Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance

Ling Yau Kiu; Wing -yu Tam; Kin Wan; Ming Hong Wong; Chak Yin Li; Yanxian Chen; Eugene Fu; Man Ki Michael Cheung; Hong Paul Lee; Hong Va Leong; Grace Ngai; Lily Yee Lai Chan; Chi Wai Do

Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance

Ling Yau Kiu
, Wing -yu Tam
, Kin Wan
, Ming Hong Wong
, Chak Yin Li
, Yanxian Chen
, Eugene Fu
, Man Ki Michael Cheung
, Hong Paul Lee
, Hong Va Leong
, Grace Ngai
, Lily Yee Lai Chan
, Chi Wai Do

Research output: Chapter in book / Conference proceeding › Conference article published in proceeding or book › Academic research › peer-review

Abstract

Purpose : Southeastern Asian countries are undergoing accelerated myopic shifts alongside economic development. Although myopia prevalence remains lower than in East Asian populations, accessible detection methods are essential as digital device use permeates younger generations. We previously demonstrated that smartphone photorefraction as a low-cost myopia screening tool, yielding results comparable to autorefraction without cycloplegia in controlled lab settings. This study evaluated its applicability for myopia detection in community vision screenings.

Methods : Vision screenings conducted in two public schools in Cambodia (August 2024) and the Philippines (January 2025). In addition to visual acuity assessment, refractive errors were measured via smartphone photorefraction and a commercial infrared photorefractor, both non-cycloplegic. University student volunteers were trained to perform smartphone photorefraction.

Results : 323 schoolchildren aged 4 to 18 years old (Mean ± SEM = 10.00 ± 0.18) with refractive errors ranging from +6.00 to -9.00D (Mean ± SEM = -0.24 ± 0.07 D) were analysed. 23% (95% CI: 19 - 26%) of the 646 eyes were myopic (spherical equivalent ≤ -0.50D), with no significant difference by nationality [X2(1, 646) = 0.61, p = 0.43]. Non-gradable photos yielded a 4% inconclusive rate. Smartphone photorefraction showed mean absolute error ± SEM of 0.75 ± 0.02D (CI: 0.72 - 0.79D) when compared with the commercial device. For detecting visually significant myopia (≤ -2.00 D), sensitivity, specificity, and positive predictive value were 93% (CI: 89 - 96%), 97% (CI: 96 - 98%), and 73% (CI: 68 - 79%), respectively. Overall accuracy was 97% (CI: 96 - 97%), with ROC AUC of 0.97 (CI: 0.95 - 0.99).

Conclusions : This represents the first field validation of smartphone photorefraction for myopia screening. Operated by lay volunteers, it sustained strong performance versus lab benchmarks, reinforcing its potential for scalable myopia detection in resource-limited settings.

This abstract was presented at the 2026 ARVO Annual Meeting, held in Denver, CO, May 3-7, 2026.

Original language	English
Title of host publication	Investigative Ophthalmology & Visual Science
Publisher	The Association for Research in Vision and Ophthalmology
Volume	67
Edition	7
ISBN (Electronic)	1552-5783
Publication status	Published - 1 Jun 2026

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SDG 8 Decent Work and Economic Growth

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Cite this

Kiu, L. Y., Tam, W. ., Wan, K., Wong, M. H., Li, C. Y., Chen, Y., Fu, E., Cheung, M. K. M., Lee, H. P., Leong, H. V., Ngai, G., Chan, L. Y. L., & Do, C. W. (2026). Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance. In Investigative Ophthalmology & Visual Science (7 ed., Vol. 67). The Association for Research in Vision and Ophthalmology. https://iovs.arvojournals.org/article.aspx?articleid=2814687&resultClick=1

