Seymen Zeynep, Vural Esra, Eris Erdem, Vural Asli, Ogreden Tulin, Aslan Onder, Celebi Ali Riza Cenk, Perente Irfan
Department of Ophthalmology, University of Health Sciences Istanbul Suleymaniye Training and Research Hospital, Istanbul, Turkey.
Department of Ophthalmology, Mardin State Hospital, Mardin, Turkey.
Beyoglu Eye J. 2019 Feb 26;4(1):32-37. doi: 10.14744/bej.2018.20591. eCollection 2019.
The purpose of the study was to compare the refractive error measurements of pediatric patients performed with a Plusoptix A09 photorefractor (PO; Plusoptix AG, Nuremberg, Germany), a Retinomax K-plus 3 (RTX; Right Group, Tokyo, Japan), and the new handheld auto refracto-keratometer, the Nidek HandyRef-K (HDY; Nidek SA, Créteil, France), and to evaluate the intermethods agreement.
A total of 194 eyes of 194 children were included in the study. All of the children underwent refraction measurement with the PO before cycloplegia and 2 autorefractors were used after cycloplegia: the RTX and the HDY.
The mean age of the patients was 16.65±10.04 months (range: 3-34 months). There were no statistically significant differences between the spherical values (SV) or cylindrical axis values (CAV) measured with the PO (SV: 1.61±1.79 diopters [D]; CAV: 94.25±72.47 D), the RTX (SV: 1.91±2.06 D; CAV: 94.3±73.44 D), and the HDY (SV: 1.89±2.04 D; CAV: 93.55±73.71 D) (p>0.05).There was a statistically significant difference in the cylindrical values (CV) assessed with the RTX (CV: -0.97±0.75 D) and the HDY (CV: -1.11±0.76 D) (p=0.003) and the HDY and the PO (CV: -0.92±0.68 D)(p=0.002), while there was no statistically significant difference between the values determined with the RTX and the PO (p>0.05). Statistically significant differences were demonstrated for spherical equivalent values (SEV) obtained with the RTX (SEV: 1.43±1.97 D) and the PO (SEV: 1.15±1.74 D) (p=0.02), and the HDY (SEV: 1.34±1.95 D) and the PO (p=0.03), but no significant difference was found between the RTX and the HDY values (p>0.05).
No significant difference was found between the SEV measured by the RTX and the HDY, but the PO was significantly less hyperopic than the RTX and the HDY. The CV measured by HDY was higher than that of other devices. These devices can be used for screening in crowded pediatric ophthalmology clinics and may be an easier way of measuring refractive errors in children younger than 3 years of age, but high SEV and CV results should serve as an alert to physicians. It should also be kept in mind that cycloplegic retinoscopy is still the gold standard and these alternative methods can only be used for screening. The prescription of eyeglasses should not be made without cycloplegic retinoscopy.
本研究旨在比较使用Plusoptix A09验光仪（PO；德国纽伦堡Plusoptix AG公司）、Retinomax K-plus 3验光仪（RTX；日本东京Right Group公司）以及新型手持式自动验光角膜曲率计Nidek HandyRef-K（HDY；法国克雷泰伊Nidek SA公司）对儿科患者进行的屈光不正测量，并评估不同方法之间的一致性。
本研究共纳入194名儿童的194只眼。所有儿童在睫状肌麻痹前使用PO进行验光测量，在睫状肌麻痹后使用两种自动验光仪：RTX和HDY。
患者的平均年龄为16.65±10.04个月（范围：3 - 34个月）。使用PO测量的球镜值（SV：1.61±1.79屈光度[D]）、柱镜轴位值（CAV：94.25±72.47 D），RTX测量的值（SV：1.91±2.06 D；CAV：94.3±73.44 D）以及HDY测量的值（SV：1.89±2.04 D；CAV：93.55±73.71 D）之间无统计学显著差异（p>0.05）。RTX（柱镜值[CV]：-0.97±0.75 D）与HDY（CV：-1.11±0.76 D）以及HDY与PO（CV：-0.92±0.68 D）测量的CV存在统计学显著差异（p = 0.003和p = 0.002），而RTX与PO测量的值之间无统计学显著差异（p>0.05）。RTX（等效球镜值[SEV]：1.43±1.97 D）与PO（SEV：1.15±1.74 D）以及HDY（SEV：1.34±1.95 D）与PO测量的SEV存在统计学显著差异（p = 0.02和p = 0.03），但RTX与HDY的值之间无显著差异（p>0.05）。
RTX和HDY测量的SEV之间无显著差异，但PO的远视度数明显低于RTX和HDY。HDY测量的CV高于其他设备。这些设备可用于在拥挤的儿科眼科诊所进行筛查，可能是测量3岁以下儿童屈光不正的一种更简便方法，但高SEV和CV结果应引起医生警惕。还应牢记，睫状肌麻痹检影法仍是金标准，这些替代方法仅可用于筛查。未经睫状肌麻痹检影法不应开具眼镜处方。
