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Published on: March 24, 2020
Evaluation of infant accommodation using retinoscopy and photoretinoscopy
Gina Marangoni Gabriel1, Donald O Mutti
1Gabreil.Gina@gmail.com
Insights
The PlusOptix PowerRefractor (PR) and Monocular Estimation Method (MEM) provide similar infant accommodation measurements. Screening PR data for inattention is key for accurate refractive error and accommodative lag estimates.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Infant Vision Science
Background:
- Infant accommodation measurement is crucial for understanding visual development.
- Accurate assessment of refractive error and accommodative function in infants is challenging.
- Existing methods like the Monocular Estimation Method (MEM) require comparison with newer technologies.
Purpose of the Study:
- To compare the PlusOptix PowerRefractor (PR) with the Monocular Estimation Method (MEM) for measuring infant accommodation.
- To evaluate the utility of individual calibration factors for PR data in infants.
- To assess accommodative lag and refractive error in infants aged 3-12 months.
Main Methods:
- 41 infants (3-12 months) participated.
- Accommodative response measured using MEM and PR at 33 and 57 cm.
- Cycloplegic refractive error assessed via retinoscopy and PR; acuity measured by Teller Acuity Cards.
Main Results:
- PR and MEM showed similar accommodative lag estimates after PR data screening for inattention.
- Infant accommodation appears adult-like between 3-12 months.
- Accommodative lag was greater at 57 cm than 33 cm and differed between sexes.
Conclusions:
- MEM and PR are comparable for estimating infant refractive error and accommodative lag with appropriate data screening.
- Infant visual acuity is likely not limited by accommodative immaturity in the first year.
- Mature accommodation may play a role in emmetropization by modulating defocus signals.
Purpose:
To compare PlusOptix PowerRefractor (PR) and Monocular Estimation Method (MEM) for measurement of infant accommodation and to assess the usefulness of applying individual calibration factors to PR data.
Methods:
Subjects were 41 infants aged 3 to 12 months. Accommodative response was measured by MEM and PR at 33 and 57 cm, acuity by Teller Acuity Cards, and cycloplegic refractive error (RE) (tropicamide 1%) by retinoscopy (Wet Ret) and PR (PR C). Monocular wear of a +2.00 diopter (D) and +4.00 D lens established a PR calibration factor for each subject.
Results:
The median individual calibration slope was significantly different from 1.0 (+0.91; Wilcoxon signed-rank test: p = 0.03), yet there was no correlation between individual calibration slopes and the difference in RE by Wet Ret and PR C (rs = 0.05, p = 0.76). For 19 infants with an accommodative response slope by PR of >0.50, the mean lag was not significantly different between methods (0.50 D PR, 0.48 D MEM; p = 0.92; 95% LoA = +/-1.78 D). Despite the improvement in acuity with age (rp = -0.56, p < 0.0001), neither age nor acuity had a significant effect on accommodative error. Lag was greater at 57 cm (0.69 D) than 33 cm (0.30 D, F1, 18 = 6.3, p = 0.022), but lag was unrelated to RE (F1, 17 = 3.3, p = 0.09). Accommodative response slopes for boys were larger (1.5) than for girls (1.0; F1, 17 = 9.5, p = 0.007).
Conclusion:
MEM and PR provided similar estimates of RE and of accommodative lag once the PR data were screened for inattention using an accommodative response slope criterion. Adult-like accommodative responses between 3 and 12 months of age suggest that acuity at these ages is not limited by accommodative immaturity. Further, mature accommodation may attenuate RE-related defocus signals for emmetropization.