@inproceedings{991a6a9fc3484010a6a956d791f94bcf,

title = "Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance",

abstract = "Purpose : Southeastern Asian countries are undergoing accelerated myopic shifts alongside economic development. Although myopia prevalence remains lower than in East Asian populations, accessible detection methods are essential as digital device use permeates younger generations. We previously demonstrated that smartphone photorefraction as a low-cost myopia screening tool, yielding results comparable to autorefraction without cycloplegia in controlled lab settings. This study evaluated its applicability for myopia detection in community vision screenings. Methods : Vision screenings conducted in two public schools in Cambodia (August 2024) and the Philippines (January 2025). In addition to visual acuity assessment, refractive errors were measured via smartphone photorefraction and a commercial infrared photorefractor, both non-cycloplegic. University student volunteers were trained to perform smartphone photorefraction. Results : 323 schoolchildren aged 4 to 18 years old (Mean ± SEM = 10.00 ± 0.18) with refractive errors ranging from +6.00 to -9.00D (Mean ± SEM = -0.24 ± 0.07 D) were analysed. 23\% (95\% CI: 19 - 26\%) of the 646 eyes were myopic (spherical equivalent ≤ -0.50D), with no significant difference by nationality [X2(1, 646) = 0.61, p = 0.43]. Non-gradable photos yielded a 4\% inconclusive rate. Smartphone photorefraction showed mean absolute error ± SEM of 0.75 ± 0.02D (CI: 0.72 - 0.79D) when compared with the commercial device. For detecting visually significant myopia (≤ -2.00 D), sensitivity, specificity, and positive predictive value were 93\% (CI: 89 - 96\%), 97\% (CI: 96 - 98\%), and 73\% (CI: 68 - 79\%), respectively. Overall accuracy was 97\% (CI: 96 - 97\%), with ROC AUC of 0.97 (CI: 0.95 - 0.99). Conclusions : This represents the first field validation of smartphone photorefraction for myopia screening. Operated by lay volunteers, it sustained strong performance versus lab benchmarks, reinforcing its potential for scalable myopia detection in resource-limited settings. This abstract was presented at the 2026 ARVO Annual Meeting, held in Denver, CO, May 3-7, 2026.",

author = "Kiu, \{Ling Yau\} and Tam, \{Wing -yu\} and Kin Wan and Wong, \{Ming Hong\} and Li, \{Chak Yin\} and Yanxian Chen and Eugene Fu and Cheung, \{Man Ki Michael\} and Lee, \{Hong Paul\} and Leong, \{Hong Va\} and Grace Ngai and Chan, \{Lily Yee Lai\} and Do, \{Chi Wai\}",

year = "2026",

month = jun,

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language = "English",

volume = "67",

booktitle = "Investigative Ophthalmology \& Visual Science",

publisher = "The Association for Research in Vision and Ophthalmology",

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Kiu, LY, Tam, W, Wan, K, Wong, MH, Li, CY, Chen, Y, Fu, E, Cheung, MKM, Lee, HP, Leong, HV , Ngai, G, Chan, LYL & Do, CW 2026, Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance. in Investigative Ophthalmology & Visual Science. 7 edn, vol. 67, The Association for Research in Vision and Ophthalmology. <https://iovs.arvojournals.org/article.aspx?articleid=2814687&resultClick=1>

Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance. / Kiu, Ling Yau; Tam, Wing -yu; Wan, Kin et al.
Investigative Ophthalmology & Visual Science. Vol. 67 7. ed. The Association for Research in Vision and Ophthalmology, 2026.

Research output: Chapter in book / Conference proceeding › Conference article published in proceeding or book › Academic research › peer-review

