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Updated: May 8, 2026

Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
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Intertester agreement in refractive error measurements.

Jiayan Huang1, Maureen G Maguire, Elise Ciner

  • 1*MS †PhD ‡OD §OD, MS ∥MD, MSCE **OD, PhD Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (JH, MGM, G-SY); Salus University, Elkins Park, Pennsylvania (EC); College of Optometry, Ohio State University, Columbus, Ohio (MTK); The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ); School of Optometry, University of California, Berkeley, Berkeley, California (DO-B); College of Optometry, Northeastern State University, Tahlequah, Oklahoma (LAC); and New England College of Optometry, Boston, Massachusetts (BM).

Optometry and Vision Science : Official Publication of the American Academy of Optometry
|August 27, 2013
PubMed
Summary
This summary is machine-generated.

Trained lay and nurse screeners showed good agreement in refractive error measurements using the Retinomax Autorefractor and SureSight Vision Screener in preschoolers. Agreement was consistent across ages but decreased with significant refractive error or low confidence readings.

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Area of Science:

  • Ophthalmology
  • Pediatric Vision Screening
  • Public Health

Background:

  • Accurate refractive error measurement is crucial for early detection of vision impairments in children.
  • Automated refractor devices are increasingly used in vision screening programs.
  • Assessing intertester agreement is vital for ensuring reliability of screening data.

Purpose of the Study:

  • To evaluate the intertester agreement of refractive error measurements between lay and nurse screeners.
  • To compare agreement using two autorefractor devices: Retinomax and SureSight.
  • To identify factors influencing agreement in preschool children.

Main Methods:

  • 1452 preschoolers (3-5 years) had refractive error measured by trained lay and nurse screeners.
  • Measurements were taken using Retinomax Autorefractor and SureSight Vision Screener in random order.
  • Intertester agreement for sphere, cylinder, and spherical equivalent (SE) was assessed using mean difference and 95% limits of agreement.

Main Results:

  • Both Retinomax and SureSight demonstrated good intertester agreement (e.g., SE limits of agreement: -1.65 to 1.56 D for Retinomax, -1.45 to 1.57 D for SureSight).
  • Agreement was not significantly affected by child's age, refractive error magnitude, or reading confidence number.
  • Wider limits of agreement were observed for eyes with significant refractive error or low confidence readings.

Conclusions:

  • Trained lay and nurse screeners achieve reliable refractive error measurements with both Retinomax and SureSight in preschool settings.
  • The agreement between screeners is largely independent of child's age for both devices.
  • Screening accuracy may be reduced in children with significant refractive errors or when readings have low confidence scores.