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Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study

  • Clinical Investigation
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Abstract

Purpose

To compare the differences between cycloplegic and noncycloplegic refraction as well as associated factors in grade one students of primary schools, and explore the effectiveness of noncycloplegic refraction for refractive error screening.

Study design

Cross-sectional study.

Methods

A school-based study of 1856 students was conducted in Lhasa, Tibetan Plateau, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P at a 5-min interval. Autorefraction was performed under both cycloplegic and noncycloplegic conditions. Bland–Altman analysis, receiver operating characteristic curve analysis, univariate and multiple linear regression models were used for analysis.

Results

Of the 1856 children enrolled, 1830 (98.60%) completed all procedures. The average age was 6.83 ± 0.46 years. 965 (52.73%) children were boys and 1737 (94.92%) were Tibetan. Overall, there was a significant difference between cycloplegic and noncycloplegic SE of 0.90 ± 0.76D (P < 0.001). However, the intra-class coefficient correlation (ICC) for cylinder between these two methods was high (ICC = 0.941, 95% CI, 0.935–0.946). Larger differences between cycloplegic and noncycloplegic SE were associated with hyperopic RE and higher cylindrical value (P < 0.001). The prevalence of myopia, emmetropia and hyperopia with and without cycloplegia was (3.93% vs 14.59%), (9.95% vs 45.8%) and (86.21% vs 39.56%), respectively. Myopia, emmetropia and hyperopia based on noncycloplegic refraction was defined as SE ≤ − 0.625D, − 0.625 < SE ≤ 0D, and SE > 0D, respectively.

Conclusions

Lack of cycloplegia leads to underestimation of hyperopia, with overestimation of myopia and emmetropia. Larger hyperopic refraction exhibited greater difference between cycloplegic and noncycloplegic refraction.

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References

  1. Sun YY, Shi-Fei W, Shi-Ming L, Jian-Ping H, Xiao-Hui Y, Kai C, et al. Cycloplegic refraction by 1% cyclopentolate in young adults: is it the gold standard? The Anyang University Students Eye Study (AUSES)? Br J Ophthalmol. 2018;2018:312199.

    Google Scholar 

  2. Kulp MT, Ying G-S, Huang J, Maguire M, Quinn G, Ciner EB, et al. Accuracy of noncycloplegic retinoscopy, retinomax autorefractor, and suresight vision screener for detecting significant refractive errors. Invest Ophthalmol Vis Sci. 2014;55:1378–85.

    Article  Google Scholar 

  3. Ip JM, Robaei D, Kifley A, Jie JW, Mitchell P. Prevalence of hyperopia and associations with eye findings in 6- and 12-year-olds. Ophthalmology. 2008;115:678–85.

    Article  Google Scholar 

  4. Giordano L, Friedman DS, Repka MX, Katz J, Tielsch JM. Prevalence of refractive error among preschool children in an urban population: the baltimore pediatric eye disease study. Ophthalmology. 2009;116:739–46.

    Article  Google Scholar 

  5. Naidoo KS, Leasher J, Bourne RR, Flaxman SR, Resnikoff S. Global vision impairment and blindness due to uncorrected refractive error, 1990–2010. Optom Vis Sci. 2016;93:227–34.

    Article  Google Scholar 

  6. Kaur G, Koshy J, Thomas S, Kapoor H, Bedi S. Vision screening of school children by teachers as a community based strategy to address the challenges of childhood blindness. J Clin Diagn Res. 2016;10:NC09-NC14.

    PubMed  PubMed Central  Google Scholar 

  7. Kalikivayi V, Naduvilath TJ, Bansal AK, Dandona L. Visual impairment in school children in Southern India. Indian J Ophthalmol. 1997;45:129–34.

    CAS  PubMed  Google Scholar 

  8. Jorge J, Queiros A, Gonzálezméijome J, Fernandes P, Almeida JB, Parafita MA. The influence of cycloplegia in objective refraction. Ophthalmic Physiol Opt. 2010;25:340–5.

    Article  Google Scholar 

  9. Zhao J, Mao J, Luo R, Li F, Pokharel GP, Ellwein LB. Accuracy of noncycloplegic autorefraction in school-age children in China. Optom Vis Sci. 2003;81:49–55.

