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  • Noncycloplegic Measurements in Students

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    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.