title: Accuracy of rural refractionists in western China.
abstract: OBJECTIVE
  We assessed the prevalence and predictors of inaccurate refractive error among rural refractionists in western China.
  
  
  METHODS
  A subset of primary school children with visual acuity (VA) ≤6/12 in ≥1 eye, undergoing subjective refinement by local refractionists after cycloplegic autorefraction in an ongoing population-based study, received repeat refraction by university optometrists for quality control.
  
  
  RESULTS
  Among 502 children (mean age 10.5 years, 53.2% girls), independent predictors of poor (inaccurate by ≥1.0 diopter [D]) refraction by 21 rural practitioners (66.7% with high school or lower education) included hyperopia (odds ratio [OR], 4.2; 95% confidence interval [CI], 2.4-7.3, P < 0.001), astigmatism (OR = 3.8; 95% CI, 2.5-5.6; P < 0.001) and VA uncorrectable to >6/12 by the rural refractionist (OR = 4.7; 95% CI, 3.1-7.3; P = < 0.001). Among 201 children whose vision was uncorrectable in ≥1 eye by the rural refractionists, vision could be improved to >6/12 by the university optometrist in 110 (54.7%). We estimate vision could be so improved in 9.1% of all children refracted by these rural refractionists. A reason for inaccuracy in this setting is the erroneous tendency of rural refractionists to adjust instrument values for accommodation, even under cycloplegia.
  
  
  CONCLUSIONS
  Rural refractionists in western China have little formal training and frequently fail to optimize VA among children, even when autorefractors are used. Training is needed emphasizing better use of automated refraction, particularly in children with astigmatism and hyperopia.
authors: State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Zhongqiang
authors: Z
authors: Zhou
authors: Junxia
authors: J
authors: Zeng
authors: Xiaochen
authors: X
authors: Ma
authors: Xiaopeng
authors: X
authors: Pang
authors: Hongmei
authors: H
authors: Yi
authors: Qianyun
authors: Q
authors: Chen
authors: Mirjam E
authors: ME
authors: Meltzer
authors: Mingguang
authors: M
authors: He
authors: Scott
authors: S
authors: Rozelle
authors: Nathan
authors: N
authors: Congdon
mesh_terms: D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009907:Optometry / Q000592:standards; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000175:diagnosis / Q000453:epidemiology*; D012424:Rural Population; D000078329:Workforce
keywords: China; accuracy; optometrist; refraction; refractionist; rural