Comparisons of objective and subjective refraction with and without cycloplegia using binocular wavefront optometer with autorefraction and retinoscopy in school-age children,Graefe's Archive for Clinical and Experimental Ophthalmology

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Comparisons of objective and subjective refraction with and without cycloplegia using binocular wavefront optometer with autorefraction and retinoscopy in school-age children
Graefe's Archive for Clinical and Experimental Ophthalmology ( IF 2.4 ) Pub Date : 2022-12-17 , DOI: 10.1007/s00417-022-05936-8
Yadi Lei _{1,

2,

3} , Xun Chen _{1,

2,

3} , Mingrui Cheng _{1,

2,

3} , Boliang Li _{1,

2,

3} , Yinjie Jiang _{1,

2,

3} , Yilin Xu _{1,

2,

3} , Xiaoying Wang _{1,

2,

3,

4}

Affiliation

Purpose

To compare school-age children’s objective and subjective refraction using a binocular wavefront optometer (BWFOM) with autorefraction and retinoscopy before and after cycloplegia.

Methods

Eighty-six eyes from 86 children (6–15 years old) were enrolled in this cross-sectional study. BWFOM objective and subjective refractions were compared with autorefraction and retinoscopy under cycloplegia. BWFOM refraction was evaluated before and after cycloplegia. Measurements were compared using a paired t-test; agreement was assessed using Bland–Altman plots.

Results

Under cycloplegia, the sphere, spherical equivalence, and J45 were significantly more negative on BWFOM objective refraction than autorefraction (− 1.39 ± 2.20 D vs. − 1.28 ± 2.23 D, P = 0.003; − 1.84 ± 2.38 D vs. − 1.72 ± 2.43 D, P = 0.001; − 0.02 ± 0.17 D vs. 0.03 ± 0.21 D, P = 0.004). The subjective sphere of BWFOM was less myopic, and the cylinder and the J45 were more negative than those with retinoscopy (− 1.17 ± 2.09 D vs. − 1.25 ± 2.20 D, P = 0.02; − 0.91 ± 0.92 D vs. − 0.76 ± 0.92 D, P < 0.001; − 0.01 ± 0.15 D vs. 0.03 ± 0.21 D, P = 0.028). For both BWFOM objective and subjective refraction, sphere and spherical equivalence with noncycloplegia were more myopic than those with cycloplegia (objective: − 1.76 ± 2.10 D vs. − 1.39 ± 2.20 D, − 2.21 ± 2.30 D vs. − 1.84 ± 2.38 D, P < 0.001; subjective: − 1.57 ± 1.92 D vs. − 1.17 ± 2.09 D, − 2.01 ± 2.13 D vs. − 1.62 ± 2.27 D, P < 0.001). Bland–Altman plots showed good agreement in spherical equivalence between BWFOM objective refraction and autorefraction (mean difference = 0.12 D, 95% confidence interval [CI] − 0.52 to 0.76), subjective refraction with retinoscopy (mean difference = − 0.01 D, 95% CI − 0.65 to 0.64), and BWFOM refractions with or without cycloplegia (objective: mean difference = − 0.37 D, 95% CI − 1.31 to 0.57; subjective: mean difference = − 0.39 D, 95% CI − 1.30 to 0.51). The time cost by BWFOM was significantly less than the total time of autorefraction and retinoscopy (264.88 ± 90.67 s vs. 315.89 ± 95.31 s, P < 0.001).

Conclusion

BWFOM is a new device that realizes both objective and subjective refraction. For children’s refractive errors, it is more convenient and quicker to obtain the proper prescription at a 0.05-D interval, and it is more accurate than autorefraction and retinoscopy under cycloplegia.

中文翻译：

使用双眼波前验光仪结合自动验光和检影在学龄儿童中比较有无睫状肌麻痹的客观和主观屈光度

目的

比较学龄儿童在睫状肌麻痹前后使用双眼波前验光仪 (BWFOM) 进行自动验光和检影检查的客观和主观屈光度。

方法

来自 86 名儿童（6-15 岁）的 86 只眼睛参加了这项横断面研究。将 BWFOM 的客观和主观屈光与睫状肌麻痹下的自动屈光和检影进行了比较。在睫状肌麻痹前后评估 BWFOM 折射。使用配对t检验比较测量值；使用 Bland-Altman 图评估一致性。

结果

在睫状肌麻痹下，球体、球面等值和 J45 在 BWFOM 物镜折射上的负性明显高于自体折射（− 1.39 ± 2.20 D 对比 − 1.28 ± 2.23 D，P = 0.003；− 1.84 ± 2.38 D 对比 − 1.72 ± 2.43 D，P = 0.001；− 0.02 ± 0.17 D 对比 0.03 ± 0.21 D，P = 0.004）。BWFOM 的主观球体近视程度较低，柱镜和 J45 比检影镜更负（− 1.17 ± 2.09 D vs. − 1.25 ± 2.20 D，P = 0.02；− 0.91 ± 0.92 D vs. − 0.76 ± 0.92 D，P < 0.001；− 0.01 ± 0.15 D 对比 0.03 ± 0.21 D，P = 0.028）。对于 BWFOM 客观和主观折射，非睫状肌麻痹患者的球面和球面等效性比睫状肌麻痹患者更近视（目标：− 1.76 ± 2.10 D 对比 − 1.39 ± 2.20 D，− 2.21 ± 2.30 D 对比 − 1.84 ± 2.38 D，P < 0.001；主观：− 1.57 ± 1.92 D 对比 − 1.17 ± 2.09 D，− 2.01 ± 2.13 D 对比 − 1.62 ± 2.27 D，P < 0.001)。Bland-Altman 图显示 BWFOM 客观验光和自体验光（平均差 = 0.12 D，95% 置信区间 [CI] − 0.52 至 0.76）、验光主观验光（平均差 = − 0.01 D，95%）之间的球面等效性良好一致CI − 0.65 至 0.64），以及伴有或不伴有睫状肌麻痹的 BWFOM 折射（客观：平均差 = − 0.37 D，95% CI − 1.31 至 0.57；主观：平均差 = − 0.39 D，95% CI − 1.30 至 0.51）。BWFOM 的时间成本明显少于自动验光和检影的总时间（264.88 ± 90.67 秒对 315.89 ± 95.31 秒，P < 0.001）。