Accuracy and repeatability of refractive error measurements by photorefractometry

Purpose: 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. Conclusion: 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.