Measurement of refractive error in Native American preschoolers: Validity and reproducibility of autorefraction

Purpose: To examine (1) reproducibility of cycloplegic retinoscopy (C-RNS), cycloplegic autorefraction (C-Autoref), and noncycloplegic autorefraction (NC-Autoref), and (2) validity of C-Autoref and NC-Autoref compared with C- RNS in preschoolers with astigmatism. Methods: Subjects were 36 Native Amer ican preschoolers. Three measurements of right eye refractive error were ob tained with each of three methods: C-RNS (by three different retinoscopists ), C-Autoref, and NC-Autoref (Nikon Retinomax K+). Vector methods (vector d ioptric distance, VDD) were used in the analyses. Results: Mean reproducibi lity was 0.41 D (SD = 0.18) for C-RNS, 0.25 D (SD = 0.17) for C-Autoref, an d 0.37 D (SD = 0.21) for NC-Autoref. Mean agreement between C-Autoref and C -RNS ranged from 0.51 to 0.61 VDD (SD = 0.24 to 0.35), and ranged from 1.66 to 1.74 VDD (SD = 1.11 to 1.25) for agreement between NC-Autoref and C-RNS . Mean bias was -0.07 +0.21 x 149 and -1.33 +0.34 x 178 for C-Autoref and N C-Autoref, respectively. Conclusions: C-Autoref provided reliable and valid measurements of refractive error in young children. NC-Autoref measurement s were reliable within subjects, but there was large variability in validit y among subjects.