A comparison of plusoptiX A12 measurements with cycloplegic refraction

Purpose: To test the accuracy and reliability of the plusoptiX A12 in detecting amblyogenic risk factors.

Methods: We prospectively collected data on children undergoing screening with the plusoptiX A12, cycloplegic refraction, and complete ophthalmic examination. American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 guidelines for the detection of amblyogenic risk factors were used for plusoptiX A12 screening and comparison of the results of both examination modes.

Results: Data on 402 eyes of 201 children (mean age, 7.63 ± 3.41 years) was collected. Mean (with standard deviation) cycloplegic refraction results were as follows: sphere, 0.88 ± 1.5 D; cylinder, -0.61 ± 0.74 D; axis, 71.17 ± 71.04; and spherical equivalent, 0.68 ± 2.63. The plusoptiX A12 measurements were as follows: sphere, 0.58 ± 1.4 D; cylinder, -0.66 ± 0.77 D; axis, 77.3 ± 68.9; and spherical equivalent, 0.25 ± 1.3. We found a strong correlation (Pearson) for sphere (r = 0.91), cylinder (r = 0.81), and axis (r = 0.7). The mean difference of the myopic spherical component between the plusoptiX and cycloplegic refraction was -0.048 ± 0.55 (95% LoA, +1.04 to -1.14 D); for the hyperopic spherical component, 0.37 ± 0.93 (LoA, +2.20 to -1.45 D); and for the cylindrical component, 0.05 ± 0.32 (LoA, +0.68 to -0.57D). The sensitivity, specificity, positive and negative predictive values for myopia were, respectively, 86%, 93%, 82%, and 94%; for astigmatism, 85%, 98%, 88% and 98%; and for hyperopia, 40%, 100%, 100%, and 98%.

Conclusions: The plusoptiX A12 accuracy is high in all subgroups but better in the myopic, astigmatic, and anisometropic subgroups. Reliability was lower in the hyperopic eyes, possibly resulting in underestimation of hyperopic refractive error.