The QuickSee autorefractor reliably measures the accommodative response in children compared with the Shin-Nippon autorefractor

Abstract

Introduction: This study evaluated the QuickSee autorefractor for measurement of the accommodative response in a cohort of children without significant ametropia, and compared the findings to those determined using the gold-standard Shin-Nippon device. Methods: Children aged 5–7 years were recruited. QuickSee and Shin-Nippon autorefractors were used to measure refractive status at distance (4 m) and near (50, 33 and 25 cm). Accommodative response was calculated as the difference between distance autorefraction and the value obtained for each accommodative demand. Individual accommodative response slopes were calculated from linear regression for response against demand and averaged to calculate mean slopes for each autorefractor. Inter-instrument agreement between the QuickSee and Shin-Nippon was assessed using the Bland–Altman method and 95% limits of agreement. Differences in measured accommodative responses between devices across accommodative demand were assessed by repeated measures ANOVA. Results: Forty-nine children with a median (IQR) spherical equivalent refraction of +0.38 (0.50 D) (range −0.63 to +1.50 D) participated. Median (IQR) accommodative responses for the 2, 3 and 4 D demands were 1.63 D (0.69), 2.50 D (0.75) and 3.13 D (0.63), respectively, for QuickSee, and 1.63 D (0.69), 2.50 D (0.56) and 3.25 D (0.63) for the Shin-Nippon. Mean ± SD slopes for accommodative response were 0.75 ± 0.22 and 0.83 ± 0.18 for QuickSee and Shin-Nippon, respectively (p = 0.09). Pearson's correlation showed no significant proportional bias for measures of accommodative response with either autorefractor (p ≥ 0.19). The mean difference in accommodative response measured by the QuickSee and Shin-Nippon did not differ significantly with accommodative demand (F = 1.70, p = 0.19). Conclusion: The agreement observed here demonstrates that the QuickSee shows promise in measuring accommodative response over a range of demands (2, 3 and 4 D) in a paediatric population without significant ametropia. Further research is required to determine if these findings translate over a wider range of refractive errors, and to evaluate the value of QuickSee accommodative response measures in vision screening.