Accuracy of the Welch Allyn SureSight for measurement of magnitude of astigmatism in 3- to 7-year-old children

Purpose: To evaluate the accuracy of the Welch Allyn SureSight in noncycloplegic measurements of astigmatism as compared to cycloplegic Retinomax K+ autorefractor measurements of astigmatism in children from a Native American population with a high prevalence of high astigmatism. Methods: Data are reported for 825 3- to 7-year-old children with no ocular abnormalities. Each child had a Retinomax K+ cycloplegic measurement of right eye astigmatism with a confidence rating ≥8 and 3 attempts to obtain a SureSight measurement on the right eye. Results: SureSight measurement success rates did not differ significantly across age or measurement confidence rating (<6 vs ≥6). Ninety-six percent of children had at least 1 measurement (any confidence), and 89% had at least 1 measurement with confidence at the manufacturer's recommended value (≥6). Overall, the SureSight tended to overestimate astigmatism. If the SureSight measurement had any dioptric value (0.00 D to 3.00 D), astigmatism of 2.00 D or less was likely to be present. If the SureSight showed astigmatism beyond the instrument's dioptric range (>3.00 D), Retinomax K+ measurements indicated that >2.00 D of astigmatism was present in 136 of 157 (86.6%). In cooperative children for whom the SureSight would not give a reading, 32 of 34 (94%) had >3.00 D of astigmatism. Conclusions: The SureSight does not provide an accurate, quantitative measure of amount of astigmatism. However, it does allow accurate categorization of amount of astigmatism as ≤2.00 D, >2.00 D, or >3.00 D, and it has high measurement success rate in young children.