Abstract
Purpose: Use of appropriate cycloplegic agent is an essential area of management in children with strabismus and refractive error. This study was designed to audit our own department’s understanding and practice with respect to cycloplegia. Methods: Children in age group of 0 - 12 years with refractive errors and strabismus were evaluated with respect to four parameters: adherence to cycloplegic refraction (group-I), choice of cycloplegic agent (group-II), dosage of cycloplegia (group-III) and duration of cycloplegia (group-IV). Following the initial audit, the hospital audit committee evaluated the results; thereafter concerned staff was educated and aidememoires of the dilatation protocol were introduced; a second audit cycle was carried out after 3 months. Results: First and second audit cycle included 334 children (mean age 6.2 ± 2.2 years) and 436 children (mean age 7.25 ± 2.9 years) respectively. A statistically significant improvement was found in all four parameters in the second audit cycle: adherence to dilation protocol (82.3% in first cycle to 94.3% in second cycle; p = 0.001), choice of cycloplegic agent (77% in the first cycle to 94.8% in the second cycle; p = 0.001), dosage of cycloplegic agent (84% in the first cycle to 96.3% in the second cycle; p = 0.001) and duration of cycloplegic agents (65% in the first cycle to 97.5% in the second cycle; p = 0.001 for CTC and 71.8% in the first cycle to 98% in the second cycle; p = 0.001 for Tropicamide). Conclusions: A complete audit cycle demonstrated a statistically significant improvement in all four parameters related to cycloplegic refraction in children. Regular auditing coupled with targeted interventions aimed to maintain the “best practice guidelines” for determination of refractive errors in children could prove effective in improving standards of clinical practice.
Highlights
Cycloplegic refraction has been described as an essential part of the paediatric ophthalmic assessment [1] and the cornerstone of strabismus evaluation [2]
A full audit cycle was planned in 2 cycles; in the first cycle data was collected over a 4-week period, following which a 3 month period was allowed to incorporate implemented changes and a second audit cycle was planned
Cycloplegic refraction was performed in 275 (82.3%) children while in the remaining 59 (17.7%) glasses were prescribed based on dry refraction
Summary
Cycloplegic refraction has been described as an essential part of the paediatric ophthalmic assessment [1] and the cornerstone of strabismus evaluation [2]. An ideal cycloplegic agent removes the detrimental effects of accommodation on measurement repeatability revealing the correct and appropriate refractive error. The primary differences in the action of the various cycloplegics used in the clinical practice are the time course for the onset and recovery of cycloplegia and the depth of cycloplegia. In order to obtain reliable measurements following instillation of a particular cycloplegic drug, there is a time limit for maximum cycloplegia to be reached and for refraction to be carried out. The use of appropriate cycloplegic agent in appropriate dosage and for appropriate duration, for different categories of children with strabismus and refractive error is an important and a challenging area of paediatric ophthalmology
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