Evaluation of the Accuracy of Non-Cycloplegic Subjective Refraction in Children with Incipient Myopia

Abstract

Objective: To determine if non-cycloplegic refraction on children with incipient myopia is accurate; to compare the differences in non-cycloplegic subjective refraction, cycloplegic autorefraction and cycloplegic subjective refraction in children with incipient myopia. Related factors that influence these measurements were analyzed to provide evidence for the preferred refractive method in the clinic. Methods: This was a prospective clinical study. Ninety children with incipient myopia aged from 9 to 13 years were included from Eye Hospital, Wenzhou Medical University from May to September 2017. Subjective refraction, phoria, NRA/PRA, and accommodative lag were measured before cycloplegia. 1% cyclopentolate was used 3 times every five minutes. After 45 minutes, measurements were taken with autorefraction (CAR) and subjective refraction (CSR). Only the values of the right eyes were assessed using ANOVA and multiple linear regression for statistical analysis. Results: The mean value of the spherical equivalent (SE) of non-cycloplegic subjective refraction was -1.09±0.30 D. The mean values of cycloplegic autorefraction and subjective refraction were -1.27±0.40 D and -1.09±0.33 D, respectively. There was no statistically significant difference between non-cycloplegic and cycloplegic subjective refraction (P>0.05). The cylinder component from cycloplegic autorefraction was significantly higher than that from subjective refraction (P 0.05). Multiple linear regression analysis showed that the difference in diopter between SR and CAR was not associated with age (β=0.044, P=0.699), refractive error (β=0.091, P=0.430), phoria (β=-0.059, P=0.599), accommodative lag (β=-0.064, P=0.576), or positive relative accommodation (β=0.043, P=0.709). Conclusions: Excluding accommodation and vergence anomalies, most children with incipient myopia can be measured accurately with non-cycloplegic subjective refraction. Key words: subjective refraction; cycloplegic refraction; accommodation; myopic; children