State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat Sen University, Guangzhou, PRC.
Ophthalmology. 2011 Jun;118(6):1162-9. doi: 10.1016/j.ophtha.2010.10.003. Epub 2011 Jan 12.
To compare visual and refractive outcomes between self-refracting spectacles (Adaptive Eyecare, Ltd, Oxford, UK), noncycloplegic autorefraction, and cycloplegic subjective refraction.
Cross-sectional study.
Chinese school-children aged 12 to 17 years.
Children with uncorrected visual acuity ≤ 6/12 in either eye underwent measurement of the logarithm of the minimum angle of resolution visual acuity, habitual correction, self-refraction without cycloplegia, autorefraction with and without cycloplegia, and subjective refraction with cycloplegia.
Proportion of children achieving corrected visual acuity ≥ 6/7.5 with each modality; difference in spherical equivalent refractive error between each of the modalities and cycloplegic subjective refractive error.
Among 556 eligible children of consenting parents, 554 (99.6%) completed self-refraction (mean age, 13.8 years; 59.7% girls; 54.0% currently wearing glasses). The proportion of children with visual acuity ≥ 6/7.5 in the better eye with habitual correction, self-refraction, noncycloplegic autorefraction, and cycloplegic subjective refraction were 34.8%, 92.4%, 99.5% and 99.8%, respectively (self-refraction versus cycloplegic subjective refraction, P<0.001). The mean difference between cycloplegic subjective refraction and noncycloplegic autorefraction (which was more myopic) was significant (-0.328 diopter [D]; Wilcoxon signed-rank test P<0.001), whereas cycloplegic subjective refraction and self-refraction did not differ significantly (-0.009 D; Wilcoxon signed-rank test P = 0.33). Spherical equivalent differed by ≥ 1.0 D in either direction from cycloplegic subjective refraction more frequently among right eyes for self-refraction (11.2%) than noncycloplegic autorefraction (6.0%; P = 0.002). Self-refraction power that differed by ≥ 1.0 D from cycloplegic subjective refractive error (11.2%) was significantly associated with presenting without spectacles (P = 0.011) and with greater absolute power of both spherical (P = 0.025) and cylindrical (P = 0.022) refractive error.
Self-refraction seems to be less prone to accommodative inaccuracy than noncycloplegic autorefraction, another modality appropriate for use in areas where access to eye care providers is limited. Visual results seem to be comparable. Greater cylindrical power is associated with less accurate results; the adjustable glasses used in this study cannot correct astigmatism. Further studies of the practical applications of this modality are warranted.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
比较自反射眼镜（英国牛津 Adaptive Eyecare 有限公司）、非睫状肌麻痹自动折射和睫状肌麻痹主观折射的视力和屈光结果。
横断面研究。
年龄在 12 至 17 岁的中国学童。
未矫正视力≤双眼 6/12 的儿童接受最小角分辨率视力对数、习惯性矫正、非睫状肌麻痹自折射、有和无睫状肌麻痹的自动折射以及睫状肌麻痹主观折射的测量。
每种方法矫正视力≥6/7.5 的儿童比例；每种方法与睫状肌麻痹主观屈光误差之间的球镜等效屈光误差差异。
在 556 名同意参加的父母的合格儿童中，554 名（99.6%）完成了自折射（平均年龄 13.8 岁；59.7%为女孩；54.0%目前戴眼镜）。在更好的眼睛中，视力≥6/7.5 的儿童比例分别为习惯性矫正（34.8%）、自折射（92.4%）、非睫状肌麻痹自动折射（99.5%）和睫状肌麻痹主观折射（99.8%）（自折射与睫状肌麻痹主观折射比较，P<0.001）。睫状肌麻痹主观折射与非睫状肌麻痹自动折射（更近视）之间的平均差异显著（-0.328 屈光度[D]；Wilcoxon 符号秩检验 P<0.001），而睫状肌麻痹主观折射与自折射之间差异不显著（-0.009 D；Wilcoxon 符号秩检验 P = 0.33）。右眼自折射（11.2%）比非睫状肌麻痹自动折射（6.0%；P = 0.002）更频繁地出现球镜等效屈光误差相差≥1.0 D。自折射的屈光力与睫状肌麻痹主观屈光误差相差≥1.0 D（11.2%）与不戴眼镜显著相关（P = 0.011），与球镜（P = 0.025）和圆柱镜（P = 0.022）屈光误差的绝对数值增加显著相关。
自折射似乎比非睫状肌麻痹自动折射不易受到调节误差的影响，后者是在获得眼科护理服务有限的地区使用的另一种合适的方法。视力结果似乎是可比的。更大的圆柱镜力与不太准确的结果相关；本研究中使用的可调眼镜无法矫正散光。需要进一步研究这种方法的实际应用。
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