Availability of Cycloplegic Refraction in Children and Adolescents

So Hee Kim; Young Chun Lee

doi:10.3341/jkos.2020.61.3.274

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Kim and Lee: Availability of Cycloplegic Refraction in Children and Adolescents

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(3): 274-280.

Published online: 17 March 2020

DOI: https://doi.org/10.3341/jkos.2020.61.3.274

Availability of Cycloplegic Refraction in Children and Adolescents

So Hee Kim, MD, Young Chun Lee, MD, PhD

Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.

Address reprint requests to Young Chun Lee, MD, PhD. Department of Ophthalmology, Uijeongbu St. Mary's Hospital, #271 Cheonbo-ro, Uijeongbu 11765, Korea. Tel: 82-31-820-3022, Fax: 82-31-847-3418, yclee@cmcnu.or.kr

Received 30 August 2018 Revised 29 January 2019 Accepted 21 February 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare non-cycloplegic and cycloplegic refractive errors and evaluate the utility of cycloplegia in Korean children and young adolescents.

Methods

An anterospective study including 406 outpatients was conducted from September 2015 to December 2017. Pre and post-cycloplegic refractive errors for both eyes were measured using Ocucyclo® and Mydrin P® with an auto-refractor. Patients were divided into different groups according to age: group 1 (< 4 years), group 2 (4–6 years), group 3 (6–8 years), group 4 (8–10 years) and group 5 (< 20 years).

Results

A total of 203 patients were studied. Standard deviation (sphere post-pre) was 1.26 ± 1.02 diopters significant in all age groups (p < 0.05). The mean difference decreased with increasing age (r = 0.207, p < 0.05), however, 9% of group with age greater than 10 years old still had manifest refraction-cycloplegic refraction (MR-CR) difference greater than 2 diopters. There were no significant cylindrical or axial component value difference before and after cycloplegia (p = 0.071). Significantly greater MR-CR differences were observed in hypermetropes ≥ 6 years old and myopes ≤8 years old (p < 0.05). The prevalence of pre-cycloplegic eyes with anisometria was 22.6% and 32.6%, a total of 7.39% regressed after cycloplegia (p > 0.05).

Conclusions

After CR hyperopic shift was observed in all age groups. In patients with age greater than 10 years old, although statistically not significant, anisometropia and pseudomyopia still existed. Thus cycloplegic refraction should be performed in young adolescent to precisely measure and correct refractive error and avoid overcorrection.

Keywords: Cycloplegic refraction, Refractive errors

Figures and Tables

Figure 1

Distribution of diopter difference after cycloplegia according to age group. D = diopters.

Table 1

Changes in manifest and cycloplegic refraction by age

Values are means ± standard deviation unless otherwise indicated.

m:f = male:female; SE: spherical equivalent; MR = manifest refraction; D = diopters; CR = cycloplegic refraction.

^*Comparing mean SE (CR-MR) difference; ^†t-test; ^‡chi-squared test.

Table 2

Changes in the values of the spherical and cylindrical components before and after cycloplegia (both eyes)

Values are means ± standard deviation.

SE = spherical equivalent; SD = spherical difference; CD = cylinder difference; S = spherical; C = cyclinder.

^*t-test.

Table 3

Proportions of spherical, cylindrical, and axial differences before and after cycloplegia (both eyes)

Values are presented as the percent of eyes that differed.

SE = spherical equivalent.

^*Differences in spherical and cylindrical values ≥ ±1.00D; ^†differences in axial values ≥20°.

Table 4

Changes in sperical MR-spherical CR differences by the type of refractive error

Values are presented as means ± standard deviation.

Sperical MR-spherical CR = spherical difference before and after cycloplegic refraction; D = diopters.

^*Myopia was defined as ≥ −1.0D; ^†emmetropia as <−1.0D to <+2D; ^‡hyperopia as ≥ +2D; ^§age ≤8 years, p < 0.05; ^∥age ≥6 years, p < 0.05; ^#t-test.

Table 5

Comparison of MR-CR difference according to strabismus type

Values are presented as mean ± standard deviation.

XT = exotropia; ET = esotropia; CR = cycloplegic refraction; MR = manifest refraction; MR-CR = spherical difference of pre-post cycloplegic refraction.

^*t-test; ^†chi-square test.

Table 6

Percentage of true myopia according to age after cycloplegia (≥6 years)

Values are presented as number (%) unless otherwise indicated. Good UCVA: Age ≤8 years old were showed UCVA ≥0.6. Age >8 years old were showed UCVA ≥0.8. Spherical difference ≥±0.5D were considered significant.

UCVA = uncorrected visual acuity; CR = cycloplegic refraction.

Table 7

Percentage of subjects with astigmatism ≥1 diopter

Values are presented as % of number of eyes.

CR = cycloplegic refraction; MR = manifest refraction.

^*chi-square test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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