A comparison between retinoscopy and autorefraction in acceptance of subjective correction in school age children

Abstract

Background: Discrepancies have been reported between the results of objective refraction obtained with autorefraction (AR), retinoscopy, and the correction which is accepted by patients on subjective refraction. Aims: To assess the refractive status of school age children using retinoscopy and autorefraction, and estimate the accuracy of each in acceptance of subjective correction. Study Settings & Design: It was a prospective cohert study. Materials and Methods: School children of 6-15 years were enrolled for the study, after obtaining informed consent from the parent/guardian and assent from the children. 140 eyes of 70 children were evaluated in this study. Cycloplegia achieved using Cyclopentolate 1% eye drops and was examined by bothretinoscopy and autorefraction. Subjective refraction was done and the relative accuracy of both methods with respect to subjective correction was noted. Statistical Analysis: The results were compared and statistical analysis was carried out using Chi-square test with p≤0.05. Results: The spherical power estimated by retinoscopy, was accepted subjectively by 89.3% eyes, while 35% eyes accepted the spherical refractive power estimated by autorefraction. The cylindrical power, estimated by retinoscopy, was accepted by 49.2% eyes, while, 72.8% eyes accepted AR values. Estimation of axis of cylinder on retinoscopy were accepted by 55.7% eyes, while those of autorefraction by 75.7% eyes. The diagnostic accuracy of retinoscopy and autorefraction were comparable, but higher agreement was found with retinoscopy for spherical power component, while autorefraction was slightly better for cylindrical refractive error. Conclusion: Conventional retinoscopy is still the most accurate objective method to estimate the refractive status in children and can be considered a reliable starting point for subjective refraction, however, autorefraction has comparable accuracy and can be a valuable aid to prescribe cylindrical correction.