Comparison of Refractive Measures of Three Autorefractors in Children and Adolescents

SIGNIFICANCE: Our study found a good agreement between three autorefractors. Not only will readers benefit as they can now compare data measured with either device in different studies but the three devices can be used in the same study to generate one pool of data, which can be analyzed together. PURPOSE: The present study aims to evaluate the agreement of three commonly used autorefractors in children and adolescents, and the potential for their interchangeable application in a large-scale study. METHODS: Participants from seven schools were enrolled using cluster sampling. Refractive errors were measured using the following three autorefractors under cycloplegic conditions in random sequence: Topcon KR-8900, Nidek ARK-510A, and Huvitz HRK-7000A. Refractive errors were compared in terms of spherical equivalent refraction (SER), cylinder power, and the J(0) and J(45) by repeated-measures analysis of variance (RM-ANOVA) and Bland-Altman 95% limits of agreement (95% LoA). RESULTS: A total of 2072 participants aged from 4 to 18 years were included. The mean +/- SD and 95% LoA of the differences in SER between Topcon and Nidek, Topcon and Huvitz, and Nidek and Huvitz were 0.01 +/- 0.24D (-0.46 to 0.48), -0.06 +/- 0.31D (-0.66 to 0.54), and -0.07 +/- 0.26D (-0.58 to 0.44), and those for the differences in cylinder power were -0.07 +/- 0.26D (-0.57 to 0.44), 0.01 +/- 0.32D (-0.63 to 0.64), and 0.07 +/- 0.28D (-0.48 to 0.62), respectively (RM-ANOVA, P <.001). Further, the mean differences in J0 and J45 between each refractor pair ranged from -0.03 to 0.01, and the 95% LoA were -0.78 to 0.74, -0.79 to 0.74, and -0.73 to 0.72 for J(0) and -0.86 to 0.87, -0.86 to 0.88, and -0.83 to 0.84 for J(45), respectively. CONCLUSIONS: Our study will allow for use of these three autorefractors interchangeably in large screening studies. Copyright (C) 2017 The Author(s). Published by Wolters Kluwer Health, Inc.