Eccentric photorefraction: improving the predictive value and yield in detection of refractive errors.

Eccentric photorefraction (EPR) is a simple photographic technique for detecting amblyopiogenic conditions. Previous EPR studies to detect refractive errors (RE) have demonstrated high sensitivity but poor predictive value. We have established new criteria for detecting RE involving quantifying retinoscopic reflex crescent widths, thereby achieving 67% predictive value with 100% sensitivity for detecting RE greater than or equal to +3.5 D in a clinical study of 69 children. Optical analysis of EPR shows that anticrescent width (light crescent-free portion of the pupil) is independent of pupil diameter. Quantifying anticrescent widths in the above clinical trial increased the predictive value to 85%. Schematic eye and human eye EPR studies verify the theoretical prediction that similar ability to detect refractive errors is maintained when the working distance and eccentricity (distance of light source from lens edge) are reduced. These improvements in EPR reduce its cost and improve its yield; both are essential for its introduction as an acceptable community screening tool.