title: A comparison of cycloplegic autorefraction and retinoscopy in Indian children.
abstract: BACKGROUND
  Correction of significant refractive errors in childhood helps in preventing amblyopia and strabismus. India has a huge demand for eye-care services related to uncorrected refractive errors with limited manpower resources. This can be overcome by autorefractors, which are free of operator bias, do not need skilled eye-care professionals and can be operated with ease. Hence, the purpose of this study, the first in the Indian population, was to determine the accuracy of autorefraction compared to traditional retinoscopy under cycloplegia.
  
  
  METHODS
  A cross-sectional study of all children meeting our inclusion criteria was conducted from July till October 2011 in a tertiary eye care centre. Children underwent cycloplegic (cyclopentolate plus tropicamide) refraction with an auto-refractometer (Topcon KR-8900) and traditional retinoscopy and the results were compared. Patients were divided into three groups: Group 1: Myopia and myopic astigmatism, Group 2: Hyperopia and hyperopic astigmatism and Group 3: Mixed astigmatism. Clinically significant difference was defined as either of more than 0.50 D difference in sphere, more than 0.5 D difference in cylinder or more than 20 degrees difference in axis.
  
  
  RESULTS
  The left eyes of 294 children (148 male) were included in the study. Mean age was 8.22 ± 3.47 years. Clinically significant differences were noted in 13.22 per cent of eyes in Group 1, 15.09 per cent of eyes in Group 2 and 20.90 per cent of eyes in Group 3. Clinically significant differences were more common in children aged less than six years (25 per cent) compared to older children (9.19 per cent). Comparing the sphere, cylinder, spherical equivalent and length of power vector values gained by autorefraction and retinoscopy, no statistically significant differences were found in any group.
  
  
  CONCLUSIONS
  Autorefraction with Topcon KR-8900 can be used reliably in Indian children older than six years, if conducted under cycloplegia. In mixed astigmatism and children less than six years, it should be corroborated with retinoscopy.
authors.affiliation: Sankara Nethralaya, Kolkata, West Bengal, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Guha
authors.affiliation: Sankara Nethralaya, Kolkata, West Bengal, India.
authors.forename: Sanil
authors.initials: S
authors.lastname: Shah
authors.affiliation: Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Khyati
authors.initials: K
authors.lastname: Shah
authors.affiliation: Sankara Nethralaya, Kolkata, West Bengal, India.
authors.forename: Preeti
authors.initials: P
authors.lastname: Hurakadli
authors.affiliation: Sankara Nethralaya, Kolkata, West Bengal, India.
authors.forename: Debalina
authors.initials: D
authors.lastname: Majee
authors.affiliation: Sankara Nethralaya, Kolkata, West Bengal, India.
authors.forename: Shyamali
authors.initials: S
authors.lastname: Gandhi
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003519:Cyclopentolate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage*; D012029:Refraction, Ocular; D042262:Retinoscopy
chemical_list: D009184:Mydriatics; D003519:Cyclopentolate
keywords: accommodation; astigmatism; children's vision; myopia