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  • Pediatric Ophth/Strabismus, Refractive Mgmt/Intervention

    In children, using adjustable-focus spectacles for self-refraction was found to be noninferior to other types of autorefraction.

    Study design

    This was a prospective, cross-sectional, noninferiority study of 112 children aged 5–11 years (mean age 9 years) with 20/40 vision or worse in at least 1 eye who were seen by optometrists and ophthalmologists at Duke University’s pediatric eye clinic. Patients were excluded if they had a systemic or ocular condition preventing them from achieving a BCVA of 20/25 or better in the eye(s) with 20/40 vision or worse. The study compared 3 types of refraction: self-refraction using fluid-filled design of adjustable-focus refraction, noncycloplegic autorefraction, and cycloplegic refraction.


    The mean spherical equivalents were −2.08 and −2.00 D from the first and second self-refractions, respectively, −2.32 D from noncycloplegic refraction, and −1.67 D from cycloplegic refraction. Compared with noncycloplegic autorefraction, self-refraction using the adjustable-focus refraction was noninferior and more hyperopic (less myopic) than noncycloplegic autorefraction. Visual acuity corrected to 20/25 or better was achieved from noncyloplegic autorefraction in 85.7% of patients and from self-refraction and cyloplegic refraction in 79.5% of patients. Failure to achieve 20/25 or better vision was associated with younger age and higher astigmatism power.


    One limitation of the study was that all currently available adjustable-focus spectacle technologies for self-refraction only provide spherical correction (i.e., myopia and hyperopia) and not cylindrical correction (i.e., astigmatism). Therefore, use of self-refraction technology largely benefits children without significant astigmatism. Another study limitation was that it was performed at an academic ophthalmology clinic rather than a community ophthalmology clinic. A community clinic is a more relevant and appropriate setting because it provides ophthalmic access for children from underserved neighborhoods who may have limited access to academic medical centers.

    Clinical significance

    This is the first published refractive accuracy study to evaluate children aged <12 years. While self-refraction with adjustable-focus spectacles resulted in more myopic power than cycloplegic refraction, the findings are not necessarily clinically relevant, as there was no significant difference in the overminused refraction with both methods. As well, it is unclear whether this technology leads to significant vision improvement (VA 20/25 or better) in children with high hyperopia or myopia. However, for clinicians in underresourced communities who care for children aged <12 years, self-refraction technology may help address uncorrected refractive errors in this pediatric population.

    Financial disclosures: Dr. Jennifer Galvin discloses no financial relationships.