title: Intra- and inter- examiner repeatability of cycloplegic retinoscopy among young children.
abstract: To evaluate the intra- and inter-examiner repeatability of cycloplegic retinoscopy in young children aged 4-5 years old.
  
  
  
  Examiner 1 refracted all children in the first sample (n = 108); firstly with masked loose lenses, then using unmasked loose lenses (intra-examiner repeatability). Examiners 1 and 2 refracted all children in the second sample (n = 97) using unmasked loose lenses, blind to the child's refractive error, presence/magnitude of habitual spectacle correction and to each other's findings (inter-examiner repeatability). Refractions were performed on one eye chosen at random. Mean differences, 95% limits of agreement (LOAs) and confidence intervals were calculated for intra- and inter-examiner repeatability of sphere, cylinder and spherical equivalent refraction (SER).
  
  
  
  Participants had a wide range of refractive errors (-1.50DS to +7.25DS; ≥4.50DC). Mean differences (95% LOAs) were small for both intra- and inter-examiner repeatability [Intra: Sphere 0.00D (-0.85, +0.85D), Cylinder -0.03D (-0.68, +0.62D), SER -0.06D (-0.90, +0.78D); Inter: Sphere -0.08D (-0.92, +0.76D), Cylinder -0.08D (-0.75, +0.59D), SER -0.13D (-0.95, +0.69D). A statistically significant proportional bias was present for intra-examiner repeatability of cylinder (ρ = 0.20, p = 0.04) and SER measurement (ρ = 0.19, p = 0.049). Proportional bias was not present for any other measure (p > 0.12). Examiners agreed on cylinder axis within ±20°in 71% of refractions where astigmatism of -0.75D or higher was present. 80% of intra- and inter-examiner measures fell within ±0.50D for spherical and cylindrical components.
  
  
  
  Differences of ±1.00D and ±0.75D or more for spherical and cylindrical measures respectively can be considered significant when performing cycloplegic retinoscopy on young children.
authors.affiliation: Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Coleraine, UK.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: McCullough
authors.affiliation: Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Coleraine, UK.
authors.forename: Lesley
authors.identifier: 0000-0001-9549-7192
authors.initials: L
authors.lastname: Doyle
authors.affiliation: Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Coleraine, UK.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Saunders
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000494:pharmacology*; D015588:Observer Variation; D012029:Refraction, Ocular / Q000502:physiology*; D012030:Refractive Errors / Q000175:diagnosis* / Q000503:physiopathology; D012160:Retina / Q000000981:diagnostic imaging*; D042262:Retinoscopy / Q000379:methods*; D015351:Vision Screening / Q000379:methods
chemical_list: D009184:Mydriatics
keywords: cycloplegia; optometry; retinoscopy; vision science