title: Screening for refractive errors in children: the plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy.
abstract: OBJECTIVE
  To evaluate the performance of the autorefractor Retinomax K-plus2 and the photoscreener plusoptiX S08 in measuring refractive errors by comparing them with cycloplegic retinoscopy (CR) and to assess limitations associated with their use.
  
  
  METHODS
  Cross-sectional study to compare data from CR, performed by an orthoptist, to data from Retinomax K-plus2 and plusoptiX S08 performed by a lay screener. Sensitivity and specificity for the detection of significant refractive errors were determined according to American Academy of Pediatric Ophthalmology and Strabismus criteria.
  
  
  RESULTS
  Two hundred children were included, with a mean age of 5.2 ± 2.6 years (3 months to 11 years). Compared to CR, the plusoptiX S08 showed a mean difference of -1.13 ± 1.25 D (95% limits of agreement [LOA], -3.59 to +1.32) for spherical equivalent (SE) and -0.23 ± 0.53 D (LOA, -1.28 to +0.81) for the cylinder. Mean difference for the Retinomax K-plus2 before cycloplegia was -0.08 ± 0.58 D (LOA, -1.23 to +1.06) for SE and 0.03 ± 0.38 D (LOA, -0.72 to +0.78) for the cylinder; after cycloplegia -2.11 ± 1.64 D (LOA, -5.33 to +1.10) for SE and -0.06 ± 0.47 D (LOA, -0.98 to +0.86) for the cylinder. Sensitivity for detecting hyperopia >3.5 D with the plusoptiX S08 was 33.3%, the Retinomax before cycloplegia 31.0% and after cycloplegia 84.6% and high for detecting myopia, astigmatism, and anisometropia.
  
  
  CONCLUSIONS
  Retinomax K-plus2 and plusoptiX S08 have high sensitivity for the detection of myopia, astigmatism, and anisometropia compared to cycloplegic retinoscopy; however, when used without cycloplegia, hyperopia is underestimated.
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tamara
authors.initials: T
authors.lastname: Paff
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Oudesluys-Murphy
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: Marietta
authors.initials: M
authors.lastname: Swart-van den Berg
authors.forename: Johan M
authors.initials: JM
authors.lastname: de Nie
authors.forename: Els
authors.initials: E
authors.lastname: Tijssen
authors.forename: Nicoline E
authors.initials: NE
authors.lastname: Schalij-Delfos
mesh_terms: D015858:Anisometropia / Q000175:diagnosis; D001251:Astigmatism / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis; D007223:Infant; D009184:Mydriatics; D009216:Myopia / Q000175:diagnosis; D009885:Ophthalmology / Q000592:standards*; D009988:Orthoptics / Q000592:standards*; D012030:Refractive Errors / Q000175:diagnosis*; D015203:Reproducibility of Results; D042262:Retinoscopy / Q000379:methods*; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000295:instrumentation / Q000379:methods / Q000592:standards
chemical_list: D009184:Mydriatics