TY - GEN

T1 - Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance

AU - Kiu, Ling Yau

AU - Tam, Wing -yu

AU - Wan, Kin

AU - Wong, Ming Hong

AU - Li, Chak Yin

AU - Chen, Yanxian

AU - Fu, Eugene

AU - Cheung, Man Ki Michael

AU - Lee, Hong Paul

AU - Leong, Hong Va

AU - Ngai, Grace

AU - Chan, Lily Yee Lai

AU - Do, Chi Wai

PY - 2026/6/1

Y1 - 2026/6/1

N2 - Purpose : Southeastern Asian countries are undergoing accelerated myopic shifts alongside economic development. Although myopia prevalence remains lower than in East Asian populations, accessible detection methods are essential as digital device use permeates younger generations. We previously demonstrated that smartphone photorefraction as a low-cost myopia screening tool, yielding results comparable to autorefraction without cycloplegia in controlled lab settings. This study evaluated its applicability for myopia detection in community vision screenings. Methods : Vision screenings conducted in two public schools in Cambodia (August 2024) and the Philippines (January 2025). In addition to visual acuity assessment, refractive errors were measured via smartphone photorefraction and a commercial infrared photorefractor, both non-cycloplegic. University student volunteers were trained to perform smartphone photorefraction. Results : 323 schoolchildren aged 4 to 18 years old (Mean ± SEM = 10.00 ± 0.18) with refractive errors ranging from +6.00 to -9.00D (Mean ± SEM = -0.24 ± 0.07 D) were analysed. 23% (95% CI: 19 - 26%) of the 646 eyes were myopic (spherical equivalent ≤ -0.50D), with no significant difference by nationality [X2(1, 646) = 0.61, p = 0.43]. Non-gradable photos yielded a 4% inconclusive rate. Smartphone photorefraction showed mean absolute error ± SEM of 0.75 ± 0.02D (CI: 0.72 - 0.79D) when compared with the commercial device. For detecting visually significant myopia (≤ -2.00 D), sensitivity, specificity, and positive predictive value were 93% (CI: 89 - 96%), 97% (CI: 96 - 98%), and 73% (CI: 68 - 79%), respectively. Overall accuracy was 97% (CI: 96 - 97%), with ROC AUC of 0.97 (CI: 0.95 - 0.99). Conclusions : This represents the first field validation of smartphone photorefraction for myopia screening. Operated by lay volunteers, it sustained strong performance versus lab benchmarks, reinforcing its potential for scalable myopia detection in resource-limited settings. This abstract was presented at the 2026 ARVO Annual Meeting, held in Denver, CO, May 3-7, 2026.

AB - Purpose : Southeastern Asian countries are undergoing accelerated myopic shifts alongside economic development. Although myopia prevalence remains lower than in East Asian populations, accessible detection methods are essential as digital device use permeates younger generations. We previously demonstrated that smartphone photorefraction as a low-cost myopia screening tool, yielding results comparable to autorefraction without cycloplegia in controlled lab settings. This study evaluated its applicability for myopia detection in community vision screenings. Methods : Vision screenings conducted in two public schools in Cambodia (August 2024) and the Philippines (January 2025). In addition to visual acuity assessment, refractive errors were measured via smartphone photorefraction and a commercial infrared photorefractor, both non-cycloplegic. University student volunteers were trained to perform smartphone photorefraction. Results : 323 schoolchildren aged 4 to 18 years old (Mean ± SEM = 10.00 ± 0.18) with refractive errors ranging from +6.00 to -9.00D (Mean ± SEM = -0.24 ± 0.07 D) were analysed. 23% (95% CI: 19 - 26%) of the 646 eyes were myopic (spherical equivalent ≤ -0.50D), with no significant difference by nationality [X2(1, 646) = 0.61, p = 0.43]. Non-gradable photos yielded a 4% inconclusive rate. Smartphone photorefraction showed mean absolute error ± SEM of 0.75 ± 0.02D (CI: 0.72 - 0.79D) when compared with the commercial device. For detecting visually significant myopia (≤ -2.00 D), sensitivity, specificity, and positive predictive value were 93% (CI: 89 - 96%), 97% (CI: 96 - 98%), and 73% (CI: 68 - 79%), respectively. Overall accuracy was 97% (CI: 96 - 97%), with ROC AUC of 0.97 (CI: 0.95 - 0.99). Conclusions : This represents the first field validation of smartphone photorefraction for myopia screening. Operated by lay volunteers, it sustained strong performance versus lab benchmarks, reinforcing its potential for scalable myopia detection in resource-limited settings. This abstract was presented at the 2026 ARVO Annual Meeting, held in Denver, CO, May 3-7, 2026.

M3 - Conference article published in proceeding or book

VL - 67

BT - Investigative Ophthalmology & Visual Science

PB - The Association for Research in Vision and Ophthalmology

ER -

Smartphone Photorefraction for Community Myopia Screening in Southeast Asia: Field Validation and Performance

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