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Accomodative tone in children under general anesthesia

Daniel J Salchow1, Inna Marcus, Thomas J Golembeski

  • 1Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.

American Journal of Ophthalmology
|August 27, 2013
PubMed

Insights

General anesthesia significantly reduces accommodative tone in children, leading to more myopic measurements during retinoscopy. Cycloplegia is recommended for accurate refractive error assessment in pediatric patients under anesthesia.

Area of Science:

  • Ophthalmology
  • Pediatric Anesthesia
  • Refractive Error Assessment

Background:

  • Accurate refractive error measurement is crucial for pediatric eye care.
  • General anesthesia can potentially alter ocular parameters, including accommodation.
  • Understanding these effects is vital for reliable diagnostic procedures in children.

Purpose of the Study:

  • To evaluate the impact of general anesthesia on the accommodative tone in children.
  • To compare refractive measurements obtained under general anesthesia with those obtained using cycloplegia.

Main Methods:

  • A cohort study was conducted in an academic practice.
  • Streak retinoscopy was performed with and without cycloplegia in children under 12 years undergoing general anesthesia.
  • The primary outcome was the difference in refractive measurements between the two conditions.

Main Results:

  • Retinoscopy under anesthesia showed significantly more myopic spherical and spherical equivalent measurements compared to cycloplegic retinoscopy (P < 0.0001).
  • Agreement was good for cylinder power and axis between the two methods.
  • Measurements under anesthesia were within 1D of cycloplegic measurements for the sphere in 61% and spherical equivalent in 68.3% of subjects.

Conclusions:

  • General anesthesia generally reduces accommodative tone in children, but residual tone can still influence refractive measurements.
  • Significant myopic shifts were observed, highlighting potential inaccuracies.
  • Cycloplegia remains recommended for precise refractive error assessment in pediatric patients under general anesthesia.
Abstract

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