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A Review on Correlation Between Autorefractometer and Cycloplegic Refraction with Subjective Acceptance in Children
Aazima Fatima1, Tara Rani1, Labishetty Sai Charan1
1Department of Optometry, University Institute of Allied Health Sciences, Chandigarh University, Mohali, 140310, India.
Insights
Cycloplegic refraction is more accurate for children
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Assessment
Background:
- Accommodation can distort pediatric autorefraction measurements.
- Cycloplegic refraction minimizes accommodation, potentially improving functional eyesight assessment.
- Accurate refractive status is crucial for pediatric vision development.
Purpose of the Study:
- To systematically review the correlation between autorefraction, cycloplegic refraction, and subjective acceptance in children aged 6-15.
- To evaluate the accuracy of different refraction methods in pediatric populations.
- To determine the optimal method for refractive error assessment in children.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched PubMed, Scopus, and Web of Science (2000-2024).
- Assessed risk of bias using QUADAS-2 with duplicate assessment.
Main Results:
- Cycloplegic refraction showed the best correlation with subjective acceptance.
- Cycloplegic refraction provided more accurate hyperopia estimates than non-cycloplegic autorefraction.
- Non-cycloplegic autorefraction tended to over-myopia/under-hyperopia in younger children.
Conclusions:
- Non-cycloplegic autorefraction alone is insufficient for accurate pediatric refractive status determination.
- Combining autorefraction with cycloplegia enhances precision and performance.
- Subjective refinement is essential for comfort and compliance in pediatric eyecare.
Introduction:
Autorefraction is fast, yet accommodation can distort pediatric measurements, and cycloplegic refraction minimizes accommodation and therefore could be more suitable for functional eyesight. The correlation between the readings of the autorefractometer, cycloplegic refraction, and the subjective acceptance was systematically reviewed in children aged between 6 and 15 years.
Methods:
Following PRISMA, PubMed, Scopus, and Web of Science were searched (20002024) in search of studies comparing the outcomes of autorefraction, cycloplegic refraction, and/or subjective refraction in children. Risk of bias (QUADAS-2) was assessed using duplicate assessment of eligibility and data extraction.
Results:
In all the suitable studies, cycloplegic refraction demonstrated the best correlation with the ultimate subjective acceptance and delivered hyperopia estimates that were more accurate in comparison to noncycloplegic cycloplegic autorefractive refraction. Non-cycloplegic autorefraction was more likely to overmyopia/ under-hyperopia in younger children. It was in agreement more when autorefraction was done under cycloplegia and in the old subgroups.
Discussion:
Since accommodation is dynamic in the pediatric population, non-cycloplegic autorefraction alone is insufficient to misclassify the refractive status. The association of autorefraction with cycloplegia is enhanced in precision and performance, whereas the subjective refinement is fundamental towards comfort and compliance.
Conclusion:
Parents of the 6- to 15-year-old age group children rely most on cycloplegic refraction as a source of prescription, with autorefraction being utilised most optimally under cycloplegia or as a screening measure followed by cycloplegic confirmation and age-adjusted additional subjective refinement.
