Cycloplegic autorefraction results in pre-school children using the Nikon Retinomax Plus and the Welch Allyn SureSight

Optom Vis Sci. 2003 Aug;80(8):573-7. doi: 10.1097/00006324-200308000-00010.


Purpose: Early detection and treatment of amblyogenic conditions such as high refractive errors and anisometropia can help prevent the development of amblyopia. The traditional gold standard for the determination of refractive error in pre-school children is retinoscopy. Difficulties with retinoscopy in pre-school children have led to the development of autorefractors that can be free of operator bias and can be used by lay individuals. The Nikon Retinomax Plus handheld autorefractor has proven to be reliable for quick and accurate assessments of refractive errors in children. The Welch Allyn SureSight Vision Screener is a relatively new handheld autorefractor. The present study compares the results of measurements with the Retinomax Plus and the SureSight to the results of cycloplegic retinoscopy in pre-school children.

Methods: Thirty-five children ranging in age from 3 to 5 years old were subjects. Any subjects with strabismus, amblyopia, nystagmus, or ocular disease were excluded. Refractive error was assessed 30 min after the application of a cycloplegic spray.

Results: Both autorefractors showed moderate agreement with cycloplegic retinoscopy results for measurement of spherical equivalent and cylinder power. In addition, the SureSight and the Retinomax Plus sphere and cylinder results showed moderate agreement with each other. Although the mean differences of the spherical equivalents determined were minimal, the 95% confidence intervals were large, which limits the value of the data obtained from each instrument.

Conclusions: Even though the Retinomax Plus and the SureSight appear to agree with each other and with the results of cycloplegic retinoscopy for determining sphere and cylinder power, interpretation of the data should be considered as screening only because the actual magnitude of sphere and cylinder may vary from the actual magnitude. These results suggest that either device may be useful only as screening tools for assessing refractive error in pre-school children.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Equipment Design
  • Humans
  • Mydriatics*
  • Ophthalmoscopy
  • Refraction, Ocular*
  • Refractive Errors / diagnosis*
  • Retina / pathology
  • Vision Screening / instrumentation*


  • Mydriatics