMaster ocular biometry in preschool children. Design-Population-based study of inner city preschool children in Los Angeles County.Participants-Two thousand five hundred forty-five Hispanic and 2178 African American children 6 to 72 months old.Methods-Subjects were identified by door-to-door screening within previously identified contiguous census tracts. Pediatric ophthalmologists or optometrists performed comprehensive eye examinations on all subjects. Refractive error and keratometry measurements were attempted on all subjects with the Retinomax autorefractor after cycloplegia. Axial length measurements with the IOLMaster partial coherence interferometer were attempted on those subjects ages 30 to 72 months.Main Outcome Measures-Ability to obtain high confidence autorefraction readings or axial length measurements on both eyes.Results-Overall, 89% were testable in both eyes with the Retinomax device, and 91% of the children were testable with the IOLMaster. Testability rose sharply with age, so that by age 36 months 98% of children were testable with the Retinomax device and 90% were testable with IOLMaster. There were no consistent gender-or ethnicity-related differences in testability overall or when stratified by age for either device.Correspondence and reprint requests to Rohit Varma, MD, MPH, Doheny Eye Institute, Department of Ophthalmology, 1450 San Pablo Street, Room 4900, Los Angeles, CA 90033-9224. rvarma@usc.edu. * For members of the Study Group, see "Appendix" (available at http://aaojournal.org).The authors have no proprietary or commercial interest in any materials discussed in the article. . These devices can also be used in the management of amblyogenic cataracts for calculating intraocular lens (IOL) power and postoperative spectacle or contact lens correction. The reliability of these and other biometric technologies has been validated in adults but has not been thoroughly validated in preschool children. The purpose of this study is to determine the testability of these two instruments in a large population-based cohort of preschool Hispanic and African American children. HHS Public Access Materials and MethodsThe Multi-ethnic Pediatric Eye Disease Study (MEPEDS) is a population-based study designed to (1) estimate and compare the prevalence of strabismus, amblyopia, and refractive error in a sample of African American, Asian American, Hispanic/Latino, and non-Hispanic Caucasian 6-to 72-month-olds and (2) evaluate the association of selected demographic, behavioral, biological, and ocular risk factors with these ocular disorders. To date, examination of the African American and Hispanic/Latino populations has been completed. Assessment of the other ethnic groups is being initiated. Thus, we are reporting the results for African American and Hispanic/Latino children only.Subjects are identified by door-to-door screening of families within 35 previously identified contiguous census tracts in Los Angeles County. The details of th...

Testability of refraction, stereopsis, and other ocular measures in preschool children: The Sydney Paediatric Eye Disease Study

“…24 In a study in which the authors used cycloplegia, an overall 89% of children 6 to 72 months of age could complete the test in both eyes. 22 By comparison, our Retinomax testability was slightly lower than these reported studies, including the MEPEDS (Figure 1). 22 A possible explanation is that, unlike the report by the Vision in Preschoolers (VIP) study group, 24 we included only children who achieved adequate cycloplegia, and those without were excluded.…”

“…22 By comparison, our Retinomax testability was slightly lower than these reported studies, including the MEPEDS (Figure 1). 22 A possible explanation is that, unlike the report by the Vision in Preschoolers (VIP) study group, 24 we included only children who achieved adequate cycloplegia, and those without were excluded. In our experience, some children responded negatively to the cycloplegic eyedrops and did not cooperate after their instillation.…”

“…In recent studies researchers have assessed the testability of commonly used eye tests in children, including visual acuity, [17][18][19] stereoacuity, 17,20,21 refraction, 17,22 and ocular biometry, by using the IOLMaster (Carl Zeiss Meditec, Jena, Germany) 17,22 ; however, none have assessed the ability to obtain fundus photographs in preschool children. There are also very few reported studies in which authors examine the testability of various measures in different ethnic populations.…”

The usefulness of the Retinomax autorefractor for childhood screening validated against a Danish preterm cohort examined at the age of 4 years

“…High testability in non-cycloplegic cohorts was thus reported in several centres using the hand-held Retinomax autorefractometer (Nikon Inc, Tokyo, Japan), and positive findings were subsequently evaluated against cycloplegic paediatric ophthalmic examinations. [10][11][12][13][14][15][16][17][18] Between the ages of 2 and 4 years, the testability of single devices increased from about 50 to 90%; however, some conditions remain undetected. The Retinomax can identify significant ametropia immediately but poor cooperation from the child should further direct attention to deviations from normal.…”

Instrument-Based Pediatric Vision Screening Policy Statement

“…However, in contrast to tabletop autorefractors, which are difficult to use with very young children, portable, handheld autorefractors are useful for screening young children. 7,[11][12][13][14][15] …”