Screening for Hyperopia in Infants Using the PowerRefractor

Abstract

Accessory +4.50 diopter sphere spectacles appeared to successfully extend the operating range of the PR with cycloplegia, allowing for detection of high levels of hyperopia that occurred in a large proportion of 2-month old infants with adequate sensitivity and specificity compared with cycloplegic retinoscopy.

Evaluation of a Pilot Protocol for Detecting Infant Hyperopia

“…High hyperopia was a common finding in the infants screened in this pediatric medical practice. The mean spherical equivalent refractive error, based on cycloplegic retinoscopy, in this sample of 473 infants was +2.54 ± 1.54 D. This is similar to samples of infants from previous studies, which find the mean refractive error in infants of similar age to range from +1.51 to +3.29 D, with SDs on the order of 0.94 to 1.60 D 10,11,26–29 . The prevalence of moderate hyperopia in this study, based on spherical equivalent classification, was 32.8%, and the prevalence of high hyperopia was 5.9%.…”

“…The prevalence of moderate and high hyperopia was slightly lower compared with a screening similar in design to this current study and also conducted in Columbus, Ohio, in 2010. Satiani and Mutti 29 found that 61% of 2-month-olds had moderate hyperopia (≥+3.0 D), and 7.5% had high hyperopia (≥+5.0 D). In older infants, Ingram et al 30 found that 9.2% of 6-month-old infants had +5.25 D or more in at least one meridian, and the Multi-Ethnic Pediatric Eye Disease Study Group 31 found that 1.1% of African American 6-month-olds and 2.7% of Hispanic 6-month-olds had +5.00 D or more in the more hyperopic eye.…”

“…A previous screening study from 2010, which used two drops of 1% tropicamide instead of one in a population similar to this study, found similar refractive errors, suggesting that two drops may not be needed. 29 There have also been studies that suggest 1% tropicamide provides the same distance refraction as 1% cyclopentolate in pediatric populations. [23][24][25] In participants who enrolled in the clinical trial portion of the study, the cycloplegic retinoscopy values (both sphere and spherical equivalent) from the baseline were significantly more hyperopic than the refractive error measured with tropicamide in the screening, but the mean difference was no greater than 0.44 D (P < .001; Table 5).…”

A comparison of the Plusoptix S08 photorefractor to retinoscopy and cycloretinoscopy

“…Recently, Satiani and Mutti applied accessory +4.50 D spectacles to extend the operating range of the PowerRefractor to detect highly hyperopic refractive errors and Nathan and Donohue modified Plusoptix referral criteria to enhance specificity of the device, whereas the original claim of the manufacturers about efficacy of photorefractors to determine the refractive errors in a defined range is still controversial. For instance, Matta and colleagues suggested that the Plusoptix S04 photoscreener is a very useful tool and vision screening programs likely will find this a useful option when examining children, while Ayse, Onder and Suheyla reported that Plusoptix S04 is not an accurate tool to estimate refraction in children.…”

Two‐dimensional simulation of eccentric photorefraction images for ametropes: factors influencing the measurement

“…13 mm vertex distance) and the pupil plane could cause up to a 10% difference in the estimate. Some studies have used spectacle lenses when testing patients with large amounts of ametropia . These spectacles can bring the retinal defocus back into the linear operating range of the eccentric photorefractor, but they will also introduce magnification or minification of the pupil image depending on the lens power and vertex distance ( Figure ).…”