The difference between cycloplegic and non-cycloplegic autorefraction and its association with progression of refractive error in Beijing urban children.

Abstract

To investigate the difference between cycloplegic and non-cycloplegic autorefraction and its association with the progression of refractive error in Beijing urban children. A total of 386 children aged 6-17 years were enrolled in the baseline investigation of the Beijing Myopia Progression Study in 2010. They were invited for follow-up vision examinations in the years 2011, 2012, and 2013, including cycloplegic (cyclopentolate 1%, three times) autorefraction. We investigated the difference between the cycloplegic spherical equivalent (SE) and the non-cycloplegic SE (DSE) provided by autorefraction and its association with refractive error progression. The progression of refractive error was defined as the difference between the cycloplegic SE at follow-up and at baseline. Two hundred and nineteen children (57%) with completed refractive data (mean ± standard deviation: -1.36 ± 2.44 D at baseline) were ultimately enrolled. The DSE reduced from 0.51 ± 0.72 D at baseline to 0.19 ± 0.43 D in the third year of follow-up (p = 0.01). The baseline DSE was positively associated with the children's baseline cycloplegic refraction (β = 0.193 dioptre dioptre-1 , p < 0.001). After further divided by refractive status, the DSE was consistently higher in the hyperopic group than in either the emmetropic or myopic groups at each follow-up (all p < 0.001). In the multivariate regression analysis, the myopic children with larger baseline DSE (β = -0.404 dioptre dioptre-1 , p = 0.01) exhibited more myopic refractive change. However, baseline DSE was not found to be a significant risk factor (relative risk, 95% confidence interval: 1.06, 0.79-1.41) for those with newly developed myopia. In this sample, the children's DSE was found to be increased as the hyperopic refraction increased. Furthermore, greater the DSE was associated with the progression of refractive error among the myopic children, but not with the onset of myopia.