Related Experiment Video
Updated: Jun 20, 2026
Subjective Refraction Test Using a Smartphone for Vision Screening
Published on: October 18, 2024
Is refraction with a hand-held autorefractometer useful in addition to visual acuity testing and questionnaires in
Toshihiko Matsuo1, Chie Matsuo, Keiko Kio
1Department of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan. matsuot@cc.okayama-u.ac.jp
Insights
Adding autorefraction to Japan
Area of Science:
- Pediatric Ophthalmology
- Public Health Screening
- Diagnostic Technology
Background:
- Japan's vision screening for 3.5-year-olds involves questionnaires, home testing, nurse/medical officer assessments, and ophthalmologist exams.
- The current system aims to detect vision problems in young children.
Purpose of the Study:
- To evaluate if adding autorefraction improves eye problem detection in a Japanese preschool vision-screening program.
- To assess the cost-effectiveness of incorporating autorefraction into existing screening protocols.
Main Methods:
- A hand-held autorefractometer was used for refraction testing alongside standard visual acuity and inspection.
- 265 children aged 3.5 years underwent 6 sessions of autorefraction.
- Referrals to ophthalmologists were based on established visual acuity and refractive error criteria (myopia ≥3D, hyperopia ≥1D, astigmatism ≥2D).
Main Results:
- Autorefraction identified only one additional case of eye disease.
- The number of children referred for ophthalmologist examination tripled.
- Referrals based solely on refractive error criteria primarily identified non-serious refractive errors.
Conclusions:
- Autorefraction did not significantly enhance the detection of eye diseases in this 3.5-year-old cohort.
- The addition of autorefraction substantially increased referral rates without a proportional increase in serious diagnoses.
- From a cost-effectiveness perspective, autorefraction is not recommended for this specific vision-screening program.
Abstract:
The vision-screening program for 3.5-year-old children in Japan consists of 3 steps:questionnaires and home visual acuity testing, visual acuity testing by nurses and inspection by medical officers at regional Public Health Centers, and examinations by ophthalmologists. In this study, we tested refraction with a hand-held autorefractometer in addition to visual acuity testing and inspection to reveal whether or not autorefraction leads to better detection of eye problems. Autorefraction was performed in 6 consecutive sessions by a single examiner in 265 children at 3.5 years of age who all visited the same center. The children were sent to the third step of examinations by ophthalmologists based on refractive error criteria:3 diopters myopia or 1 diopter hyperopia, and/or 2 diopters astigmatism in either eye, in addition to the current criteria:1) failure in either eye for 0.5 visual acuity at the center, 2) eye-related symptoms revealed by the questionnaires, or 3) eye problems detected by medical officers. Notices to visit ophthalmologists were issued for 64 children (24%), and 37 of those (58%) made the visits, so that documents containing final diagnoses were sent back to the Public Health Office. Of the 64 children, 12 were sent to ophthalmologists based on the current criteria only, 10 based on both the current criteria and the refractive error criteria, and 42 based on the refractive error criteria only. Twelve of the 13 children visiting ophthalmologists by the current criteria had diagnoses such as amblyopia and strabismus. In contrast, 15 of 24 children visiting ophthalmologists by only the refractive error criteria had mainly diagnoses of refractive errors, with no serious problems. In conclusion, autorefraction in addition to visual acuity testing and inspection led to detection of only one additional case of an eye disease at 3.5 years, while tripling the number of children sending to the third-step examination by an ophthalmologist. Thus, from a cost-effectiveness standpoint, autorefraction is not recommended as an additional test when the current system is conducted as designed.
