Intra- and Inter- Examiner Repeatability of Cycloplegic Retinoscopy Among Young Children

PURPOSE: To evaluate the intra- and inter-examiner repeatability of cycloplegic retinoscopy in young children aged 4-5 years old. METHODS: Examiner 1 refracted all children in the first sample (n = 108); firstly with masked loose lenses, then using unmasked loose lenses (intra-examiner repeatability). Examiners 1 and 2 refracted all children in the second sample (n = 97) using unmasked loose lenses, blind to the child's refractive error, presence/magnitude of habitual spectacle correction and to each other's findings (inter-examiner repeatability). Refractions were performed on one eye chosen at random. Mean differences, 95% limits of agreement (LOAs) and confidence intervals were calculated for intra- and inter-examiner repeatability of sphere, cylinder and spherical equivalent refraction (SER). RESULTS: Participants had a wide range of refractive errors (-1.50DS to +7.25DS; ≥4.50DC). Mean differences (95% LOAs) were small for both intra- and inter-examiner repeatability [Intra: Sphere 0.00D (-0.85, +0.85D), Cylinder -0.03D (-0.68, +0.62D), SER -0.06D (-0.90, +0.78D); Inter: Sphere -0.08D (-0.92, +0.76D), Cylinder -0.08D (-0.75, +0.59D), SER -0.13D (-0.95, +0.69D). A statistically significant proportional bias was present for intra-examiner repeatability of cylinder (ρ = 0.20, p = 0.04) and SER measurement (ρ = 0.19, p = 0.049). Proportional bias was not present for any other measure (p > 0.12). Examiners agreed on cylinder axis within ±20° in 71% of refractions where astigmatism of -0.75D or higher was present. 80% of intra- and inter-examiner measures fell within ±0.50D for spherical and cylindrical components. CONCLUSIONS: Differences of ±1.00D and ±0.75D or more for spherical and cylindrical measures respectively can be considered significant when performing cycloplegic retinoscopy on young children.