Systematic review and meta‐analysis on the agreement of non‐cycloplegic and cycloplegic refraction in children

Wilson, Salma; Ctori, Irene; Shah, Rakhee; Suttle, Catherine; Conway, Miriam L.

doi:10.1111/opo.13022

Cited by 29 publications

(18 citation statements)

References 59 publications

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“…The results of the current study indicate that for the spherical equivalent, there is a risk of myopic overcorrection without the use of cyclopentolate. This is well known for a variety of measurement techniques that do not require the direct cooperation of the subject, such as autorefraction,18 19 28–34 retinoscopy28 35 and photorefraction 36 37. A similar trend can be observed for wavefront-assisted objective refraction.…”

Section: Discussionsupporting

confidence: 56%

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

Müller,

Chen,

Ohlendorf

et al. 2024

BMJ Open Ophth

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ObjectiveThis 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.MethodsA 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, J0and J45, and Bland-Altman plots were used to analyse the agreement between methods.ResultsLinear 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.ConclusionThe 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.Trial registration numberNCT05288335.

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Section: Discussionsupporting

confidence: 56%

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

Müller,

Chen,

Ohlendorf

et al. 2024

BMJ Open Ophth

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“…Meta-analysis and study on children aged 4 to 15 showed that, non-cycloplegia refraction resulted in a mean SE difference of −0.60D compared to cycloplegia, with greater differences observed in younger participants and in eyes with hyperopic refraction degree [47,48]. Therefore, the influence of noncycloplegia data on this study could be limited.…”

Section: Discussionmentioning

confidence: 89%

The rate of orthokeratology lens use and associated factors in 33,280 children and adolescents with myopia: a cross-sectional study from Shanghai

Zhao

Wang

Xie

et al. 2023

Eye

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Objectives To investigate the rate of orthokeratology lens (ortho-k lens) use and its associated factors in children and adolescents with myopia. Methods Cross-sectional study. Children from 104 primary and middle schools in Shanghai were enrolled by cluster sampling. Ophthalmic examinations were conducted and information was obtained using questionnaires for associated factors analysis. Results A total of 72,920 children and adolescents were included, among which 32,259 were the potential population for ortho-k lens use. A total of 1021 participants used ortho-k lenses, equating to a use rate of 1.4% in the total population and 3.1% in the potential population. Age (OR 0.91, 95% CI: 0.88–0.95, p < 0.001), BMI (≥95th percentile: OR 0.48, 95% CI: 0.35–0.66, p < 0.001), age at initiation of refractive correction (≤12 years: OR 1.75, 95% CI: 1.31–2.33, p < 0.001), and parental myopia (either: OR 2.09, 95% CI: 1.58–2.75, p < 0.001; both: OR 3.94, 95% CI: 3.04–5.11, p < 0.001) were independently associated with ortho-k lens use. Of the ortho-k lenses users, 12.4% had a logMAR CVA of ≥0.3. A correction target (SE) of ≤−3.0 D (OR 2.05, 95% CI: 1.38–3.05, p < 0.001) and a sleeping duration of ≤6 h (OR 4.19, 95% CI: 2.03–8.64, p < 0.001) were factors independently associated with CVA ≥ 0.3. Conclusions A certain proportion of children and adolescents in Shanghai chose to wear ortho-k lenses, related to the situation of parents and children themselves. Health education and follow-ups should be strengthened to ensure orthokeratology application quality.

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“…Cycloplegic refraction is well recommended in young children [17], whereas there is no consensus on whether the ocular components be measured before or after cycloplegia. In clinical practice, ocular biometry could be performed during the intervals of applying cycloplegic drops to save time.…”

Section: Discussionmentioning

confidence: 99%

Comparisons of Using Cycloplegic Biometry Versus Non-cycloplegic Biometry in the Calculation of the Cycloplegic Refractive Lens Powers

et al. 2022

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Introduction This study investigated the difference between the calculation of cycloplegic crystalline lens power (LP) using non-cycloplegic and cycloplegic biometry data in children, and associated factors were explored. Methods A total of 821 children were enrolled and only right eye was analyzed. The corneal radii (CR), corneal power (CP), anterior chamber depth (ACD), lens thickness (LT), and axial length (AL) before and after cycloplegia were obtained using IOLMaster 700. Anterior segment length (ASL) was defined as ACD plus LT. The cycloplegic LP was calculated with Bennett’s formula. In addition, LP calculated with cycloplegic data was defined as cLP, otherwise it was defined as nLP. The ΔLP (defined as the value as cLP minus nLP) was compared among age, gender, and refractive states groups. Associated factors of ΔLP and |ΔLP| were explored by Pearson’s correlation and multivariate linear regression. Results The mean age of the 821 subjects was 9.83 ± 2.97 years with a mean spherical equivalent refraction (SER) of − 1.06 ± 2.12 D. Overall, the ACD, LT, and ASL were significantly affected by cycloplegia agent (all p < 0.001; paired t test). Conversely, no statistically significant differences were documented in AL, CP, or AL/CR ratio before and after inducing cycloplegia ( p = 0.917, p = 0.515, and p = 0.549, respectively). Significant difference was found between nLP and cLP (21.24 ± 1.58 D vs 21.43 ± 1.92 D, p = 0.001). The mean ΔLP was 0.11 ± 0.87 D (range from − 7.01 D to 7.08 D). Significant change in LP was found in low and medium groups, respectively (0.13 ± 0.81 D, p = 0.001; 0.11 ± 0.48 D, p = 0.043). In the multiple regression analysis, |ΔLP| was exclusively associated with ΔASL ( β = 0.172, [95% CI 0.112–0.300], p < 0.001). Conclusion Our results indicated that using cycloplegic biometry could lead to an overestimation in LP for low and moderate myopia eyes. This finding is likely to facilitate the refractive development research in children. Trial Registration ClinicalTrials.gov identifier, NCT05247099. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00569-w.

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Systematic review and meta‐analysis on the agreement of non‐cycloplegic and cycloplegic refraction in children

Cited by 29 publications

References 59 publications

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

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

The rate of orthokeratology lens use and associated factors in 33,280 children and adolescents with myopia: a cross-sectional study from Shanghai

Comparisons of Using Cycloplegic Biometry Versus Non-cycloplegic Biometry in the Calculation of the Cycloplegic Refractive Lens Powers

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