JUL 01, 2022
Noncycloplegic Measurements in Students
By Lynda Seminara
Selected by Russell N. Van Gelder, MD, PhD
Refractive Mgmt/Intervention
Journal Highlights
Ophthalmology, July 2022
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Measuring cycloplegic refraction in school settings can pose logistical and consent challenges, leading to suboptimal participation in school-based vision programs. Although noncycloplegic refraction in the same setting is less complicated, it’s unclear if this parameter is a viable starting point for prescribing glasses. Guo et al. explored differences between autorefraction measurements, with and without cycloplegia, among predominantly Black and Hispanic students in Chicago. They found that spherical equivalents (SEs) for cycloplegic and noncycloplegic measurements varied by less than a diopter in three-fourths of their study group. Concordance was more likely in myopic and older participants.
This cross-sectional review included 11,119 participants (mean age, 10.8 ± 4 years). In addition to documenting differences between cycloplegic and noncycloplegic measurements for each participant, the authors explored factors linked to significant discrepancies between the two types of measurements. They collected demographic data during eye exams and performed autorefraction before and after the cycloplegic state. Myopia, hyperopia, and astigmatism were established from cycloplegic and noncycloplegic measurements.
Slightly more than half (52.4%) of the participants were female, 62.9% were Black, and 32.3% were Hispanic. Noncycloplegic SE measurements were found to be .65 ± 1.04 D more myopic than cycloplegic SE measurements. After adjusting for demographics and refractive error, individuals with at least 1 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) tended to be younger than 5 years of age (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18-1.79) or between 5 and 10 years of age (OR, 1.32; 95% CI, 1.18-1.48). An SE difference of at least 1 D was more common in Hispanics (OR, 1.23; 95% CI, 1.10-1.36) and in those with hyperopia (OR range, 4.20-13.31). Factors linked to a cylindrical difference of at least .75 D (5.1%) between refractions were young age (<5 years); male sex; the presence of mild, moderate, or high myopia; and the presence of moderate to high hyperopia.
Understanding differences in the measurements used to assess refractive error may be helpful for future studies and school-based vision programs, said the authors. They cautioned that the generalizability of their findings may be limited by the racial/ethnic makeup of their study cohort.
The original article can be found here.