Is Noncycloplegic Photorefraction Applicable for Screening Refractive Amblyopia Risk Factors?

Purpose: to compare the accuracy of noncycloplegic photorefraction (ncp) with that of cycloplegic refraction (cr) for detecting refractive amblyopia risk factors (rarfs) and to determine cutoff points. methods: in this diagnostic test study, right eyes of 185 children (aged 1 to 14 years) first underwent ncp using the plusoptix so4 photoscreener followed by cr. based on cr results, hyperopia (+3.5 d or higher), myopia (-3 d or higher), astigmatism (1.5 d or higher), and anisometropia (1.5 d or higher) were set as diagnostic criteria based on aapos guidelines. the difference in the detection of rarfs by the two methods was the main outcome measure. results: rarfs were present in 57 (30.8%) and 52 (28.1%) of cases by cr and ncp, respectively, with an 89.7% agreement. in contrast to myopia and astigmatism, mean spherical power in hyperopic eyes was significantly different based on the two methods (p < 0.001), being higher with cr (+5.96 ± 2.13 d) as compared to ncp (+2.37 ± 1.36 d). considering cr as the gold standard, specificities for ncp exceeded 93% and sensitivities were also acceptable (at least 83%) for myopia and astigmatism. nevertheless, sensitivity of ncp for detecting hyperopia was only 45.4%. using a cutoff point of +1.87 d, instead of +3.5 d, for hyperopia, sensitivity of ncp was increased to 81.8% with specificity of 84%. conclusion: ncp is a relatively accurate method for detecting rarfs in myopia and astigmatism. using an alternative cutoff point in this study, ncp may be considered an acceptable device for detecting hyperopia as well