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Do all children need a cycloplegic refraction? A comparison of Mohindra's versus cycloplegic refraction
Farnaz Kauser1, Yogesh Gupta1, Abadan K Amitava1
1Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India.
Insights
Mohindra's near retinoscopy (MNR) provides accurate refractive error measurements in children, closely correlating with post-cycloplegic refraction (PCRef). This suggests MNR is a viable alternative for pediatric eye exams.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Assessment
Background:
- Accurate refractive error assessment is crucial for pediatric eye care.
- Cycloplegic refraction is the gold standard but requires pharmacologic intervention.
- Near retinoscopy techniques offer potential alternatives for faster assessment.
Purpose of the Study:
- To evaluate the correlation, regression, and agreement between Mohindra's near retinoscopy (MNR) and post-cycloplegic refraction (PCRef) in children aged 1-12 years.
- To determine the clinical utility of MNR as a standalone refractive assessment tool.
Main Methods:
- Prospective comparative study involving 101 children (202 eyes).
- Mohindra's near retinoscopy (MNR) performed with streak retinoscope at 50 cm, with a -1.25 D lens subtraction.
- Cycloplegic refraction (CRef) using cyclopentolate 1%, followed by post-cycloplegic refraction (PCRef) 72 hours later; all data converted to Spherical Equivalent (SE).
Main Results:
- A strong correlation (r=0.97, r²=0.94, P<0.001) was found between MNR and PCRef SE values.
- Agreement analysis indicated MNR overestimates hyperopia and underestimates myopia by approximately 0.3 D compared to PCRef.
- Regression analysis showed PCRef SE is 95% of MNR SE, minus 0.20 D.
Conclusions:
- Mohindra's near retinoscopy (MNR) demonstrates high accuracy and significant correlation with the gold standard post-cycloplegic refraction (PCRef).
- MNR can be considered a reliable and viable single-point refraction method for pediatric eye examinations.
- The findings support the increased use of MNR as an efficient alternative in pediatric refractive assessment.
Purpose:
In 1-12 years old children, we assessed correlation, regression, and agreement between spherical equivalents (SE) obtained on Mohindra's near retinoscopy (MNR) and the post cycloplegic refraction (PCRef), performed 72 h after a cycloplegic refraction (CRef) using cyclopentolate 1% drops.
Methods:
In this prospective comparative study, Mohindra's near retinoscopy (MNR) was performed on 202 eyes of 101 children, from 50 cm with a streak retinoscope, in a dimly lit room, subtracting 1.25 from the trial lens used for neutralization, to obtain the final refraction. Subsequently we undertook CRef, half-hour after instilling 1% cyclopentolate, with a PCRef 72 h later. All refractive data were converted to SE for evaluation. We compared the SEs using correlation, linear regression, and agreement (Bland-Altman graphic analysis) and paired t-test. Significance was set at P ≤ 0.05.
Results:
The mean SE on MNR was 1.71 ± 2.49 D compared to 1.43 ± 2.42 D on PCRef. A significant correlation with r = 0.97 (r2= 0.94, P < 0.001) existed. Agreement analysis suggested that MNR overestimates hypermetropia and underestimates myopia each by 0.3 D than the standard procedure of CRef-PCRef. The regression analysis suggested that SE on PCRef is 95% of that on MNR, less 0.20.
Conclusion:
Our study suggests that MNR offers single point refraction very similar to CRef-PCRef, and may be considered as a viable option more often.
