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Pinpointing precision: axial length and refraction in paediatric myopia trials-a mixed methods study
Annegret H Dahlmann-Noor1,2,3, Nick Freemantle4
1UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK. Anngret.dahlmann@ucl.ac.uk.
Trials
|July 11, 2026
Summary
Axial length measurement is as precise as cycloplegic autorefraction for paediatric myopia trials. However, axial length is preferred due to reduced participant discomfort and improved trial efficiency.
Area of Science:
- Ophthalmology
- Clinical Trials
- Paediatric Eye Care
Background:
- Paediatric myopia intervention trials commonly use axial length and cycloplegic autorefraction as primary outcomes.
- Standardizing primary outcomes can enhance trial efficiency, reduce participant burden, and improve retention.
Purpose of the Study:
- To evaluate the precision of axial length and cycloplegic autorefraction in paediatric myopia trials.
- To explore the perspectives of eye care professionals and young people regarding cycloplegia.
Main Methods:
- A mixed-methods approach was employed, including a meta-analysis of published trial data.
- Qualitative data were gathered through interviews with eye care professionals and discussions with children and young people.
Main Results:
- Meta-analysis showed similar precision between axial length and cycloplegic spherical equivalent refraction.
- Eye care professionals and young people reported significant discomfort, distress, and adverse effects associated with cycloplegia.
- Concerns include blurred vision, light sensitivity, and potential non-attendance at follow-up appointments.
Conclusions:
- Axial length and cycloplegic autorefraction demonstrate comparable precision in paediatric myopia trials.
- Cycloplegic autorefraction leads to longer study visits and greater patient discomfort.
- Future trial designs should prioritize axial length as the primary outcome to enhance efficiency and patient experience.
