Accuracy of Photorefraction and Wavefront-Based Autorefraction in Children Under 3 Years of Age

INTRODUCTION: This study was designed to assess the accuracy of photorefraction and wavefront-based autorefraction in children under 3 years of age.
METHODS: A cross-sectional study was performed with children who had no ocular abnormalities other than a refractive error and were less than 3 years old. Spot Vision Screener (Welch Allyn Inc., Skaneateles Falls, NY, USA) was used for photorefraction and SureSight Vision Screener (Welch Allyn, Skaneateles Falls, NY) was used for autorefraction. The measurements were performed with both devices before and after cycloplegia. The results were compared with those obtained using cycloplegic retinoscopy. The assessments were performed in terms of spherical equivalent (SE) values and Jackson cross-cylinder power values ( J0 and J45).
RESULTS: A total of 305 children with a mean age of 15.1±10.4 months were included. The mean SE values measured with the Spot Vision and SureSight before cycloplegia were 0.43±0.75 D and 0.90±0.86 D, respectively. Following cycloplegia, the mean SE values were 1.80±1.25 D and 1.55±1.40 D, respectively. The mean SE value obtained with cycloplegic retinoscopy was 1.53±1.34 D. The mean SE values measured with both devices prior to cycloplegia were significantly lower than that measured with cycloplegic retinoscopy (p<0.001). No significant difference was observed between the cycloplegic SE values obtained with SureSight and retinoscopy (p=0.66). Spot Vision yielded significantly higher cycloplegic SE values compared with cycloplegic retinoscopy (p<0.001).
DISCUSSION AND CONCLUSION: Both devices underestimated SE values in comparison with cycloplegic retinoscopy in children under 3 years of age. Wavefront-based autorefraction performed with cycloplegia may be an alternative to cycloplegic retinoscopy, but needs confirmation.