Cycloplegic and Noncycloplegic Refractions of Chinese Neonatal Infants

Abstract

To examine Chinese neonatal infants with both cycloplegic and noncycloplegic retinoscopy and to compare the distribution of refractive errors for the two techniques. Cycloplegic retinoscopy was performed by two experienced pediatric ophthalmologists on 81 neonatal infants randomly selected from a group of 185 neonates who had undergone noncycloplegic retinoscopy. All infants were between 1 day and 6 days of age and were born without incident at full term. The mean cycloplegic spherical equivalent (CSE) was highly hyperopic (+3.55 diopters [D] ± 2.39 D). The mean noncycloplegic spherical equivalent (nCSE) was +0.58 D ± 2.32 D. The high reliability of the refractive measurements was demonstrated by high correlations between examiners (CSE: OD, r = 0.96; OS, r = 0.97; nCSE: OD, r = 0.94; OS, r = 0.93 OS) and between eyes (CSE: examiner 1, r = 0.94; examiner 2, r = 0.95; nCSE: examiner 1, r = 0.95; examiner 2, r = 0.97). The correlation between CSE and nCSE was much lower (examiner 1: OD, r = 0.76; OS, r = 0.73; examiner 2: OD, r = 0.72; OS, r = 0.70). Prevalence of astigmatism was very low (1.6% ≥ 1.0 D). The level of hyperopia was very high in these infants, and the offsetting tonic accommodation demonstrated by the difference between CSE and nCSE was much higher than in any previous report. Low amounts of infantile hyperopia and high astigmatism are associated with future myopia in the West. The Chinese neonates in this study had high amounts of hyperopia and little astigmatism, yet they are at high risk to become myopic.