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Multicenter Study
. 2013 Oct;90(10):1128-37.
doi: 10.1097/OPX.0000000000000025.

Intertester agreement in refractive error measurements

Jiayan Huang  1 , Maureen G Maguire, Elise Ciner, Marjean T Kulp, Graham E Quinn, Deborah Orel-Bixler, Lynn A Cyert, Bruce Moore, Gui-Shuang Ying; Vision In Preschoolers (VIP) Study Group
Collaborators, Affiliations
Multicenter Study

Intertester agreement in refractive error measurements

Jiayan Huang et al. Optom Vis Sci. 2013 Oct.

Abstract

Purpose: To determine the intertester agreement of refractive error measurements between lay and nurse screeners using the Retinomax Autorefractor and the SureSight Vision Screener.

Methods: Trained lay and nurse screeners measured refractive error in 1452 preschoolers (3 to 5 years old) using the Retinomax and the SureSight in a random order for screeners and instruments. Intertester agreement between lay and nurse screeners was assessed for sphere, cylinder, and spherical equivalent (SE) using the mean difference and the 95% limits of agreement. The mean intertester difference (lay minus nurse) was compared between groups defined based on the child's age, cycloplegic refractive error, and the reading's confidence number using analysis of variance. The limits of agreement were compared between groups using the Brown-Forsythe test. Intereye correlation was accounted for in all analyses.

Results: The mean intertester differences (95% limits of agreement) were -0.04 (-1.63, 1.54) diopter (D) sphere, 0.00 (-0.52, 0.51) D cylinder, and -0.04 (1.65, 1.56) D SE for the Retinomax and 0.05 (-1.48, 1.58) D sphere, 0.01 (-0.58, 0.60) D cylinder, and 0.06 (-1.45, 1.57) D SE for the SureSight. For either instrument, the mean intertester differences in sphere and SE did not differ by the child's age, cycloplegic refractive error, or the reading's confidence number. However, for both instruments, the limits of agreement were wider when eyes had significant refractive error or the reading's confidence number was below the manufacturer's recommended value.

Conclusions: Among Head Start preschool children, trained lay and nurse screeners agree well in measuring refractive error using the Retinomax or the SureSight. Both instruments had similar intertester agreement in refractive error measurements independent of the child's age. Significant refractive error and a reading with low confidence number were associated with worse intertester agreement.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
The flowchart for the analyzable refractive error measurements from the Retinomax.
Figure 2
Figure 2
The flowchart for the analyzable refractive error measurements from the SureSight.
Figure 3
Figure 3
Bland-Altman plots for the inter-tester agreement of refractive error measurements (sphere, cylinder and spherical equivalent) between lay and nurse screeners from: (A) the Retinomax (N=2849 eyes); (B) the SureSight (N=2729 eyes).
See this image and copyright information in PMC

References

    1. Schmidt P, Maguire M, Dobson V, Quinn G, Ciner E, Cyert L, Kulp MT, Moore B, Orel-Bixler D, Redford M, Ying GS. Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study. Vision In Preschoolers (VIP) Study Group. Ophthalmology. 2004;111:637–650. - PubMed
    1. Vision In Preschoolers (VIP) Study Group. Preschool vision screening tests administered by nurse screeners compared to lay screeners in the Vision in Preschoolers Study. Invest Ophthalmol Vis Sci. 2005;46:2639–2648. - PubMed
    1. Cordonnier M, De Maertelaer V. Comparison between two hand-held autorefractors: the SureSight and the Retinomax. Strabismus. 2004;12:261–274. - PubMed
    1. Ying GS, Maguire M, Quinn G, Kulp MT, Cyert L. ROC analysis of the accuracy of Noncycloplegic retinoscopy, Retinomax Autorefractor, and SureSight Vision Screener for preschool vision screening. Invest Ophthalmol Vis Sci. 2011;52:9658–9664. - PMC - PubMed
    1. Paff T, Oudesluys-Murphy AM, Wolterbeek R, Swart-van den Berg M, de Nie JM, Tijssen E, Schalij-Delfos NE. Screening for refractive errors in children: the plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy. J AAPOS. 2010;14:478–483. - PubMed

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