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Comparison of Cycloplegic and Non-Cycloplegic Refraction in School-Aged Children: A Cross-Sectional, Observational
Tilottama Kar1, Ankur K Shrivastava2
1Ophthalmology, All India Institute of Medical Sciences, Patna, Patna, IND.
Insights
Cycloplegic refraction is crucial for accurate vision assessment in children. Non-cycloplegic methods overestimate myopia and underestimate hyperopia, highlighting the need for cycloplegic eye exams in pediatric refractive error evaluation.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Assessment
Background:
- Accurate refractive error assessment in children is vital for timely intervention and management of visual impairments.
- Non-cycloplegic refraction may lead to inaccurate measurements due to accommodative effort in young individuals.
Purpose of the Study:
- To compare cycloplegic and non-cycloplegic refraction in school-aged children.
- To determine the impact of cycloplegia on refractive error measurements in pediatric populations.
Main Methods:
- A cross-sectional observational study involving 110 children aged 5-15 years in central India.
- Autorefraction was performed both with and without cycloplegia induced by cyclopentolate 1% eye drops.
- Spherical equivalent (SE) values from the right eye were recorded for analysis.
Main Results:
- Mean SE was -0.54 D without cycloplegia and +0.18 D with cycloplegia.
- Non-cycloplegic refraction overestimated myopia (62.7% vs 40.9%) and underestimated hyperopia (31.8% vs 57.3%).
- A statistically significant strong correlation was found between cycloplegic and non-cycloplegic SE values.
Conclusions:
- Cycloplegic refraction provides a more accurate measurement of refractive errors in children compared to non-cycloplegic methods.
- Routine use of cycloplegic refraction is recommended for precise diagnosis and management of pediatric refractive errors.
- Understanding these differences is essential for effective myopia control and hyperopia management strategies.
Abstract:
Aim The aim of the study was to evaluate the differences between cycloplegic and non-cycloplegic refraction in school-aged children. Materials and methods This cross-sectional, observational study was conducted at a tertiary care institute in central India, comprising 110 children aged 5-15 years. Visual acuity was recorded, and anterior segment examination was performed. Undilated autorefraction was done using an autokerato-refractometer. The participants were cyclopleged using eye drop cyclopentolate 1%, one drop every 15 minutes in both eyes, for over one hour. The vertical pupillary diameter was measured using slit lamp biomicroscopy. Cycloplegic autorefraction was done using the same autokerato-refractometer. Autorefraction values of the right eye were recorded to eliminate bias. Results The mean spherical equivalent (SE) in dioptres without cycloplegia was -0.54, and with cycloplegia was +0.18. The mean ± SD of the difference between cycloplegic and non-cycloplegic refraction was 0.72 ± 0.72. Without cycloplegia, SE determined 69 (62.7%) participants as myopic, six (5.5%) as emmetropic, and 35 (31.8%) as hypermetropic. Whereas, with cycloplegia, SE determined 45 (40.9%) as myopic, two (1.8%) as emmetropic, and 63 (57.3%) as hypermetropic. Conclusion The study discovered a strong correlation between SE (with cycloplegic) and SE (without cycloplegic), and this correlation was statistically significant. Myopia was overestimated, and hypermetropia was underestimated with non-cycloplegic refraction compared to cycloplegic refraction. Hence, cycloplegic refraction is recommended for the precise measurement of refractive error in children.
