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Refractive Accuracy and Visual Outcome by Self-Refraction Using Adjustable-Focus Spectacles in Young Children: A
Lloyd Zhao1,2, Qing Wen3, David Nasrazadani1,4
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
JAMA Ophthalmology
|August 24, 2023
Summary
Self-refraction with adjustable-focus spectacles is a viable method for children aged 5-11 years to achieve good visual acuity (VA). However, younger children and those with higher astigmatism were less likely to reach 20/25 VA.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Uncorrected refractive error is a leading cause of vision impairment in children.
- While effective for older children, the utility of self-refraction in younger age groups (5-11 years) using adjustable-focus spectacles remains under-investigated.
Purpose of the Study:
- To evaluate the refractive accuracy and corrected visual acuity (VA) achieved by children aged 5 to 11 years using self-refraction with adjustable-focus spectacles.
- To compare these outcomes with noncycloplegic autorefraction and cycloplegic refraction.
- To identify factors associated with failure to achieve a corrected VA of 20/25 or better through self-refraction.
Main Methods:
- A cross-sectional noninferiority trial involving 112 children aged 5-11 years with uncorrected VA of 20/40 or worse.
- Children performed self-refraction using adjustable-focus spectacles.
- Outcomes measured included spherical equivalent refractive error and corrected VA, compared against noncycloplegic autorefraction and cycloplegic refraction.
Main Results:
- The proportion of children achieving a corrected VA of 20/25 or better was comparable between self-refraction (79.5%) and cycloplegic refraction (79.5%), but slightly lower than noncycloplegic autorefraction (85.7%).
- Self-refraction yielded a slightly more myopic refractive power compared to cycloplegic refraction, though not always clinically significant.
- Failure to achieve 20/25 VA with self-refraction was associated with higher astigmatism (OR, 10.6) and younger age (OR, 1.5).
Conclusions:
- Self-refraction using adjustable-focus spectacles is a potentially effective method for refractive correction in children aged 5-11 years.
- The success of self-refraction is influenced by factors such as age and the presence of astigmatism.
- Further research may optimize self-refraction protocols for younger children and those with specific refractive challenges.
