Accommodative lag by autorefraction and two dynamic retinoscopy methods

Ruth E. Manny; Danielle L. Chandler; Mitchell M. Scheiman; Jane E. Gwiazda; Susan Cotter; Donald F. Everett; Jonathan M. Holmes; Leslie G. Hyman; Marjean T. Kulp; Don W. Lyon; Wendy Marsh-Tootle; Noelle Matta; B. Michele Melia; Thomas T. Norton; Michael X. Repka; David I. Silbert; Erik M. Weissberg; Jane Gwiazda; Danielle Chandler; Leslie Hyman; Michele Melia; David Silbert; Erik Weissberg

doi:10.1097/OPX.0b013e318197180c

Accommodative lag by autorefraction and two dynamic retinoscopy methods

Ruth E. Manny, Danielle L. Chandler, Mitchell M. Scheiman, Jane E. Gwiazda, Susan Cotter, Donald F. Everett, Jonathan M. Holmes, Leslie G. Hyman, Marjean T. Kulp, Don W. Lyon, Wendy Marsh-Tootle, Noelle Matta, B. Michele Melia, Thomas T. Norton, Michael X. Repka, David I. Silbert, Erik M. Weissberg, Jane Gwiazda, Danielle Chandler, Leslie HymanMichele Melia, David Silbert, Erik Weissberg

School of Medicine

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

PURPOSE. To evaluate two clinical procedures, Monocular Estimate Method (MEM) and Nott retinoscopy, for detecting accommodative lags 1.00 diopter (D) or greater in children as identified by an open-field autorefractor. METHODS. One hundred sixty-eight children 8 to <12 years old with low myopia, normal visual acuity, and no strabismus participated as part of an ancillary study within the screening process for a randomized trial. Accommodative response to a 3.00 D demand was first assessed by MEM and Nott retinoscopy, viewing binocularly with spherocylindrical refractive error corrected, with testing order randomized and each performed by a different masked examiner. The response was then determined viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor, which was the gold standard used for eligibility for the clinical trial. Sensitivity and specificity for accommodative lags of 1.00 D or more were calculated for each retinoscopy method compared to the autorefractor. RESULTS. One hundred sixteen (69%) of the 168 children had accommodative lag of 1.00 D or more by autorefraction. MEM identified 66 children identified by autorefraction for a sensitivity of 57% (95% CI = 47 to 66%) and a specificity of 63% (95% CI = 49 to 76%). Nott retinoscopy identified 35 children for a sensitivity of 30% (95% CI = 22 to 39%) and a specificity of 81% (95% CI = 67 to 90%). Analysis of receiver operating characteristic curves constructed for MEM and for Nott retinoscopy failed to reveal alternate cut points that would improve the combination of sensitivity and specificity for identifying accommodative lag ≥1.00 D as defined by autorefraction. CONCLUSIONS. Neither MEM nor Nott retinoscopy provided adequate sensitivity and specificity to identify myopic children with accommodative lag ≥1.00 D as determined by autorefraction. A variety of methodological differences between the techniques may contribute to the modest to poor agreement.

Original language	English (US)
Pages (from-to)	233-243
Number of pages	11
Journal	Optometry and Vision Science
Volume	86
Issue number	3
DOIs	https://doi.org/10.1097/OPX.0b013e318197180c
State	Published - Mar 1 2009

Keywords

Accommodative lag
Autorefractor
Children
Dynamic retinoscopy
Myopia
Sensitivity
Specificity

ASJC Scopus subject areas

Ophthalmology
Optometry

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10.1097/OPX.0b013e318197180c

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Manny, R. E., Chandler, D. L., Scheiman, M. M., Gwiazda, J. E., Cotter, S., Everett, D. F., Holmes, J. M., Hyman, L. G., Kulp, M. T., Lyon, D. W., Marsh-Tootle, W., Matta, N., Melia, B. M., Norton, T. T., Repka, M. X., Silbert, D. I., Weissberg, E. M., Gwiazda, J., Chandler, D., ... Weissberg, E. (2009). Accommodative lag by autorefraction and two dynamic retinoscopy methods. Optometry and Vision Science, 86(3), 233-243. https://doi.org/10.1097/OPX.0b013e318197180c

