Rise of the Machines? Comparison of Cycloplegic Refraction Using Retinoscopy and the Retinomax K-Plus 5 in Children

Abstract

Purpose: To compare the ability to detect refractive anomalies in children using automated refraction versus retinoscopic cycloplegic refraction. Methods: A pediatric population from a pediatric eye institute underwent complete ophthalmic examinations. Children were randomly assigned to one of two pediatric optometrists who performed manual cycloplegic refraction using retinoscopy and automated cycloplegic refraction using a handheld autorefractometer (Retinomax K-plus 5; Right Mfg. Co., Ltd.). Recorded patient data included refraction values for each eye (sphere, astigmatism, and axis), use of glasses, and degree of cooperation. Results: Two hundred thirteen children were included. The mean age was 6.2 years. For all ages, strong associations were found in sphere and spherical equivalent (SE) measurements between the two methods (b = 0.78, P < .001; b = 0.71, P < .001; respectively). Among children older than 5 years, associations between the two methods were significant in all parameters (sphere: b = 0.99, P < .001; astigmatism: b = 0.69, P < .001; axis: b = 0.19, P < .05; SE: b = 0.97, P < .001), whereas among children 5 years and younger, a significant association was found only in the axis measurements (b = 0.31, P < .01). Retinomax K-plus 5 measurements showed significantly more hyperopic results in sphere measurements and higher astigmatism in all children examined, but this difference was markedly higher in children 5 years and younger. Good cooperation was observed in 94.1% of children older than 5 years and 77% of children 5 years and younger ( P < .001). Conclusions: The Retinomax K-plus 5 may be used for screening in children older than 5 years. However, in all age groups, it may not be accurate enough for treatment and decision making, even with good cooperation. [ J Pediatr Ophthalmol Strabismus . 2022;59(6):380–387.]