Screening of infants for significant refractive error using videorefraction.

Isotropic photorefraction has been suggested as a suitable method for screening infants for refractive error. Recently published data suggested that reasonable consistency with retinoscopy results might be achieved using cycloplegic videophotorefraction (VPR) for spherical refractive error but that results might be unreliable for astigmatic errors. Non-cycloplegic VPR did not appear to produce results consistent with retinoscopy. A practical idea of how many children might be identified using this technique and how many missed was needed by personnel designing screening projects. Hence the VPR was tested by screening a population of 247 infants for significant refractive error, and comparing the results with cycloplegic retinoscopy. Sensitivity and specificity scores were calculated for a range of test levels of ametropia. Without cycloplegia, sensitivity of VPR was poor. With cycloplegia the situation was much improved, with sensitivity for hyperopia +4.00 D or over of 83.3% and specificity of 90.6%. Sensitivity for astigmatism of 1 D or greater (84.6%) was high but specificity was poor (45.6%). Acceptable sensitivity was achieved for identifying children in this age group at risk of developing squint and amblyopia due to refractive error, providing cycloplegia was used.