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Agreement Between Non-Cycloplegic Photorefraction and Retinoscopy in Pediatric Refraction
Ana Roque1, Amélia Fernandes Nunes2, Henrique Nascimento1
1School of Administration, Engineering and Aeronautics (EGEA), Instituto Superior de Educação e Ciências de Lisboa (ISEC Lisboa), Alameda das Linhas de Torres, 179, 1750-142 Lisboa, Portugal.
Life (Basel, Switzerland)
|May 4, 2026
Summary
Handheld photorefraction shows modest mean differences but significant individual variability compared to static retinoscopy in children. These refractive error assessment tools are not interchangeable for individual clinical decisions.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Accurate refractive error assessment is crucial for pediatric clinical decisions.
- Non-cycloplegic refractive assessment methods have uncertain agreement, especially with varying accommodative demand.
Purpose of the Study:
- To evaluate agreement between static retinoscopy and handheld photorefraction in children aged 4-16 years.
- To assess if agreement varies by refractive status (emmetropia, myopia, hyperopia).
Main Methods:
- Cross-sectional observational study of 193 children.
- Objective refraction using non-cycloplegic static retinoscopy (distance fixation) and handheld infrared photorefraction (~1m fixation).
- Analysis via Bland-Altman plots, ICCs, MAE, and non-parametric tests.
Main Results:
- Photorefraction showed a statistically significant myopic shift compared to retinoscopy (Spherical: -0.16 D, Cylindrical: -0.24 D, SE: -0.28 D).
- Moderate agreement for spherical equivalent (ICC=0.73) and spherical power (0.71), lower for cylindrical power (0.46).
- Mean Absolute Error for SE was 0.80 D, with 45.1% within ±0.50 D, varying by refractive status.
Conclusions:
- Non-cycloplegic photorefraction exhibits modest mean differences but substantial individual variability compared to retinoscopy.
- Variability is likely influenced by accommodative demand differences between techniques.
- Photorefraction is suitable for pediatric vision screening but not interchangeable with retinoscopy for individual refractive assessment.
