Comparison of Autorefraction and Photorefraction with and without Cycloplegia Using 1% Tropicamide in Preschool Children.

Ertuğrul Tan Yassa,Cihan Ünlü

doi:10.1155/2019/1487013

Abstract

Purpose We aimed to investigate whether the accuracy of the Plusoptix A09 photorefractor in children with ametropia is enhanced by cycloplegia with 1% tropicamide. Methods A total of 70 eyes (70 children) were retrospectively reviewed. Noncycloplegic photorefraction, cycloplegia with 1% tropicamide, cycloplegic photorefraction, and cycloplegic refraction with a tabletop autorefractometer were performed on all subjects in this order. Measurements were compared statistically. Results The mean age was 45.9 ± 11.4 months. The mean spherical equivalent (0.61 ± 1.03 diopters (D); range, −2.38 to 3.63 D) and mean spherical power (1.16 ± 0.92 D; range, −1.25 to 3.75 D) values that were acquired from the photorefraction without cycloplegia showed statistically significant differences from those of the autorefraction with cycloplegia (mean spherical equivalent = 1.00 ± 1.27 D; range, −1.50 to 4.25 D, mean spherical power = 1.60 ± 1.14; range, −1.25 to 4.50 D). The mean difference for the spherical equivalent was −0.39 ± 0.93 D (P=0.021; 95% limits of agreement (LoA) = −2.22 D to 1.44 D) and for spherical power was −0.44 ± 1.02 D (P=0.016; LoA = −2.44 D to 1.56 D). Without cycloplegia, Plusoptix A09 showed myopic shift, while after cycloplegia, it showed hyperopic shift. Spherical equivalent (mean difference (MD) ± SD = 0.78 ± 1.00 D, P < 0.001; LoA = −1.17 D to 2.72 D) and spherical power (MD ± SD = 0.73 ± 1.04 D, P < 0.001; LoA = −1.31 D to 2.77 D) values were significantly different from those of autorefraction with cycloplegia. Cylindrical power values obtained by photorefraction both with and without cycloplegia were not statistically different from those of autorefraction with cycloplegia (P > 0.05). Conclusion Cycloplegia with 1% tropicamide did not improve the accuracy of photorefraction using Plusoptix A09 in preschool children. The spherical equivalent and spherical power values obtained by photorefraction with cycloplegia were significantly higher from those obtained by autorefraction with cycloplegia.

Highlights

Precise and early assessment of eye refractive errors is crucial because undetected anisometropia and high hyperopia may lead to amblyopia and promote strabismus
We aimed to investigate whether cycloplegia with 1% tropicamide increased the accuracy of the Plusoptix A09 photorefractor in preschool children with ametropia
E spherical equivalent values that were acquired via photorefraction without cycloplegia and photorefraction with cycloplegia showed statistically significant differences (P < 0.001). e mean difference in spherical equivalents between the photorefraction without cycloplegia and photorefraction with cycloplegia was −1.17 ± 1.12 D (Plusoptix without cycloplegia showed myopic shift). e spherical power obtained via the photorefraction without cycloplegia and photorefraction with cycloplegia showed a statistically significant difference (P < 0.001). e difference in mean spherical power was −1.17 ± 1.15 D. e difference in cylindrical power that was obtained by the two methods was not statistically significant (P > 0.999), and the mean difference was 0.004 ± 0.36 D

Summary

Introduction

Precise and early assessment of eye refractive errors is crucial because undetected anisometropia and high hyperopia may lead to amblyopia and promote strabismus. While there is some controversy as to the age when amblyopia becomes irreversible, there is consensus that the effectiveness of amblyopic treatment is greatest when initiated before the age of five [1]. On the other hand, obtaining accurate refractive error measurements in very young children continues to be a challenging exercise. Cycloplegic refraction using retinoscopy is still the most accurate method for examining children, and it represents the most commonly used gold standard for assessment. E accuracy of the tabletop autorefractometers with cycloplegia for the refractive examinations of children has been established by the previous studies [3, 4]. Maintaining a suitable position of the child and achieving visual fixation on a target for a sufficient length of time are some of the problems

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