Cycloplegic refraction is the gold standard for epidemiological studies

Area of Science:

• Ophthalmology
• Optometry
• Epidemiology

Background:

• Lack of cycloplegia in pediatric studies leads to myopia overestimation and refractive error prevalence inaccuracies.
• Previous assumptions suggested cycloplegia is unnecessary beyond childhood/early adulthood, impacting adult refractive error studies.
• A need exists to define cycloplegia's necessity for refractive error measurement in the 20-50 age group.

Purpose of the Study:

• To determine if cycloplegic refraction is necessary for accurate refractive error assessment in adults aged 20-50.
• To evaluate the impact of non-cycloplegic refraction on refractive error categories and prevalence estimates in this age group.

Main Methods:

• Analysis of data from the Tehran Eye Study.
• Analysis of data from the Beaver Dam Offspring Eye Study.
• Comparison of refractive error measurements with and without cycloplegia.

Main Results:

• Non-cycloplegic refraction introduced significant errors in estimating myopia, emmetropia, and hyperopia in adults aged 20-50.
• These findings mirror those observed in pediatric populations.
• While myopia prevalence estimation might tolerate non-cycloplegia in some cases, other refractive categories and spherical equivalents become unreliable.

Conclusions:

• Cycloplegic refraction is crucial for accurate epidemiological studies of refractive error in both children and adults up to age 50.
• Non-cycloplegic refraction introduces significant biases, compromising the reliability of refractive error data in this demographic.
• Cycloplegic refraction should be considered the gold standard for population-based refractive error research across a wide age range.