PDF(Pubmed)
Abstract：
BACKGROUND: Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia.
METHODS: A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL).
RESULTS: Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences.
CONCLUSIONS: Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.
METHODS: A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL).
RESULTS: Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences.
CONCLUSIONS: Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.
摘要：
背景：建议儿科患者评估睫状肌麻痹下的屈光不正；然而，这可能并不总是可行的。在这些情况下,折射必须依赖于在主动调节下进行的测量，这可能会增加测量的可变性和误差。因此,评估非睫状肌麻痹屈光和生物特征测量的准确性和准确性是临床相关的。近视大师,一种结合了自动折射和生物测量的新型仪器，是专为监测屈光不正和眼生物测量在近视管理。这项研究评估了其可重复性和自屈光和生物特征测量前后的一致性。
方法：一项前瞻性横断面研究评估了96名接受眼科检查的儿科患者的队列。验光师在睫状肌麻痹前后进行了两次自屈光和生物测量的重复测量。重测可重复性（TRT）被评估为连续测量之间的差异，并且一致性被评估为后和前睫状肌麻痹测量之间的差异。对于球形当量(SE)，屈光和角膜曲率J0/J45散光分量，平均角膜曲率（Km）和轴向长度（AL）。
结果：截肢药显着提高了SE可重复性（TRT，预循环：0.65D，循环后：0.31天）。与远视眼相比，SE测量在近视和近视眼中更可重复。角膜角化术（Km）的可重复性没有随着睫状肌麻痹而改变（TRT，预循环：0.25D，循环后：0.27D)和AL重复性略有提高(TRT，预循环：0.14毫米，循环后：0.09毫米）。关于睫状肌麻痹前后的协议，SE在+0.79D时变得更积极，随着屈光不正而变化。近视眼表现出+0.31D的平均差,而远位相差+1.57D。平均角膜曲率测量，屈光和角膜曲率J0/J45和AL没有临床显着差异。
结论：折射率测量，使用近视Master的睫状肌麻痹前的精确度比睫状肌麻痹后的精确度低2.5倍。睫状肌麻痹前屈光不正测量的准确性通常大于临床上的显着阈值（0.25D），并且与屈光不正有关。与自动折射测量相比，精度更高，眼肌麻痹前后的一致性和AL测量的屈光不正独立性强调了AL在屈光不正监测中的优越性。
方法：一项前瞻性横断面研究评估了96名接受眼科检查的儿科患者的队列。验光师在睫状肌麻痹前后进行了两次自屈光和生物测量的重复测量。重测可重复性（TRT）被评估为连续测量之间的差异，并且一致性被评估为后和前睫状肌麻痹测量之间的差异。对于球形当量(SE)，屈光和角膜曲率J0/J45散光分量，平均角膜曲率（Km）和轴向长度（AL）。
结果：截肢药显着提高了SE可重复性（TRT，预循环：0.65D，循环后：0.31天）。与远视眼相比，SE测量在近视和近视眼中更可重复。角膜角化术（Km）的可重复性没有随着睫状肌麻痹而改变（TRT，预循环：0.25D，循环后：0.27D)和AL重复性略有提高(TRT，预循环：0.14毫米，循环后：0.09毫米）。关于睫状肌麻痹前后的协议，SE在+0.79D时变得更积极，随着屈光不正而变化。近视眼表现出+0.31D的平均差,而远位相差+1.57D。平均角膜曲率测量，屈光和角膜曲率J0/J45和AL没有临床显着差异。
结论：折射率测量，使用近视Master的睫状肌麻痹前的精确度比睫状肌麻痹后的精确度低2.5倍。睫状肌麻痹前屈光不正测量的准确性通常大于临床上的显着阈值（0.25D），并且与屈光不正有关。与自动折射测量相比，精度更高，眼肌麻痹前后的一致性和AL测量的屈光不正独立性强调了AL在屈光不正监测中的优越性。
