Overestimation of hyperopia with auto-refraction compared to retinoscopy under cycloplegia in school-age children

Purpose: To compare sphere and cylinder refraction values using retinoscopy and autorefraction under cycloplegic conditions in children. Methods: This cross-sectional study was carried out using multistage cluster sampling. The target population was 6- to 12-year old children in Shahroud, a northern city in Iran. Examinations included measurements of visual acuity, subjective refraction, and objective refraction. Objective refraction was measured with and without cycloplegia with a retinoscope and an auto-refractometer. Results: After applying the exclusion criteria, data from 5053 children were analyzed. Spherical refraction results with autorefraction were significantly higher than results with retinoscopy (p<0.001). Refraction overestimation was significant in all age groups (p<0.0001). Comparison of differences in different spherical ametropia subgroups also showed a significant inter-method difference in all refractive states (p<0. 01). Overall, autorefraction tended to over plus hyperopics and under minus myopic cases compared to retinoscopy. The 95% limits of agreement for spherical values measured with the two techniques were -0.35 Diopter (D) to 0.50 D. The values of J0 and J45 vectors with autorefraction were significantly higher than those with retinoscopy (p<0.001). The 95% limits of agreement between the two methods for vectors J0 and J45 were -0.12 to 0.15 D and -0.10 to 0.11D, respectively. Conclusion: Since the observed differences in spherical refraction and the cylindrical components obtained through retinoscopy and autorefraction are statistically significant, but clinically insignificant, and the two methods have a strong correlation and agreement, it can be concluded that autorefraction can be a suitable substitute for retinoscopy in children under cycloplegic conditions