title: A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children.
abstract: OBJECTIVE
  To evaluate the accuracy of autorefraction using three autorefractors comparing to subjective refraction in diagnosing refractive error in children.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  setting: Community based study. study population: 117 children sampled from primary schools. procedures: All subjects underwent autorefraction using three auto refractors and subjective refraction with and without cycloplegia. main outcome measures: Spherical power, cylindrical power, and spherical equivalence (SE).
  
  
  RESULTS
  Without cycloplegia, the mean SE were significantly different for Retinomax K plus 2 (-1.55 diopters, SD 2.37 diopters; 95% CI -1.98 to -1.12; P < .0001) and Canon RF10 (-1.11 diopters; SD 2.61 diopters; 95% CI -1.59 to -0.64; P = .0023) compared with monocular subjective refraction (-0.80 diopters; SD 2.25 diopters; 95% CI -1.21 to -0.35). Mean SE was significantly different for Grand Seiko WR5100K (-0.79 diopters; SD 2.40 diopters; 95% CI -1.23 to -0.35; P = .0002) compared with binocular subjective refraction (-0.62 diopters; SD 2.51 diopters; 95% CI -1.07 to -0.16). With cycloplegia, there was no significant difference in mean SE between refraction methods. Sensitivity and specificity results for the diagnosis of myopia: Without cycloplegia: Retinomax K plus 2 (sensitivity 1.0, specificity 0.51); Canon RF10 (sensitivity 0.92, specificity 0.81); and Grand Seiko WR5100K (sensitivity 0.91, specificity 0.98). With cycloplegia: Retinomax K plus 2 (sensitivity 0.97, specificity 0.99); Canon RF10 (sensitivity 0.97, specificity 0.96); and Grand Seiko WR5100K (sensitivity 1.0, specificity 0.97).
  
  
  CONCLUSIONS
  Under noncycloplegic conditions, all three autorefractors have a tendency towards minus over correction in children resulting in over diagnosis of myopia. However autorefractors were accurate under cycloplegic conditions.
authors.affiliation: Department of Ophthalmology, Hospital Selayang, Kuala Lumpur, Selangor, Malaysia. yeefongchoong@yahoo.co.uk
authors.forename: Yee-Fong
authors.initials: YF
authors.lastname: Choong
authors.forename: Ai-Hong
authors.initials: AH
authors.lastname: Chen
authors.forename: Pik-Pin
authors.initials: PP
authors.lastname: Goh
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D003519:Cyclopentolate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis*; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage*; D009216:Myopia / Q000175:diagnosis*; D011680:Pupil / Q000187:drug effects; D012029:Refraction, Ocular; D015203:Reproducibility of Results; D042262:Retinoscopy / Q000592:standards*; D012680:Sensitivity and Specificity; D015348:Vision, Binocular
chemical_list: D009184:Mydriatics; D003519:Cyclopentolate