Manny, RE, Chandler, DL, Scheiman, MM, Gwiazda, JE, Cotter, S, Everett, DF, Holmes, JM, Hyman, LG, Kulp, MT, Lyon, DW, Marsh-Tootle, W, Matta, N, Melia, BM, Norton, TT, Repka, MX, Silbert, DI, Weissberg, EM, Gwiazda, J, Chandler, D, Hyman, L, Melia, M, Silbert, D & Weissberg, E 2009, 'Accommodative lag by autorefraction and two dynamic retinoscopy methods', Optometry and Vision Science, vol. 86, no. 3, pp. 233-243. https://doi.org/10.1097/OPX.0b013e318197180c

@article{8ef6d60de6b64059bb9a3616c61f68ca,

title = "Accommodative lag by autorefraction and two dynamic retinoscopy methods",

abstract = "PURPOSE. To evaluate two clinical procedures, Monocular Estimate Method (MEM) and Nott retinoscopy, for detecting accommodative lags 1.00 diopter (D) or greater in children as identified by an open-field autorefractor. METHODS. One hundred sixty-eight children 8 to <12 years old with low myopia, normal visual acuity, and no strabismus participated as part of an ancillary study within the screening process for a randomized trial. Accommodative response to a 3.00 D demand was first assessed by MEM and Nott retinoscopy, viewing binocularly with spherocylindrical refractive error corrected, with testing order randomized and each performed by a different masked examiner. The response was then determined viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor, which was the gold standard used for eligibility for the clinical trial. Sensitivity and specificity for accommodative lags of 1.00 D or more were calculated for each retinoscopy method compared to the autorefractor. RESULTS. One hundred sixteen (69%) of the 168 children had accommodative lag of 1.00 D or more by autorefraction. MEM identified 66 children identified by autorefraction for a sensitivity of 57% (95% CI = 47 to 66%) and a specificity of 63% (95% CI = 49 to 76%). Nott retinoscopy identified 35 children for a sensitivity of 30% (95% CI = 22 to 39%) and a specificity of 81% (95% CI = 67 to 90%). Analysis of receiver operating characteristic curves constructed for MEM and for Nott retinoscopy failed to reveal alternate cut points that would improve the combination of sensitivity and specificity for identifying accommodative lag ≥1.00 D as defined by autorefraction. CONCLUSIONS. Neither MEM nor Nott retinoscopy provided adequate sensitivity and specificity to identify myopic children with accommodative lag ≥1.00 D as determined by autorefraction. A variety of methodological differences between the techniques may contribute to the modest to poor agreement.",

keywords = "Accommodative lag, Autorefractor, Children, Dynamic retinoscopy, Myopia, Sensitivity, Specificity",

author = "Manny, {Ruth E.} and Chandler, {Danielle L.} and Scheiman, {Mitchell M.} and Gwiazda, {Jane E.} and Susan Cotter and Everett, {Donald F.} and Holmes, {Jonathan M.} and Hyman, {Leslie G.} and Kulp, {Marjean T.} and Lyon, {Don W.} and Wendy Marsh-Tootle and Noelle Matta and Melia, {B. Michele} and Norton, {Thomas T.} and Repka, {Michael X.} and Silbert, {David I.} and Weissberg, {Erik M.} and Jane Gwiazda and Danielle Chandler and Leslie Hyman and Michele Melia and David Silbert and Erik Weissberg",

year = "2009",

month = mar,

day = "1",

doi = "10.1097/OPX.0b013e318197180c",

language = "English (US)",

volume = "86",

pages = "233--243",

journal = "Optometry and Vision Science",

issn = "1040-5488",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - Accommodative lag by autorefraction and two dynamic retinoscopy methods

AU - Manny, Ruth E.

AU - Chandler, Danielle L.

AU - Scheiman, Mitchell M.

AU - Gwiazda, Jane E.

AU - Cotter, Susan

AU - Everett, Donald F.

AU - Holmes, Jonathan M.

AU - Hyman, Leslie G.

AU - Kulp, Marjean T.

AU - Lyon, Don W.

AU - Marsh-Tootle, Wendy

AU - Matta, Noelle

AU - Melia, B. Michele

AU - Norton, Thomas T.

