Is Noncycloplegic Photorefraction Applicable for Screening Refractive Amblyopia Risk Factors?

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. 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. 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%. 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.