Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
İki Farklı El Tipi Taşınabilir Otorefraktometre ile Pediatrik Yaş Grubunda Yapılan Sikloplejili ve Sikloplejisiz Refraksiyon Ölçümlerinin Karşılaştırılması: Kesitsel, Gözlemsel Araştırma
Comparison of Noncycloplegic and Cycloplegic Refraction Measurements in Pediatric Patients Obtained with Two Different Hand-Held Portable Autorefractometers: Cross-Sectional, Observational Research
Osman KIZILAYa , Özge Pınar AKARSU AÇARb , Gökhan ÇELİKa
aZeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, İstanbul, Türkiye
bTekirdağ Namık Kemal Üniversitesi Araştırma ve Uygulama Hastanesi, Göz Hastalıkları ABD, Tekirdağ, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(1):15-21
doi: 10.5336/ophthal.2023-98913
Article Language: TR
Full Text
ÖZET
 Amaç: Klinik pratikte kullanılan iki el tipi taşınabilir otorefraktometre [Nidek HandyRef-K, Nidek, Tokyo, Japonya (HRK); Welch Allyn Spot Vision Screener, NewYork, ABD (WA)] ile pediatrik hasta grubunda elde edilen refraktif sonuçların karşılaştırılması amaçlandı. Gereç ve Yöntemler: Göz polikliniğine başvuran 1-10 yaş arasındaki çocuk hastalar, bu kesitsel gözlemsel çalışma kapsamına alındı. Yüz elli sekiz hastanın 158 gözünün refraksiyon değeri önce HRK sonra WA otorefraktometreleri ile sikloplejisiz olarak ölçüldü. Sikloplejili olarak her iki cihazla ölçümler tekrarlandı. Sferik değer (diyoptri (D)), silendirik değer (D), silendirik aks ve sferik eş değer (sferik değer D + [silendirik değer/2]) sonuçları kaydedildi. Bulgular: HRK cihazı ile elde edilen değerlerin WA cihazı ile elde edilenlere göre anlamlı olarak daha az hipermetropik olduğu (p<0,001) görüldü. Sikloplejisiz ölçümlerle elde edilen veriler değerlendirildiğinde iki cihaz arasında; sferik ve silendirik değerlerde anlamlı (sırasıyla p değerleri; p<0,001, p<0,001) güçlü korelasyon [sırasıyla; r=0,924 (0,896-0,944) ve r=0,921 (0,891-0,942)]; aks ölçümlerinde anlamlı (p<0,001) korelasyon [r=0,524 (0,349-0,652)]; sferik eş değer ölçümlerinde ise anlamlı (p<0,001) güçlü korelasyon [r=0,923 (0,895-0,944)] gözlendi. Sikloplejili ölçümlerle elde edilen veriler değerlendirildiğinde 2 cihaz arasında; sferik ve silendirik değerlerde anlamlı (sırasıyla p değerleri; p<0,001, p<0,001) [sırasıyla; r=0,976 (0,968-0,983) ve r=0,889 (0,849-0,919)] güçlü korelasyon; aks ölçümlerinde anlamlı (p<0,001) [r=0,524 (0,349-0,652)] korelasyon; sferik eş değer ölçümlerinde ise anlamlı (p<0,001) [r=0,976 (0,968-0,983)] güçlü korelasyon izlendi. Her iki cihazla elde edilen sferik değer, silendirik değer ve sferik eş değer için yapılan Bland-Altman analizinde ölçümler arasındaki farklılıkların tüm ölçümlerde ±2SD arasında olduğu saptandı. Sonuç: Kırma kusurlarının erken tanısında bu çalışmada değerlendirilen iki cihazın birbiriyle güçlü korelasyon gösterdiği ve bu iki cihazla elde edilen sonuçların uyumlu olduğu görüldü.

Anahtar Kelimeler: El tipi taşınabilir otorefraktometre; ambliyopi; refraksiyon; retinoskopi; siklopleji
ABSTRACT
 Objective: To compare the refractive results obtained with two hand-held autorefractometers [HandyRef-K, Nidek, Tokyo, Japan, (HRK); Welch Allyn Spot Vision Screener, NewYork, USA, (WA)] in pediatric patients. Material and Methods: Patients aged 1-10 years were included in this cross-sectional observational study. The refraction values of 158 eyes were measured first with HRK and then with WA without cycloplegia and then were repeated with cycloplegia. The spherical and cylindrical value (diopter (D)), cylindrical axis and spherical equivalent (spherical value D + [cylindrical value/2]) were recorded. Results: The values obtained with the HRK were significantly less hyperopic (p<0.001) than those obtained with the WA. The data without cycloplegia showed; a significant and strong correlation in spherical and cylindrical values (p<0.001, p<0.001; respectively), [r=0.924 (0.896-0.944) and r=0.921 (0.891- 0.942); respectively]; a significant correlation in axis (p<0.001), [r=0.524 (0.349- 0.652)] and a significant strong correlation (p<0.001), [r=0.923 (0.895-0.944)] in spherical equivalent. With cycloplegic evaluation, a significant and strong correlation in spherical and cylindrical values (p<0.001, p<0.001; respectively) [r=0.976 (0.968-0.983) and r=0.889 (0.849-0.919); respectively]; a significant correlation (p<0.001) [r=0.524 (0.349-0.652)] in axis and a significant strong correlation (p<0.001) [r=0.976 (0.968-0.983)] in spherical equivalent was observed. In the Bland-Altman analysis performed for the spherical value, cylindrical value and spherical equivalent obtained with both devices, it was determined that the differences were between ±2SD in all measurements. Conclusion: In the early diagnosis of refractive errors, it was observed that the data of the two devices evaluated showed a strong correlation with each other and the results obtained with these two devices were compatible.

