School bus accommodation-relaxing skiascopy

Andrew W Arnold,1 Stephanie L Arnold,1 Jacob H Sprano,2 Robert W Arnold3 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Kansas City University of Osteopathic Medicine, Kansas City, MO, USA; 3Alaska Blind Child Discovery, Alaska Children’s Eye & Str...

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Autores principales:	Arnold AW, Arnold SL, Sprano JH, Arnold RW
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	hyperopia retinoscopy cycloplegia skiascopy Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/4830f9bd8bb747e2a267e34e532250ef
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spelling	oai:doaj.org-article:4830f9bd8bb747e2a267e34e532250ef2021-12-02T03:47:49ZSchool bus accommodation-relaxing skiascopy1177-5483https://doaj.org/article/4830f9bd8bb747e2a267e34e532250ef2019-10-01T00:00:00Zhttps://www.dovepress.com/school-bus-accommodation-relaxing-skiascopy-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Andrew W Arnold,1 Stephanie L Arnold,1 Jacob H Sprano,2 Robert W Arnold3 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Kansas City University of Osteopathic Medicine, Kansas City, MO, USA; 3Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, AK, USACorrespondence: Robert W ArnoldAlaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561 1917Fax +1 907 563 5373Email eyedoc@alaska.netObjective: Accurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia.Methods: Design: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve.Results: Of 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (−1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific.Conclusion: Accommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia.Clinical Trials Registry: NCT03668067.Keywords: hyperopia, retinoscopy, cycloplegia, skiascopy  Arnold AWArnold SLSprano JHArnold RWDove Medical PressarticlehyperopiaretinoscopycycloplegiaskiascopyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 1841-1851 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	hyperopia retinoscopy cycloplegia skiascopy Ophthalmology RE1-994
spellingShingle	hyperopia retinoscopy cycloplegia skiascopy Ophthalmology RE1-994 Arnold AW Arnold SL Sprano JH Arnold RW School bus accommodation-relaxing skiascopy
description	Andrew W Arnold,1 Stephanie L Arnold,1 Jacob H Sprano,2 Robert W Arnold3 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Kansas City University of Osteopathic Medicine, Kansas City, MO, USA; 3Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, AK, USACorrespondence: Robert W ArnoldAlaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561 1917Fax +1 907 563 5373Email eyedoc@alaska.netObjective: Accurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia.Methods: Design: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve.Results: Of 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (−1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific.Conclusion: Accommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia.Clinical Trials Registry: NCT03668067.Keywords: hyperopia, retinoscopy, cycloplegia, skiascopy
format	article
author	Arnold AW Arnold SL Sprano JH Arnold RW
author_facet	Arnold AW Arnold SL Sprano JH Arnold RW
author_sort	Arnold AW
title	School bus accommodation-relaxing skiascopy
title_short	School bus accommodation-relaxing skiascopy
title_full	School bus accommodation-relaxing skiascopy
title_fullStr	School bus accommodation-relaxing skiascopy
title_full_unstemmed	School bus accommodation-relaxing skiascopy
title_sort	school bus accommodation-relaxing skiascopy
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/4830f9bd8bb747e2a267e34e532250ef
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School bus accommodation-relaxing skiascopy

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