Cycloplegic Refraction Most Accurately Detects Refractive Error in Children

Cycloplegic refraction is the most accurate method of measuring refractive error in children younger than 12 years, according to a study published in Ophthalmic and Physiological Optics. Non cycloplegic autorefraction, however, can accurately estimate refractive error in young children with low to moderate levels of hyperopia.

Researchers performed an  electronic database search for comparative studies exploring refractions performed on children under both non cycloplegic and cycloplegic conditions (using only cyclopentolate hydrochloride). Overall, 10 studies consisting of 2724 participants were included in the meta-analysis. Participants underwent non cycloplegic and cycloplegic refractions using 3 autorefractors. The mean difference between cycloplegic and non cycloplegic conditions was not evaluated for 1 device due to its intended use on undilated pupils. The team also performed cycloplegic retinoscopy. The primary objective was to determine the diagnostic agreement of non cycloplegic and cycloplegic refraction in children.

A comparison between the non cycloplegic autorefractor and the 2 devices that could be used under cycloplegic conditions revealed no statistically significant differences when testing for overall effect (Z=0.34; P =.74). According to the report, the pooled mean difference (MD) was −0.08 diopters ([D]; 95% CI, −0.54D−0.38 D) with a prediction interval of −1.72D to +1.56 D, indicating minimal inaccuracies under non cycloplegic conditions. 

However, when investigators compared non-cycloplegic conditions using each device with cycloplegic conditions using the same device (except for the non cycloplegic device), they noted significant differences in values between the 2 methods (P <.001 for both devices).

Researchers acknowledge the usefulness of the non cycloplegic autorefractor in measuring refractive error in children with low to moderate levels of hyperopia, but stress that cycloplegic refraction should remain the professional standard. “Our findings suggest that when compared with [cycloplegic] retinoscopy, [non cycloplegic] autorefraction is an inaccurate method of measuring refractive error, as it often results in an overestimate of myopia and a wide range of effect sizes,” according to the report.

Study limitations include a high or unknown risk of bias in some studies, an inability to conduct a sensitivity analysis, and a lack of data concerning refractive error types.