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      Comparison of Dynamic Retinoscopy and Autorefraction for Measurement of Accommodative Amplitude

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          Abstract

          Significance.

          This study promotes the use of dynamic retinoscopy to obtain objective measures of accommodative amplitude (AA) in the clinical setting in lieu of the subjective push-up technique.

          Purpose.

          This study compared the agreement between open-field autorefraction and a modified dynamic retinoscopy for the objective measurement of AA.

          Methods.

          AA was measured using two objective techniques for subjects age 5-60 years. Test order was randomized and monocular AA measured as subjects viewed printed letters 0.9mm in height with their dominant eye and distance refraction. For retinoscopy, subjects held a near rod and viewed the target at the nearest (most proximal) point of clear vision. The examiner then performed dynamic retinoscopy along the horizontal meridian and identified the physical location of neutrality of the reflex, which was converted to AA in Diopters (D). Autorefraction was performed obtaining repeated measures of refraction beginning from a target demand of 2.5D and increasing in discrete steps until there was no subsequent increase in accommodative response. Refractions were converted to power in the horizontal meridian and expressed as accommodation in D with the maximum value termed the AA. Distance over-refractions were measured for both techniques to adjust AA for any uncorrected refractive error. Difference versus mean analysis was used to compare agreement between tests.

          Results.

          The 95% limits of agreement (LOA) between techniques were calculated after removal of two young outliers who responded poorly to one of the techniques. The overall mean difference for 95 subjects was 0.02D ± 0.97D with LOA spanning −1.87D to 1.92D. No significant linear relationship between the magnitude of the AA and the differences between techniques was observed.

          Conclusions.

          Agreement between dynamic retinoscopy and open-field autorefraction was less than 2D with no systematic bias, suggesting dynamic retinoscopy may be a suitable clinical technique to measure objective AA.

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          Author and article information

          Journal
          8904931
          6277
          Optom Vis Sci
          Optom Vis Sci
          Optometry and vision science : official publication of the American Academy of Optometry
          1040-5488
          1538-9235
          17 July 2019
          September 2019
          01 September 2020
          : 96
          : 9
          : 670-677
          Affiliations
          University of Houston, College of Optometry, Houston, Texas
          Author notes
          Corresponding author: Heather A Anderson, handerson@ 123456central.uh.edu
          Article
          PMC6727979 PMC6727979 6727979 nihpa1534701
          10.1097/OPX.0000000000001423
          6727979
          31479022
          1f3c11c1-c4f0-4207-af49-9ed750111760
          History
          Categories
          Article

          autorefraction,dynamic retinoscopy,objective testing,test agreement,accommodative amplitude

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