A comparison of manifest refractions, cycloplegic refractions and retinoscopy on the RMA-3000 autorefractometer in children aged 3 to 15 years

PURPOSE: The study was conducted to compare the accuracy of readings of the RMA-3000 autorefractometer (Topcon, Tokyo, Japan) with traditional retinoscopy as a means of determining the approximate subjective refraction in children after cycloplegia. METHODS: 142 children aged 3 to 15 years were included. All children had their refractive status measured with the RMA-3000 autorefractometer (noncycloplegic autorefraction [AR]). Subsequently all children underwent cycloplegia and the refractive status was estimated again with the autorefractometer (cycloplegic autorefraction [ARC]) and traditional retinoscopy (RC) by examiners who were unaware of the results from the other techniques. RESULTS: From 69 right eyes with negative sphere we observed that the sphere power was significantly higher (more than 0.5 diopters) in AR than in ARC (P = 0.0001) and RC (P = 0.0001). From the 73 normal and hyperopic right eyes we observed that the sphere power was significantly lower (more than 0.5 diopters) in AR than in ARC (P = 0.0001) and RC (P = 0.0001). CONCLUSIONS: The use of the autorefractometer in children (in whom accommodation is more active than older patients) without cycloplegia may underestimate the actual hyperopia and overestimate the actual myopia. Manual retinoscopy is still the most accurate technique to estimate refractive status in children.