Related Experiment Video
Updated: Jan 4, 2026
Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
Published on: September 16, 2025
Agreement and Repeatability of Noncycloplegic and Cycloplegic Wavefront-based Autorefraction in Children
Franziska G Rauscher1, Heike Lange2, Maryam Yahiaoui-Doktor1
1Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany.
Insights
Cycloplegic autorefraction in children offers improved accuracy for refractive error assessment, reducing accommodation influence. Repeating noncycloplegic measurements significantly enhances reliability for myopia and hyperopia screening.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Refractive errors are increasingly common in children, necessitating accurate screening methods.
- Wavefront-based autorefraction is a key tool, but its accuracy without cycloplegia requires further understanding.
- Accommodation significantly impacts noncycloplegic measurements, introducing uncertainty.
Purpose of the Study:
- To evaluate the repeatability and agreement of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront autorefraction.
- To assess the impact of cycloplegia on accommodation in children aged 2-15 years.
- To determine the clinical utility of ZEISS i.Profiler plus in pediatric refractive error assessment.
Main Methods:
- Three consecutive wavefront autorefraction measurements were performed on 145 children's eyes (OD) under both cycloplegic and noncycloplegic conditions.
- Spherical equivalent (M) and astigmatic components (J0, J45) were analyzed.
- Data were analyzed for agreement (ARc vs. ARnc) and repeatability within each condition.
Main Results:
- Cycloplegic refraction showed a statistically significant hyperopic shift (0.55 D) compared to noncycloplegic measurements.
- Astigmatic components demonstrated excellent repeatability under both conditions (SD < 0.11 D).
- The repeatability of spherical equivalent improved significantly with cycloplegia (95% interval 0.50 D vs. 1.49 D without).
- Propensity to accommodate was reduced by over half with cycloplegia (0.19 D vs. 0.44 D).
Conclusions:
- Wavefront-based autorefraction provides highly repeatable and precise measurements for astigmatic components in children.
- Noncycloplegic measurements of spherical equivalent exhibit a systematic bias and reduced repeatability.
- Cycloplegia is crucial for accurate refractive error assessment in children, significantly reducing accommodative influence and improving measurement reliability.
Significance:
Increasing prevalence of refractive error requires assessment of ametropia as a screening tool in children. If cycloplegia is not an option, knowledge about the increase in uncertainty for wavefront-based autorefraction is needed. The cycloplegic agent as the principal variant presents cross-reference and allows for extraction of the influence of accommodation.
Purpose:
The purpose of this study was to determine the repeatability, agreement, and propensity to accommodate of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront-based autorefraction (ZEISS i.Profiler plus; Carl Zeiss Vision, Aalen, Germany) in children aged 2 to 15 years.
Methods:
In a clinical setting, three consecutive measurements were feasible for 145 eyes (OD) under both conditions. Data are described by spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45). In the case of M, the most positive value of the three measurements was chosen, whereas the mean was applied for astigmatic components.
Results:
Regarding agreement, differences for ARc minus ARnc were statistically significant: for M, 0.55 (0.55 D; mean [SD]; P < .001), that is, more hyperopic in cycloplegia; for J0, -0.03 (0.11 D; P = .002); and for J45, -0.03 D (SD, 0.09 D; P < .001). Regarding repeatability, astigmatic components showed excellent repeatability: SD < 0.11 D (ARnc) and SD < 0.09 D (ARc). The repeatability of M was SD = 0.57 D with a 95% interval of 1.49 D (ARnc). Under cycloplegia, this decreased to SD = 0.17 D (ARc) with a 95% interval of 0.50 D. The mean propensity to accommodate was 0.44 D from repeated measurements; in cycloplegia, this was reduced to 0.19 D.
Conclusions:
Wavefront-based refraction measurement results are highly repeatable and precise for astigmatic components. Noncycloplegic measurements of M show a systematic bias of 0.55 D. Cycloplegia reduces the propensity to accommodate by a factor of 2.4; for noncycloplegic repeated measurements, accommodation is controlled to a total interval of 1.49 D (95%). Without cycloplegia, results improve drastically when measurements are repeated.
