Rauscher Franziska G, Lange Heike, Yahiaoui-Doktor Maryam, Tegetmeyer Helmut, Sterker Ina, Hinz Andreas, Wahl Siegfried, Wiedemann Peter, Ohlendorf Arne, Blendowske Ralf
Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany.
Department of Ophthalmology, Leipzig University, Leipzig, Germany.
Optom Vis Sci. 2019 Nov;96(11):879-889. doi: 10.1097/OPX.0000000000001444.
Increasing prevalence of refractive error requires assessment of ametropia as a screening tool in children. If cycloplegia is not an option, knowledge about the increase in uncertainty for wavefront-based autorefraction is needed. The cycloplegic agent as the principal variant presents cross-reference and allows for extraction of the influence of accommodation.
The purpose of this study was to determine the repeatability, agreement, and propensity to accommodate of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront-based autorefraction (ZEISS i.Profiler plus; Carl Zeiss Vision, Aalen, Germany) in children aged 2 to 15 years.
In a clinical setting, three consecutive measurements were feasible for 145 eyes (OD) under both conditions. Data are described by spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45). In the case of M, the most positive value of the three measurements was chosen, whereas the mean was applied for astigmatic components.
Regarding agreement, differences for ARc minus ARnc were statistically significant: for M, 0.55 (0.55 D; mean [SD]; P < .001), that is, more hyperopic in cycloplegia; for J0, -0.03 (0.11 D; P = .002); and for J45, -0.03 D (SD, 0.09 D; P < .001). Regarding repeatability, astigmatic components showed excellent repeatability: SD < 0.11 D (ARnc) and SD < 0.09 D (ARc). The repeatability of M was SD = 0.57 D with a 95% interval of 1.49 D (ARnc). Under cycloplegia, this decreased to SD = 0.17 D (ARc) with a 95% interval of 0.50 D. The mean propensity to accommodate was 0.44 D from repeated measurements; in cycloplegia, this was reduced to 0.19 D.
Wavefront-based refraction measurement results are highly repeatable and precise for astigmatic components. Noncycloplegic measurements of M show a systematic bias of 0.55 D. Cycloplegia reduces the propensity to accommodate by a factor of 2.4; for noncycloplegic repeated measurements, accommodation is controlled to a total interval of 1.49 D (95%). Without cycloplegia, results improve drastically when measurements are repeated.
屈光不正患病率的上升需要将屈光不正评估作为儿童的一种筛查工具。如果不能使用睫状肌麻痹，那么就需要了解基于波前像差的自动验光仪测量不确定性的增加情况。作为主要变量的睫状肌麻痹剂提供了相互参照，并有助于提取调节的影响。
本研究的目的是确定2至15岁儿童中，使用睫状肌麻痹剂（ARc）和未使用睫状肌麻痹剂（ARnc）的基于波前像差的自动验光仪（蔡司i.Profiler plus；德国卡尔蔡司视觉公司，阿伦）的可重复性、一致性以及调节倾向。
在临床环境中，两种情况下对145只眼（右眼）均可行连续三次测量。数据用等效球镜度（M）、水平或垂直散光分量（J0）以及斜向散光分量（J45）来描述。对于M，选择三次测量中的最大正值，而散光分量则采用平均值。
关于一致性，ARc减去ARnc的差异具有统计学意义：对于M，为0.55（0.55 D；平均值[标准差]；P <.001），即睫状肌麻痹时更远视；对于J0，为-0.03（0.11 D；P =.002）；对于J45，为-0.03 D（标准差，0.09 D；P <.001）。关于可重复性，散光分量显示出极好的可重复性：标准差<0.11 D（ARnc）且标准差<0.09 D（ARc）。M的可重复性为标准差=0.57 D，95%区间为1.49 D（ARnc）。在睫状肌麻痹下，这一数值降至标准差=0.17 D（ARc），95%区间为0.50 D。重复测量得到的平均调节倾向为0.44 D；在睫状肌麻痹时，这一数值降至0.19 D。
基于波前像差的验光测量结果对于散光分量具有高度可重复性和精确性。M的非睫状肌麻痹测量显示出0.55 D的系统偏差。睫状肌麻痹使调节倾向降低了2.4倍；对于非睫状肌麻痹的重复测量，调节被控制在1.49 D（95%）的总区间内。在不使用睫状肌麻痹剂的情况下，重复测量时结果会大幅改善。
