# Method comparison and overview of refractive measurements in children: implications for myopia management

## TL;DR

This study compares different methods of measuring vision in myopic children and finds that using wavefront-based refraction without cycloplegic drops can lead to more myopic results.

## Contribution

The study provides new insights into the impact of cyclopentolate and refraction levels on agreement between refraction methods in children.

## Key findings

- Wavefront-based refraction without cycloplegia leads to more myopic measurements compared to subjective refraction.
- The bias between wavefront and subjective refraction increases with higher myopic refractive error.
- Cycloplegia reduces the clinically relevant bias in wavefront-based refraction for higher myopia.

## Abstract

This study investigated the agreement between objective wavefront-based refraction and subjective refraction in myopic children. It also assessed the impact of cyclopentolate and refraction levels on the agreement.

A total of 84 eyes of myopic children aged 6–13 years were included in the analysis. Non-cycloplegic and cycloplegic objective wavefront-based refraction were determined and cycloplegic subjective refraction was performed for each participant. The data were converted into spherical equivalent, J0 and J45, and Bland-Altman plots were used to analyse the agreement between methods.

Linear functions were used to determine the dependency between the central myopic refractive error and the difference between the method of refraction (=bias). The influence of central myopia was not clinically relevant when analysing the agreement between wavefront results with and without cyclopentolate (comparison 1). The bias for wavefront-based minus subjective spherical equivalent refraction (comparison 2) was ≤−0.50 D (95% limits of agreement −0.010 D to −1.00 D) for myopia of −4.55 D and higher when cycloplegia was used (p<0.05). When no cyclopentolate was used for the wavefront-based refraction (comparison 3), the bias of −0.50 D (95% limits of agreement −0.020 D to −0.97 D) was already reached at a myopic error of −2.97 D. Both astigmatic components showed no clinically relevant bias.

The spherical equivalent, measured without cycloplegic agents, led to more myopic measurements when wavefront-based refraction was used. The observed bias increased with the amount of myopic refractive error for comparisons 2 and 3, which needs to be considered when interpreting wavefront-refraction data.

NCT05288335.