The authors evaluated the accuracy of the PlusoptiX A04 for measuring pupillary distance as compared to measurements taken by a trained optician. This retrospective review included 256 children who had undilated PA04 screening and had pupil distance measurement done by the optician using the L8 digital pupil distance meter. Children were aged 1-16 years: 142 ortho, 97 esotropia and 17 exotropia. The mean absolute difference for the two measures for the entire cohort was 0.3mm (SD-3.12). There was good agreement of 0.76 correlation coefficient. Agreement was less for strabismic patients at 0.8mm for esotropia. The range of measurements provided by PA04 was wider than acceptable and therefore the authors propose that this should not be preferred as a first line method.