The Fundus Red Reflex Test Using a Smartphone Showed High Accuracy Compared to an Autorefractor to Detect Refractive Errors in Children.

PURPOSE: To determine the accuracy of the fundus red reflex test using a smartphone and autorefractor to detect refractive errors in children. METHODS: This cross-sectional study included 1302 eyes of 651 school-age children aged 6-13 years with visual acuity worse than 6/9 in at least one eye, examined using the Snellen chart. Study participants were selected using purposive sampling, after which non-cycloplegic refractive measurement was performed using two instruments: a smartphone-based application (MD EyeCare) and an autorefractor. The detection of refractive errors using the online platform was compared with autorefraction as the reference standard. RESULTS: Our study found that 46.10% of participants with abnormal red reflex had significant myopia, 41.20% had nonsignificant refractive errors, and 12.70% had significant hypermetropia. The mean difference between the smartphone-based application and the autorefractor was ≤ - 3.00 D (range: - 2.88 to - 2.63), with a sensitivity of 0.89 to 0.90 and a specificity of 0.86 to 0.87 for significant myopia, and the area under the curve was between 0.94 and 0.97. The mean difference between the smartphone-based application and the autorefractor was ≥ +1.00 D (range: +0.13 to +0.38), with a sensitivity of 0.76 and a specificity of 0.97 for significant hypermetropia, and the area under the curve was between 0.88 and 0.96. CONCLUSION: A smartphone-based application could be used as a screening tool for refractive errors in children, especially in resource-limited settings.