# Comparison of Cycloplegic and Non-Cycloplegic Refraction in School-Aged Children: A Cross-Sectional, Observational Study

## TL;DR

This study compares eye refraction measurements in children with and without eye drops to relax the eye muscles, finding that using drops gives more accurate results.

## Contribution

The study provides empirical evidence on the accuracy of cycloplegic versus non-cycloplegic refraction in children.

## Key findings

- Non-cycloplegic refraction overestimated myopia and underestimated hypermetropia in children.
- Cycloplegic refraction showed a statistically significant correlation with non-cycloplegic measurements.
- Cycloplegic refraction is recommended for precise refractive error assessment in children.

## Abstract

Aim

The aim of the study was to evaluate the differences between cycloplegic and non-cycloplegic refraction in school-aged children.

Materials and methods

This cross-sectional, observational study was conducted at a tertiary care institute in central India, comprising 110 children aged 5-15 years. Visual acuity was recorded, and anterior segment examination was performed. Undilated autorefraction was done using an autokerato-refractometer. The participants were cyclopleged using eye drop cyclopentolate 1%, one drop every 15 minutes in both eyes, for over one hour. The vertical pupillary diameter was measured using slit lamp biomicroscopy. Cycloplegic autorefraction was done using the same autokerato-refractometer. Autorefraction values of the right eye were recorded to eliminate bias.

Results

The mean spherical equivalent (SE) in dioptres without cycloplegia was -0.54, and with cycloplegia was +0.18. The mean ± SD of the difference between cycloplegic and non-cycloplegic refraction was 0.72 ± 0.72. Without cycloplegia, SE determined 69 (62.7%) participants as myopic, six (5.5%) as emmetropic, and 35 (31.8%) as hypermetropic. Whereas, with cycloplegia, SE determined 45 (40.9%) as myopic, two (1.8%) as emmetropic, and 63 (57.3%) as hypermetropic.

Conclusion

The study discovered a strong correlation between SE (with cycloplegic) and SE (without cycloplegic), and this correlation was statistically significant. Myopia was overestimated, and hypermetropia was underestimated with non-cycloplegic refraction compared to cycloplegic refraction. Hence, cycloplegic refraction is recommended for the precise measurement of refractive error in children.