소아에서 망막검영법과 자동굴절검사로 시행한 현성굴절검사와 조절마비굴절검사의 비교
Comparison of Manifest Refraction and Cycloplegic Refraction Using Retinoscopy or an Autorefractor in Children
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목적: 소아에서 현성굴절검사와 조절마비굴절검사를 망막검영법과 자동굴절검사로 시행하여 비교하고, 검사 간 차이와 관련된 인자를 알아보았다. 대상과 방법: 평균 나이 7.4 ± 3.6세인 소아 388명을 대상으로 조절마비 전후 망막검영법과 자동굴절검사(Grand Seiko GR-3500KA)를 시행하여 굴절력을 비교하고, 성별, 나이, 굴절이상 종류, 약시, 사시, 전신질환 동반에 따른 차이가 있는지 조사하였다. 구면도수, 난시도수를 각각 비교하였고, 두 검사 결과가 ±0.50디옵터 이상의 차이를 보이면 의미 있는 측정오차로 정하였다. 결과: 현성자동굴절검사는 망막검영법에 비해 구면도수 47.2%에서 더 근시로 측정되었고, 난시도수 37.1%에서 더 크게 측정되었으며, 이러한 구면도수 차이는 7세 미만, 원시, 약시인 경우에 더 흔하였다(각각 p=0.002, p<0.001, p=0.033). 조절마비자동굴절검사는 구면도수 29.4%, 난시도수 30.7%에서 망막검영법과 차이가 있었으나, 의미 있는 측정오차는 아니었고 임상양상에 따른 차이도 없었다. 조절마비 전후 망막검영법에서 구면도수 차이가 있는 경우의 55.6%는 조절마비 전 망막검영법과 자동굴절검사에서도 차이를 보였으며, 이 두 차이 간에는 의미 있는 상관관계가 있었다. 결론: 조절마비자동굴절검사의 제한적 사용이 가능해 보이나, 여전히 30%의 소아에서 망막검영법과 차이가 있었다. 나이가 어리거나 원시, 약시인 경우, 조절마비 전 망막검영법과 자동굴절검사 간 차이를 보인 경우, 현성굴절검사나 자동굴절검사가 망막검영법에 의한 조절마비굴절검사와 차이가 있을 수 있어 더욱 주의하여야 하겠다.
Abstract
Purpose: To compare the measurements between manifest refraction and cycloplegic refraction using retinoscopy or an autorefractor in children and to investigate factors affecting the difference. Methods: A total of 388 children with a mean age of 7.4 ± 3.6 years were examined using retinoscopy and a Grand Seiko GR-3500KA autorefractor before and after cycloplegia. We compared the difference in spherical and cylindrical components between refractions and analyzed the results according to gender, age, type of refractive error, amblyopia, strabismus, and neuro- developmental disorder. A difference in refractions of ±0.50 D or more was considered as a significant discrepancy. Results: Before cycloplegia, the spherical portion of the refractive error via autorefractor measurement was more myopic than for the retinoscopic measurement in 47.2% of patients, and the cylindrical portion was greater in 37.1%. The spherical discrepancies were more common in children aged < 7 years, with hyperopia, or amblyopia (respectively, p = 0.002, p < 0.001, and p = 0.033). After cycloplegia, the spherical component of the refractive error by auto-refraction differed from retinoscopic measurement in 29.4% of patients, and the cylindrical portion differed in 30.7%. However, the difference was not significant and there was no difference according to clinical features. More than half of the children with discrepancies in the spherical component between retinoscopic refractions before and after cycloplegia had a discrepancy between auto-refraction and retinoscopic refraction before cycloplegia, and the two discrepancies had a significant correlation. Conclusions: Auto-refraction after cycloplegia can estimate retinoscopic values partially. Nevertheless, 30% of the children still showed a discrepancy. The discrepancy of manifest refraction or auto-refraction compared to retinoscopic refraction with cycloplegia should be considered in younger children, cases with hyperopia or amblyopia, and cases with a difference in auto-refraction and retinoscopic refraction before cycloplegia.
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