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Analysis of 2-year spherical equivalent progression in emmetropic children with non-cycloplegic refraction: a
1Department of Ophthalmology, Graduate School, Kyung Hee University, Seoul, Korea.
Insights
Children with emmetropic cycloplegic refraction (CR) showed greater spherical equivalent (SE) progression than those with hyperopic CR. Cycloplegia is crucial for accurate refractive status assessment in children to predict myopia progression.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Research
Background:
- Investigating refractive error progression in children is vital for early myopia detection.
- Non-cycloplegic refraction (NCR) may not accurately reflect a child's true refractive status.
Purpose of the Study:
- To compare the 2-year spherical equivalent (SE) progression in children with emmetropic versus hyperopic cycloplegic refraction (CR).
- To determine the necessity of cycloplegia for accurate refractive assessment in pediatric populations.
Main Methods:
- Retrospective review of 59 children under 10 years old.
- Categorization into emmetropia (Group 1) and hyperopia (Group 2) based on CR values.
- Comparison of SE progression and myopia prevalence over 2 years, with correlation and regression analyses.
Main Results:
- Children with emmetropic CR showed significantly greater myopic SE progression compared to baseline and to the hyperopic CR group at 2 years.
- Myopia prevalence increased substantially in the emmetropic CR group (61.1%) versus the hyperopic CR group (16.7%) after 2 years.
- Baseline age and the difference between CR and NCR were significant predictors of SE progression.
Conclusions:
- Emmetropic CR in children is associated with greater SE progression than hyperopic CR, even if NCR indicates emmetropia.
- Cycloplegia is essential for determining a child's accurate refractive status and predicting myopia progression.
- A non-cycloplegic refraction cutoff of 0.20 D demonstrated high sensitivity and specificity in distinguishing between groups.
Background:
We aimed to investigate children with an emmetropic non-cycloplegic refraction (NCR) to compare the difference in progression of NC spherical equivalent (SE) over 2 years between the children with emmetropic and hyperopic cycloplegic refraction (CR) values.
Methods:
Through a retrospective medical record review, 59 children aged under 10 years were evaluated. Refractive error was calculated as the average of the SE values of both eyes. According to the CR results, children with emmetropia (-0.50 to 1.00 diopter [D]) were assigned to group 1 (n = 29), and those with hyperopia (≥ 1.00 D) were assigned to group 2 (n = 30). The prevalence of myopia and SE progression were compared over 2 years. Correlations between final SE progression and baseline age and refractive error were analyzed and multiple regression analysis was conducted. Receiver operating characteristic curves that achieved the best cutoff points to distinguish between the groups were calculated.
Results:
Group 1 showed significantly myopic SE changes compared to baseline at the 1-year follow-up, and group 1 was significantly myopic compared with group 2 at the 2-year follow-up. Myopia prevalence was 51.7% in group 1 and 6.7% in group 2 after 1 year, and 61.1% and 16.7% after 2 years, respectively. In the correlation analysis, baseline age, baseline CR, and difference between CR and NCR showed significant correlations with the 2-year SE progression (r = -0.359, p = 0.005; r = 0.450, p < 0.001; r = -0.562, p < 0.001, respectively). However, NCR refractive error showed no significant correlation (r = -0.097, p = 0.468). In multiple regression analysis, baseline age (β= -0.082), and CR-NCR difference (β= -0.214) showed a significant effect on SE progression for 2 years. When an NCR value of 0.20 D was set as the cut-off value to distinguish between the groups, a sensitivity of 70% and specificity of 92% were obtained.
Conclusion:
Even if NCR showed emmetropia, children with baseline CR values of emmetropia showed greater SE progression compared with those with hyperopia. Cycloplegia is essential to confirm the correct refractive status in children. It may be useful for predicting prognosis of SE progression.
