• Pediatric Ophth/Strabismus

    Review of: Accuracy of Autorefraction in Children: A Report by the American Academy of Ophthalmology

    Wilson L, Melia M, Kraker R, et al. Ophthalmology, September 2020

    This Ophthalmic Technology Assessment compared the accuracy of autorefraction and cycloplegic retinoscopy in children aged 3 months to 17 years.

    Study design

    The authors performed a literature search and identified 15 level 1 and 2 studies Four articles were rated as Level 1 and 11 were rated as Level 2.


    Thirteen studies comparing cycloplegic autorefraction with cycloplegic retinoscopy found a mean difference in spherical equivalent or sphere of less than 0.5 D; most were less than 0.25 D. Compared with cycloplegic autorefractions, noncyloplegic refraction tended to over minus by 1 to 2 D. Despite low mean variability, the authors found some relevant and significant variability in individual measurements.


    This study was a pooled analysis of data and the limitations are that of a meta-analysis.

    Clinical significance

    Cycloplegic autorefraction is an accurate way to measure refractive error when that is the only ocular abnormality. Despite indications that cycloplegic autorefraction is suitable for pediatric use, the authors suggest that clinicians confirm the results using retinoscopy, particularly when corrected visual acuity is worse than expected. Noncycloplegic autorefraction does not appear to be accurate and should not be used in children.