Comparisons of objective and subjective refraction with and without cycloplegia using binocular wavefront optometer with autorefraction and retinoscopy in school-age children.

Purpose: To compare school-age children's objective and subjective refraction using a binocular wavefront optometer (BWFOM) with autorefraction and retinoscopy before and after cycloplegia.

Methods: Eighty-six eyes from 86 children (6-15 years old) were enrolled in this cross-sectional study. BWFOM objective and subjective refractions were compared with autorefraction and retinoscopy under cycloplegia. BWFOM refraction was evaluated before and after cycloplegia. Measurements were compared using a paired t-test; agreement was assessed using Bland-Altman plots.

Results: Under cycloplegia, the sphere, spherical equivalence, and J45 were significantly more negative on BWFOM objective refraction than autorefraction (- 1.39 ± 2.20 D vs. - 1.28 ± 2.23 D, P = 0.003; - 1.84 ± 2.38 D vs. - 1.72 ± 2.43 D, P = 0.001; - 0.02 ± 0.17 D vs. 0.03 ± 0.21 D, P = 0.004). The subjective sphere of BWFOM was less myopic, and the cylinder and the J45 were more negative than those with retinoscopy (- 1.17 ± 2.09 D vs. - 1.25 ± 2.20 D, P = 0.02; - 0.91 ± 0.92 D vs. - 0.76 ± 0.92 D, P < 0.001; - 0.01 ± 0.15 D vs. 0.03 ± 0.21 D, P = 0.028). For both BWFOM objective and subjective refraction, sphere and spherical equivalence with noncycloplegia were more myopic than those with cycloplegia (objective: - 1.76 ± 2.10 D vs. - 1.39 ± 2.20 D, - 2.21 ± 2.30 D vs. - 1.84 ± 2.38 D, P < 0.001; subjective: - 1.57 ± 1.92 D vs. - 1.17 ± 2.09 D, - 2.01 ± 2.13 D vs. - 1.62 ± 2.27 D, P < 0.001). Bland-Altman plots showed good agreement in spherical equivalence between BWFOM objective refraction and autorefraction (mean difference = 0.12 D, 95% confidence interval [CI] - 0.52 to 0.76), subjective refraction with retinoscopy (mean difference =  - 0.01 D, 95% CI - 0.65 to 0.64), and BWFOM refractions with or without cycloplegia (objective: mean difference =  - 0.37 D, 95% CI - 1.31 to 0.57; subjective: mean difference =  - 0.39 D, 95% CI - 1.30 to 0.51). The time cost by BWFOM was significantly less than the total time of autorefraction and retinoscopy (264.88 ± 90.67 s vs. 315.89 ± 95.31 s, P < 0.001).

Conclusion: BWFOM is a new device that realizes both objective and subjective refraction. For children's refractive errors, it is more convenient and quicker to obtain the proper prescription at a 0.05-D interval, and it is more accurate than autorefraction and retinoscopy under cycloplegia.