title: Accuracy and Repeatability of Refractive Error Measurements by Photorefractometry.
abstract: OBJECTIVE
  To determine the accuracy of photorefraction and autorefraction as compared to cycloautorefraction and to detect the repeatability of photorefraction.
  
  
  METHODS
  This diagnostic study included the right eyes of 86 children aged 7-12 years. Refractive status was measured using photorefraction (PlusoptiX SO4, GmbH, Nürnberg, Germany) and autorefraction (Topcon RM800, USA) with and without cycloplegia. Photorefraction for each eye was performed three times to assess repeatability.
  
  
  RESULTS
  The overall agreement between photorefraction and cycloautorefraction was over 81% for all refractive errors. Photorefractometry had acceptable sensitivity and specificity for myopia and astigmatism. There was no statistically significant difference considering myopia and astigmatism in all comparisons, while the difference was significant for hyperopia using both amblyogenic (P = 0.006) and nonamblyogenic criteria (P = 0.001). A myopic shift of 1.21 diopter (D) and 1.58 D occurred with photorefraction in nonamblyogenic and amblyogenic hyperopia, respectively. Using revised cut-off points of + 1.12 D and + 2.6 D instead of + 2.00 D and + 3.50 D improved the sensitivity of photorefractometry to 84.62% and 69.23%, respectively. The repeatability of photorefraction for measurement of myopia, astigmatism and hyperopia was acceptable (intra-cluster correlation [ICC]: 0.98, 0.94 and 0.77, respectively). Autorefraction results were significantly different from cycloautorefraction in hyperopia (P < 0.0001), but comparable in myopia and astigmatism. Also, noncycloglegic autorefraction results were similar to photorefraction in this study.
  
  
  CONCLUSIONS
  Although photorefraction was accurate for measurement of myopia and astigmatism, its sensitivity for hyperopia was low which could be improved by considering revised cut-off points. Considering cut-off points, photorefraction can be used as a screening method.
authors.affiliation: Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran.
authors.forename: Zhale
authors.initials: Z
authors.lastname: Rajavi
authors.affiliation: Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamideh
authors.initials: H
authors.lastname: Sabbaghi
authors.affiliation: Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran.
authors.forename: Ahmad Shojaei
authors.initials: AS
authors.lastname: Baghini
authors.affiliation: Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Yaseri
authors.affiliation: Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran.
authors.forename: Koroush
authors.initials: K
authors.lastname: Sheibani
authors.affiliation: School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ghazal
authors.initials: G
authors.lastname: Norouzi
keywords: Accuracy; Autorefraction; Cycloautorefraction; Photorefraction; Repeatability