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Difference Between Cycloplegic and Noncycloplegic Refraction in Young Adults With Myopia
TAKE-HOME MESSAGE
- In a cohort of young individuals with myopia, primarily Asian adults (age, 18–26 years), the comparison of cycloplegic versus noncycloplegic autorefraction indicated a mean difference of −0.20 (generally, noncycloplegic refraction resulted in more myopic refraction).
- The authors suggest that noncycloplegic autorefraction is a good starting point for refraction in this population. This information may be useful for the preoperative assessment of patients undergoing refractive surgery.
abstract
This abstract is available on the publisher's site.
Access this abstract nowSIGNIFICANCE
This study explores the difference between cycloplegic and noncycloplegic refraction in young adult myopes.
PURPOSE
From the available literature, it is unclear whether cycloplegia is necessary when refracting young adults. This study investigates the agreement between noncycloplegic autorefraction and cycloplegic autorefraction and investigates factors affecting the agreement between the two methods.
METHODS
In total, 125 myopes with ages ranging between 18 and 26 years were included from Australia and Vietnam. Each participant underwent noncycloplegic autorefraction and cycloplegic autorefraction. Cycloplegia was induced with 1% ophthalmic tropicamide.
RESULTS
The mean spherical equivalent difference (95% confidence interval) between noncycloplegic autorefraction and cycloplegic autorefraction was -0.20 D (-0.25 to -0.14 D; t124 = -7.18, p<0.0001 ) . A mean difference of >0.25 D was seen in 46.8% of eyes. The lower and upper limits of agreement were -0.80 and 0.41 D, respectively. With univariate analysis, factors including age, degree of refractive error, accommodation amplitude, and distance phorias showed no impact on the average difference between cycloplegic autorefraction and noncycloplegic autorefraction. Yet, eyes with near exophoria ( F2,120 = 6.63, p=0.0019) and Caucasian eyes ( F3,121 = 2.85, p=0.040) exhibited the smallest paired differences. However, in the multivariate analysis, only near exophoria was associated with a lower mean difference. A significantly smaller proportion (34.9%) of eyes with near exophoria had a paired difference of -0.25 D or more compared with esophoria (50%) and orthophoria (65%; χ2 = 6.6, p=0.038).
CONCLUSIONS
Noncycloplegic autorefraction results in more myopic refractive error than cycloplegic autorefraction in young adults.
Additional Info
Disclosure statements are available on the authors' profiles:
Comparison between cycloplegic and noncycloplegic refraction in young adult myopes
Optom Vis Sci 2024 Jul 01;101(7)470-476, HA Khan, H Tran, TJ Naduvilath, N Tahhan, T Ha, P SankaridurgFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors make an important point at the outset that, "in a clinical eye care setting, noncycloplegic subjective refraction techniques are more appropriate for prescribing refractive correction that is tailored to an individual's habitual noncycloplegic state"; however, "in a research setting and/or for the accurate diagnosis of myopia and monitoring of myopia progression, autorefraction under cycloplegia is considered the gold standard for precise distance refractive error measurement in children and young adults." This distinction between the clinical relevance of prescribing for individual patients and the more generalized research findings in population studies should always be kept in mind.
Having said that, this study corroborates what has been previously reported, that the mean difference between cycloplegic and noncycloplegic autorefraction was −0.13 D for patients with exophoria at near. This is important since the majority of patients with myopia exhibit near-point exophoria, and the difference between manifest and cycloplegic refractive values is, therefore, not clinically significant, being less than 0.25 D. This means that, from a population standpoint, cycloplegic refraction is not essential for young adults with myopia aged 18 to 26 years. However, the difference between manifest and cycloplegic refraction does rise to the level of clinical significance for patients with near-point orthophoria (−0.31 D) or esophoria (−0.35 D).