Abstract
Anecdotal evidence has revealed much debateabout the use of cycloplegia when screening children.The issue of precision versus practicalityremains an unresolved debate. In the developingworld, with huge disparities in eye care resourcesand services, there is a need to address this issueso as to ensure that access is not compromised inthe search for precision and vice versa. This studytherefore compared autorefraction measurementswith and without cycloplegia.Methods: One hundred and fifty childrenof 5 to 15 years of age were randomly selectedfrom a study population of 4890. Autorefractionwas conducted on the sample using the handheldNikon Retinomax autorefractor and thesereadings are referred to as the dry autorefractionreadings. Thereafter, readings were repeatedonce cycloplegia was reached following theinstillation of cyclopentolate and these arereferred to as the wet autorefraction readings.Of the 150 children, only 118 eyes met thefull cycloplegic criteria, that is, pupil diametergreater than 6 mm and absent light reflex.Results: Data analysis revealed a clinicallysignificant difference of 0.97 D between themean nearest equivalent sphere of the dry andwet readings with the majority of wet readingstending towards more positive values. This differencewas statistically significant to the 99%confidence interval (p = 0.00).Conclusions: Autorefraction with cycloplegiais the more reliable methodology of detectingrefractive error in screening or pre-examapplication. The difference is significant enoughto warrant the use of cycloplegics in children,given the minimal side-effects and despite theextra time and effort.
Highlights
The introduction of automated refraction has created a new dynamic in the vision care industry
Thereafter, readings were repeated once cycloplegia was reached following the instillation of cyclopentolate and these are referred to as the wet autorefraction readings
Data analysis revealed a clinically significant difference of 0.97 D between the mean nearest equivalent sphere of the dry and wet readings with the majority of wet readings tending towards more positive values
Summary
The introduction of automated refraction has created a new dynamic in the vision care industry. It is fast becoming a preferred method of both preliminary testing and screening in various eye care settings. The growing use of autorefraction has stemmed from the numerous studies conducted on its reliability and accuracy[1,2,3]. Even though autorefraction is not selected as the only refractive technique in the patient examination, it is a useful adjunct. In the management of large numbers of patients, it is essential to employ methods of examination that are more objective and less time consuming, making autorefraction one of the principal tests used in vision screening.
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