Abstract
PurposeTo determine the difference between cycloplegic and non-cycloplegic refractive error and its associated factors in Chinese children and adolescents with a high prevalence of myopia.MethodsA school-based study including 1565 students aged 6 to 21 years was conducted in 2013 in Ejina, Inner Mongolia, China. Comprehensive eye examinations were performed. Pre-and postcycloplegic refractive error were measured using an auto-refractor. For cycloplegic refraction, one drop of topical 1.0% cyclopentolate was administered to each eye twice with a 5-minute interval and a third drop was administered 15 minutes after the second drop if the pupil size was less than 6 mm or if the pupillary light reflex was still present.ResultsTwo drops of cyclopentolate were found to be sufficient in 59% of the study participants while the other 41% need an additional drop. The prevalence of myopia was 89.5% in participants aged over 12 years and 68.6% in those aged 12 years or younger (P<0.001). When myopia was defined as spherical equivalent (SE) of less than -0.5 diopter (D), the prevalence estimates were 76.7% (95% confidence interval [CI] 74.6–78.8) and 54.1% (95%CI 51.6–56.6) before and after cycloplegic refraction, respectively. When hyperopia was defined as SE of more than 0.5D, the prevalence was only 2.8% (95%CI 1.9–3.6) before cycloplegic refraction while it was 15.5% (95%CI 13.7–17.3) after cycloplegic refraction. Increased difference between cycloplegic and non-cycloplegic refractive error was associated with decreased intraocular pressures (P = 0.01).ConclusionsLack of cycloplegia in refractive error measurement was associated with significant misclassifications in both myopia and hyperopia among Chinese children and adolescents. Decreased intraocular pressure was related to a greater difference between cycloplegic and non-cycloplegic refractive error.
Highlights
Refractive error is a global health concern affecting a huge number of people[1,2,3,4,5] and is associated with various ocular morbidities[6,7,8]
When myopia was defined as spherical equivalent (SE) of less than -0.5 diopter (D), the prevalence estimates were 76.7% (95% confidence interval [CI] 74.6–78.8) and 54.1% (95%CI 51.6–56.6) before and after cycloplegic refraction, respectively
Lack of cycloplegia in refractive error measurement was associated with significant misclassifications in both myopia and hyperopia among Chinese children and adolescents
Summary
Refractive error is a global health concern affecting a huge number of people[1,2,3,4,5] and is associated with various ocular morbidities[6,7,8]. Feasibility and side effects of cycloplegia were challenges It has been well-established that generally myopia could be overestimated and hyperopia be underestimated if refraction was performed without cycloplegia, but to which extent the prevalence of refractive errors are overestimated or underestimated in different populations is different as the prevalence of refractive errors seems to be a major determinant for the difference between cycloplegic and non-cycloplegic refractive error. The Shandong Children Eye Study compared the prevalence of myopia before and after cycloplegia and found that non-cycloplegic refraction led to a misclassification of refractive error in a significant proportion of children.[17] the prevalence of myopia was not high in the Shandong Children Eye Study (37%) compared with other Chinese population with similar ages. Whether the finding could be extrapolated to other Chinese populations with predominately myopes remains unclear It remains unclear what factors the difference between cycloplegic and non-cycloplegic refractive error are associated with
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