AU - Repka, Michael X.

AU - Silbert, David I.

AU - Weissberg, Erik M.

AU - Gwiazda, Jane

AU - Chandler, Danielle

AU - Hyman, Leslie

AU - Melia, Michele

AU - Silbert, David

AU - Weissberg, Erik

PY - 2009/3/1

Y1 - 2009/3/1

N2 - PURPOSE. To evaluate two clinical procedures, Monocular Estimate Method (MEM) and Nott retinoscopy, for detecting accommodative lags 1.00 diopter (D) or greater in children as identified by an open-field autorefractor. METHODS. One hundred sixty-eight children 8 to <12 years old with low myopia, normal visual acuity, and no strabismus participated as part of an ancillary study within the screening process for a randomized trial. Accommodative response to a 3.00 D demand was first assessed by MEM and Nott retinoscopy, viewing binocularly with spherocylindrical refractive error corrected, with testing order randomized and each performed by a different masked examiner. The response was then determined viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor, which was the gold standard used for eligibility for the clinical trial. Sensitivity and specificity for accommodative lags of 1.00 D or more were calculated for each retinoscopy method compared to the autorefractor. RESULTS. One hundred sixteen (69%) of the 168 children had accommodative lag of 1.00 D or more by autorefraction. MEM identified 66 children identified by autorefraction for a sensitivity of 57% (95% CI = 47 to 66%) and a specificity of 63% (95% CI = 49 to 76%). Nott retinoscopy identified 35 children for a sensitivity of 30% (95% CI = 22 to 39%) and a specificity of 81% (95% CI = 67 to 90%). Analysis of receiver operating characteristic curves constructed for MEM and for Nott retinoscopy failed to reveal alternate cut points that would improve the combination of sensitivity and specificity for identifying accommodative lag ≥1.00 D as defined by autorefraction. CONCLUSIONS. Neither MEM nor Nott retinoscopy provided adequate sensitivity and specificity to identify myopic children with accommodative lag ≥1.00 D as determined by autorefraction. A variety of methodological differences between the techniques may contribute to the modest to poor agreement.

AB - PURPOSE. To evaluate two clinical procedures, Monocular Estimate Method (MEM) and Nott retinoscopy, for detecting accommodative lags 1.00 diopter (D) or greater in children as identified by an open-field autorefractor. METHODS. One hundred sixty-eight children 8 to <12 years old with low myopia, normal visual acuity, and no strabismus participated as part of an ancillary study within the screening process for a randomized trial. Accommodative response to a 3.00 D demand was first assessed by MEM and Nott retinoscopy, viewing binocularly with spherocylindrical refractive error corrected, with testing order randomized and each performed by a different masked examiner. The response was then determined viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor, which was the gold standard used for eligibility for the clinical trial. Sensitivity and specificity for accommodative lags of 1.00 D or more were calculated for each retinoscopy method compared to the autorefractor. RESULTS. One hundred sixteen (69%) of the 168 children had accommodative lag of 1.00 D or more by autorefraction. MEM identified 66 children identified by autorefraction for a sensitivity of 57% (95% CI = 47 to 66%) and a specificity of 63% (95% CI = 49 to 76%). Nott retinoscopy identified 35 children for a sensitivity of 30% (95% CI = 22 to 39%) and a specificity of 81% (95% CI = 67 to 90%). Analysis of receiver operating characteristic curves constructed for MEM and for Nott retinoscopy failed to reveal alternate cut points that would improve the combination of sensitivity and specificity for identifying accommodative lag ≥1.00 D as defined by autorefraction. CONCLUSIONS. Neither MEM nor Nott retinoscopy provided adequate sensitivity and specificity to identify myopic children with accommodative lag ≥1.00 D as determined by autorefraction. A variety of methodological differences between the techniques may contribute to the modest to poor agreement.

KW - Accommodative lag

KW - Autorefractor

KW - Children

KW - Dynamic retinoscopy

KW - Myopia

KW - Sensitivity

KW - Specificity

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SN - 1040-5488

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JO - Optometry and Vision Science

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Accommodative lag by autorefraction and two dynamic retinoscopy methods

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