Comparing low-cost handheld autorefractors: A practical approach to measuring refraction in low-resource settings

PURPOSE: To compare and validate the accuracy and ease of use of handheld autorefractors against retinoscopic refraction by an ophthalmologist for assessing the visual acuity of older adults in India. METHODS: 190 patients were enrolled at the Sankara Eye Hospital in Bangalore, India, to undergo refraction using three different handheld devices—Retinomax (Nikon Inc., Japan), Netra (Eyenetra, Inc., USA), and QuickSee (PlenOptika, Inc., USA)—and the results were compared with cycloplegic retinoscopy and refraction done by an ophthalmologist. We analyzed the mean, standard deviation (S.D.), and Bland-Altman comparison of dioptric (D) power accuracy. RESULTS: The difference between the handheld devices and subjective refraction for each device was: Retinomax (N = 186), mean -0.41 D, S.D. 2.14; Netra (N = 179), mean 0.61 D, S.D. 2.20; and QuickSee (N = 182), mean -0.05 D, S.D. 1.04. CONCLUSION: The QuickSee and the Retinomax may be used successfully as refraction screening tools in epidemiologic studies of adults in India and as diagnostic tools in low-resource settings.