Purpose: To evaluate the ability of the monocular QuickSee Free (QSF) portable autorefractor (PlenOptika) to detect and measure refractive error relative to gold standard cycloplegic retinoscopy in a population of school-aged children in a low-resource setting in The Gambia.
Methods: A total of 101 children, aged between 3 and 17 years (10.2 ± 3.45 years) underwent visual acuity screening, autorefraction by the QSF, and complete ophthalmic examination including cycloplegic retinoscopy. The agreement of the results was evaluated by Bland-Altman plots. The sensitivity and specificity of detecting myopia, anisometropia, and astigmatism were calculated based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2021 guidelines. The overall accuracy of detecting refractive error was analyzed with receiver operating characteristic curves.
Results: Spherical equivalent (SE), sphere, and cylinder of the QSF all displayed moderate interclass correlation with cycloplegic retinoscopy with cylinder correlating the highest with physician measurements followed by SE, then sphere. The average bias for the QSF was slightly negative for sphere and spherical equivalents, indicating that on average the QSF tended to underestimate these measures relative to physicians. Based on AAPOS 2021 guidelines, the sensitivity and specificity (in respective order) were 62% and 93% for detecting myopia, 57% and 86% for detecting anisometropia, and 78% and 95% for detecting astigmatism. The area under the receiver operating characteristic curve was greater than 0.75 for all three conditions, suggesting the QSF has good predictive ability to detect myopia, anisometropia, and astigmatism.
Conclusions: The QSF displayed moderate agreement with physician reported refractions and it also tended to underestimate spherical equivalents and sphere. The device exhibited high predictability in detecting refractive error in the low-resource setting. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].