title: Intertester agreement in refractive error measurements.
abstract: OBJECTIVE
  To determine the intertester agreement of refractive error measurements between lay and nurse screeners using the Retinomax Autorefractor and the SureSight Vision Screener.
  
  
  METHODS
  Trained lay and nurse screeners measured refractive error in 1452 preschoolers (3 to 5 years old) using the Retinomax and the SureSight in a random order for screeners and instruments. Intertester agreement between lay and nurse screeners was assessed for sphere, cylinder, and spherical equivalent (SE) using the mean difference and the 95% limits of agreement. The mean intertester difference (lay minus nurse) was compared between groups defined based on the child's age, cycloplegic refractive error, and the reading's confidence number using analysis of variance. The limits of agreement were compared between groups using the Brown-Forsythe test. Intereye correlation was accounted for in all analyses.
  
  
  RESULTS
  The mean intertester differences (95% limits of agreement) were -0.04 (-1.63, 1.54) diopter (D) sphere, 0.00 (-0.52, 0.51) D cylinder, and -0.04 (1.65, 1.56) D SE for the Retinomax and 0.05 (-1.48, 1.58) D sphere, 0.01 (-0.58, 0.60) D cylinder, and 0.06 (-1.45, 1.57) D SE for the SureSight. For either instrument, the mean intertester differences in sphere and SE did not differ by the child's age, cycloplegic refractive error, or the reading's confidence number. However, for both instruments, the limits of agreement were wider when eyes had significant refractive error or the reading's confidence number was below the manufacturer's recommended value.
  
  
  CONCLUSIONS
  Among Head Start preschool children, trained lay and nurse screeners agree well in measuring refractive error using the Retinomax or the SureSight. Both instruments had similar intertester agreement in refractive error measurements independent of the child's age. Significant refractive error and a reading with low confidence number were associated with worse intertester agreement.
authors: *MS †PhD ‡OD §OD, MS ∥MD, MSCE **OD, PhD Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (JH, MGM, G-SY); Salus University, Elkins Park, Pennsylvania (EC); College of Optometry, Ohio State University, Columbus, Ohio (MTK); The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ); School of Optometry, University of California, Berkeley, Berkeley, California (DO-B); College of Optometry, Northeastern State University, Tahlequah, Oklahoma (LAC); and New England College of Optometry, Boston, Massachusetts (BM).
authors: Jiayan
authors: J
authors: Huang
authors: Maureen G
authors: MG
authors: Maguire
authors: Elise
authors: E
authors: Ciner
authors: Marjean T
authors: MT
authors: Kulp
authors: Graham E
authors: GE
authors: Quinn
authors: Deborah
authors: D
authors: Orel-Bixler
authors: Lynn A
authors: LA
authors: Cyert
authors: Bruce
authors: B
authors: Moore
authors: Gui-Shuang
authors: GS
authors: Ying
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage; D015588:Observer Variation; D011680:Pupil / Q000187:drug effects; D012030:Refractive Errors / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000295:instrumentation*
chemical_list: D009184:Mydriatics
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