Autorefractor Device Measures More Repeatable in Patients Without Amblyopia

Close up of woman checking eyesight on autorefractor. Ophthalmologist clinic interior.
Close up of woman checking eyesight on autorefractor. Ophthalmologist clinic interior.
A single measure of accommodation in patients with amblyopia may not suffice.

Accommodative measures obtained using an autorefractor device developed by Grand Seiko appear to have high repeatability and reliability in both children and adults without amblyopia, but repeated measures of accommodation for children with amblyopia may be necessary, according to the results of a study published in the American Journal of Ophthalmology.

The investigators prospectively evaluated test-retest repeatability and reliability of the accommodative response in children (5 to <11 years) with and without amblyopia and adults (18 to <35 years) using the Grand Seiko autorefractor. Participants viewed 20/150-sized letters at 33 cm using the Grand Seiko autorefractor during test-retest of accommodative measures. 

Overall, the study included 24 children with amblyopia, 36 children without amblyopia, and 34 adults. The investigators evaluated and compared accommodative responses between the fellow and amblyopic eyes of children with amblyopia and Eye 1 and Eye 2 of participants with normal vision.

The Bland-Altman 95% limits of agreement (LOA) of the accommodative response was greatest in the amblyopic eyes (-1.25 D, 1.62 D) of children with amblyopia. LOA was similar between the fellow eyes (-0.88 D, 0.74 D) of children with amblyopia, both eyes of the children without amblyopia (Eye 1: -0.68 D, 0.71 D; Eye 2: -0.59 D, 0.70 D), and eyes of adults (Eye 1: -0.49 D to 0.45 D; Eye 2: -0.66 D to 0.67 D). 

The investigators calculated intraclass correlations coefficients (ICC) and demonstrated that the Grand Seiko autorefractor is reliable for measuring accommodative response. The ICCs were 0.81 (95% confidence interval, 0.57-0.92) in the amblyopic eyes and 0.92 (0.82-0.97) in the fellow eyes of children with amblyopia and ranged from 0.83 (0.66-0.92) to 0.88 (0.77-0.94) in the eyes of children without amblyopia and adults.

For study limitations, the authors noted that they used a large accommodative target; participants were allowed minimal under-correction of refractive error; they only assessed same-day repeatability; and the study was underpowered to analyze the data by amblyopia classification type.

“The Grand Seiko autorefractor was more repeatable and reliable when measuring the AR in children and adults without amblyopia than in the amblyopic eye in children with amblyopia,” according to the report. The investigators recommend multiple measures of the AR are obtained in amblyopic eyes to improve the precision of measures.


Chinn RN, Raghuram A, Curtiss M, Gehring A, De Paula AJ, Roberts TL. Repeatability of the accommodative response measured by the Grand Seiko autorefractor in children with and without amblyopia and adults. Published online October 23, 2021. Am J Ophthalmol. doi:10.1016/j.ajo.2021.10.019