Greater accuracy of cycloplegic refraction
Reviewed by Fiona Rowe

The authors conducted this study on 5320 pre-school (four to six-year-old) and 6475 school (seven to ten years) children to compare the results of final glasses prescription based on cycloplegic refraction with atropine to those of non-cycloplegic refraction. For younger children with mild, moderate and high myopia, the mean difference between cyclo and non-cyclo refraction was 1.21 ±0.90, 0.56 ±0.65 and 1.08 ±1.08D; and for hypermetropia was 1.58 ±0.90, 1.65 ±1.04 and 1.03 ±0.91D. All were significantly different. For older children with mild, moderate and high myopia, the mean difference between cyclo and non-cyclo refraction was 0.41 ±0.56, 0.38 ±0.52 and 0.70 ±0.81D; and for hypermetropia was 1.25 ±0.94, 1.33 ±0.99 and 0.89 ±0.90D. All were significantly different and there was a greater difference than for younger children. After cycloplegia, 62.5% of young and 11.3% of older children in the mild myopia group became emmetropic or hypermetropic. Glasses prescriptions based on non-cyclo refraction had higher corrections. The authors recommend cyclo refraction for all myopic children aged 4-10 years to avoid over prescription. Prescriptions were underestimated for hypermetropic, therefore cyclo refractions may provide greater accuracy.

Evaluation of the necessity for cycloplegia during refraction of Chinese children between 4 and 10 years old.
Liu X, Ye L, Chen C, et al.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2020;57:257-63.