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Noncycloplegic photorefractive screening in pre-school children with the "PowerRefractor" in a pediatric practice
Frank Schaeffel1, Ute Mathis, Gunther Brüggemann
1Section of Neurobiology of Eye, University Eye Hospital, Tübingen, Germany. frank.schaeffel@uni-tuebingen.de
Insights
Non-cycloplegic photorefraction offers a framework for refractive development in children. This screening method identified 11.5% of children for specialist referral, though its accuracy for detecting hyperopia requires further investigation.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Development
Background:
- Refractive development in children is crucial for visual health.
- Accurate measurement of refractive errors in young children presents challenges.
- Non-cycloplegic photorefraction is a widely used screening tool.
Purpose of the Study:
- To establish a normative framework for typical refractive development in children using non-cycloplegic infrared photorefraction.
- To assess the effectiveness and utility of a screening protocol for refractive errors in a pediatric population.
- To evaluate the referral criteria and their impact on identifying children needing eye care specialist intervention.
Main Methods:
- Retrospective analysis of refractive data from 736 unselected children aged 0-6 years in Germany.
- Measurements were taken using a commercial infrared photorefractor (PowerRefractor).
- A subset of children (172) had refractions measured with +3 D lenses to assess hyperopia detection; referral criteria included specific thresholds for hyperopia, astigmatism, anisometropia, and myopia.
Main Results:
- Average non-cycloplegic spherical refractive error showed a linear decline from +0.93 D to +0.62 D over the first 6 years, being less hyperopic than cycloplegic retinoscopy findings.
- +3 D lenses did not improve hyperopia detection.
- Average cylinder magnitude and absolute anisometropia decreased with age.
- 11.5% of children were referred, with 61.2% receiving spectacles, 16.4% under observation, and 21.2% false positives.
Conclusions:
- Non-cycloplegic photorefraction yields less hyperopic results compared to cycloplegic retinoscopy.
- The tested screening protocol referred 11.5% of children, but with a 20% false-positive rate.
- The screening showed potential for identifying at-risk children, but the rate of false negatives remains undetermined.
Purpose:
To provide a framework for typical refractive development, as measured without cycloplegia with a commercial infrared photorefractor. To evaluate the usefulness of the screening for refractive errors, we retrospectively analyzed the data of a large number of unselected children of different ages in a pediatric practice in Tuebingen, Germany.
Methods:
During the standard regular preventive examinations that are performed in 80% to 90% of the young children in Germany by a pediatrician (the German "U1 to U9" system), 736 children were also measured with the first generation PowerRefractor (made by MCS, Reutlingen, Germany, but no longer available in this version). Of those, 172 were also measured with +3 D spectacles to find out whether this helps detect hyperopia. Children with more than +2 D of hyperopia or astigmatism, more than 1.5 D of anisometropia, or more than 1 D of myopia in the second year of life were referred to an eye care specialist. The actions taken by the eye care specialist were used to evaluate the merits of the screening.
Results:
The average noncycloplegic spherical refractive errors in the right eyes declined linearly from +0.93 to +0.62 D over the first 6 years (p < 0.001)-between 1.5 and 0.5 D less hyperopic than in published studies with cycloplegic retinoscopy. As expected, +3 D spectacle lenses moved the refractions into the myopic direction, but this shift was not smaller in hyperopic children. The average negative cylinder magnitudes declined from -0.89 to 0.48 D (linear regression: p < 0.001). The J0 components displayed high correlations in both eyes (p < 0.001) but the J45 components did not. The average absolute anisometropias (difference of spheres) declined from 0.37 to 0.23 (linear regression: p < 0.001). Of the 736 children, 85 (11.5%) were referred to an eye care specialist. Of these, 52 received spectacles (61.2%), 14 (16.4%) were identified as "at risk" and remained under observation, and 18 (21.2%) were considered "false-positive."
Conclusions:
Non cycloplegic photorefraction provides considerably less hyperopic readings than retinoscopy under cycloplegia. Additional refractions performed through binocular +3-D lenses did not facilitate detection of hyperopia. With the referral criteria above, 11% of the children were referred to an eye care specialist, but with a 20% false-positive rate. The screening had some power to identify children at risk but the number of false-negatives remained uncertain.