Keywords: Hand-held portable autorefractometer; ambliyopia; refraction; retinoscopy; cycloplegia
REFERENCES:
  1. Varma R, Deneen J, Cotter S, Paz SH, Azen SP, Tarczy-Hornoch K, et al; Multi-Ethnic Pediatric Eye Disease Study Group. The multi-ethnic pediatric eye disease study: design and methods. Ophthalmic Epidemiol. 2006;13(4):253-62. [Crossref]  [PubMed] 
  2. Wilson LB, Melia M, Kraker RT, VanderVeen DK, Hutchinson AK, Pineles SL, et al. Accuracy of autorefraction in children: a report by the American Academy of Ophthalmology. Ophthalmology. 2020;127(9):1259-67. [Crossref]  [PubMed] 
  3. Rassow B, Wesemann W. Automatic infrared refractors--1985. Ophthalmology. 1985;92(8 Suppl):20-33. [Crossref]  [PubMed] 
  4. Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group. Progressive-addition lenses versus single-vision lenses for slowing progression of myopia in children with high accommodative lag and near esophoria. Invest Ophthalmol Vis Sci. 2011;52(5):2749-57. [Crossref]  [PubMed]  [PMC] 
  5. Fozailoff A, Tarczy-Hornoch K, Cotter S, Wen G, Lin J, Borchert M, et al; Writing Committee for the MEPEDS Study Group. Prevalence of astigmatism in 6- to 72-month-old African American and Hispanic children: the Multi-ethnic Pediatric Eye Disease Study. Ophthalmology. 2011;118(2):284-93. [Crossref]  [PubMed]  [PMC] 
  6. Ying GS, Maguire M, Quinn G, Kulp MT, Cyert L; Vision In Preschoolers (VIP) Study Group. ROC analysis of the accuracy of Noncycloplegic retinoscopy, Retinomax Autorefractor, and SureSight Vision Screener for preschool vision screening. Invest Ophthalmol Vis Sci. 2011;52(13):9658-64. [Crossref]  [PubMed]  [PMC] 
  7. Harvey EM, Miller JM, Wagner LK, Dobson V. Reproducibility and accuracy of measurements with a hand held autorefractor in children. Br J Ophthalmol. 1997;81(11):941-8. [Crossref]  [PubMed]  [PMC] 
  8. Oral Y, Gunaydin N, Ozgur O, Arsan AK, Oskan S. A comparison of different autorefractors with retinoscopy in children. J Pediatr Ophthalmol Strabismus. 2012;49(6):370-7. [Crossref]  [PubMed] 
  9. Seymen Z, Vural E, Eris E, Vural A, Ogreden T, Aslan O, et al. HandyRef-K: Comparison of the latest handheld auto refracto-keratometer with retinomax and plusoptix in patients younger than three years of age. Beyoglu Eye J. 2019;4(1):32-7. [Crossref]  [PubMed]  [PMC] 
  10. Paff T, Oudesluys-Murphy AM, Wolterbeek R, Swart-van den Berg M, de Nie JM, Tijssen E, et al. Screening for refractive errors in children: the plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy. J AAPOS. 2010;14(6):478-83. [Crossref]  [PubMed] 
  11. Arıcı C, Türk A, Ceylan OM, Mutlu FM, Altınsoy Hİ. Okulçağı çocuk ve erişkin popülasyonda Plusoptix S08, Potec PRK-6000 ve Nidek ARK-30 elde taşınabilir otorefraktometre ile ölçülen refraksiyon kusurlarının karşılaştırılması [Comparison of refractive errors measured by Plusoptix S08, Potec PRK-6000 and Nidek ARK-30 hand-held autorefractometer in school age children and adult population]. Türk Oftalmoloji Dergisi. 2010;40(6):328-32. [Crossref] 
  12. Cotter SA; Pediatric Eye Disease Investigator Group; Edwards AR, Wallace DK, Beck RW, Arnold RW, Astle WF, Barnhardt CN, et al. Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology. 2006;113(6):895-903. [Crossref]  [PubMed]  [PMC] 
  13. Friedburg D, Klöppel KP. Frühzeitige Korrektion von Hyperopie und Astigmatismus bei Kindern führt zu besserer Entwicklung der Sehschärfe [Early correction of hyperopia and astigmatism in children leads to better development of visual acuity]. Klin Monbl Augenheilkd. 1996;209(1):21-4. German. [Crossref]  [PubMed] 
  14. Kirk VG, Clausen MM, Armitage MD, Arnold RW. Preverbal photoscreening for amblyogenic factors and outcomes in amblyopia treatment: early objective screening and visual acuities. Arch Ophthalmol. 2008;126(4):489-92. [Crossref]  [PubMed] 
  15. Venkataraman AP, Brautaset R, Domínguez-Vicent A. Effect of six different autorefractor designs on the precision and accuracy of refractive error measurement. PLoS One. 2022;17(11):e0278269. [Crossref]  [PubMed]  [PMC] 
  16. Saunders KJ. Early refractive development in humans. Surv Ophthalmol. 1995;40(3):207-16. [Crossref]  [PubMed] 
  17. Abrahamsson M, Fabian G, Sjöstrand J. Changes in astigmatism between the ages of 1 and 4 years: a longitudinal study. Br J Ophthalmol. 1988;72(2):145-9. [Crossref]  [PubMed]  [PMC] 
  18. Wilson S, Ctori I, Shah R, Suttle C, Conway ML. Systematic review and meta-analysis on the agreement of non-cycloplegic and cycloplegic refraction in children. Ophthalmic Physiol Opt. 2022;42(6):1276-88. [Crossref]  [PubMed]  [PMC] 

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