    Article  Google Scholar 

  10. Choong YF, Chen A-H, Goh P-P. A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children. Am J Ophthalmol. 2006;142:68–74.

    Article  Google Scholar 

  11. Morgan IG, Rose KA, Ellwein LB, Group TRESiCS. Is emmetropia the natural endpoint for human refractive development? An analysis of population-based data from the refractive error study in children (RESC). Acta Ophthalmol. 2010;88:877–84.

  12. Morgan IG, Iribarren R, Fotouhi A, Grzybowski A. Cycloplegic refraction is the gold standard for epidemiological studies. Acta Ophthalmol. 2015;93:581–5. https://doi.org/10.1111/aos.12642.

    Article  PubMed  Google Scholar 

  13. Chua W-H, Balakrishnan V, Chan Y-H, Tong L, Ling Y, Quah B-L, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006;113:2285–91.

    Article  Google Scholar 

  14. Gong Q, Janowski M, Luo M, Wei H, Liu L. Efficacy and adverse effects of atropine in childhood myopia: a meta-analysis. Jama Ophthalmol. 2017;135:624–30.

    Article  Google Scholar 

  15. Wakayama A, Nishina S, Miki A, Utsumi T, Sugasawa J, Hayashi T, et al. Incidence of side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in Japanese children: a multicenter study. Jpn J Ophthalmol. 2018;62:531–6.

    Article  CAS  Google Scholar 

  16. Hu YY, Feng WJ, Liang LT, Hui W, Wei S, Rong WX, et al. Effect of cycloplegia on the refractive status of children: The Shandong children eye study. PLoS ONE. 2015;2015:10. https://doi.org/10.1371/journal.pone.0117482.

    Article  CAS  Google Scholar 

  17. Prabhakar SK, Prathiba KS, Angadhi AP, Kumar SA, Reddy AR, Shamsiya NA. Cycloplegic influence on the accuracy of autorefractometer in myopic and hyperopic children. Nepal J Ophthalmol. 2015;7:148–58.

    Article  CAS  Google Scholar 

  18. Loewen N, Barry JC. The use of cycloplegic agents. Results of a 1999 survey of German-speaking centers for pediatric ophthalmology and strabology. Strabismus. 1999;2000(8):91–9.

    Google Scholar 

  19. Fotouhi A, Morgan IG, Iribarren R, Khabazkhoob M, Hashemi H. Validity of noncycloplegic refraction in the assessment of refractive errors: the Tehran Eye Study. Acta Ophthalmol. 2012;90:380–6.

    Article  Google Scholar 

  20. Hashemi H, Khabazkhoob M, Asharlous A, Soroush S, Yekta A, Dadbin N, et al. Cycloplegic autorefraction versus subjective refraction: the Tehran Eye Study. Br J Ophthalmol. 2016;100:1122–7.

    Article  Google Scholar 

  21. Chen W, Fu J, Meng Z, Li L, Su H, Dai W, et al. Lhasa childhood eye study: the rationale, methodology, and baseline data of a 5 year follow-up of school-based cohort study in the Tibetan plateau region of Southwest China. BMC Ophthalmol. 2020;2020:20.

    Google Scholar 

  22. Li S-M, Liu L-R, Li S-Y, Ji Y-Z, Fu J, Wang Y, et al. Design, methodology and baseline data of a school-based cohort study in Central China: the Anyang Childhood Eye Study. Ophthalmic Epidemiol. 2013;20:348–59.

    Article  CAS  Google Scholar 

  23. Zhou WJ, Zhang YY, Li H, Wu YF, Xu J, Lv S, et al. Five-year progression of refractive errors and incidence of myopia in school-aged children in Western China. J epidemiol. 2016;26:386–95.

    Article  CAS  Google Scholar 

  24. Huynh SC, Kifley A, Rose KA, Morgan I, Heller GZ, Mitchell P. Astigmatism and its components in 6-year-old children. Invest Ophthalmol Vis Sci. 2006;47:55–64.

    Article  Google Scholar 

  25. Hopkins S, Sampson GP, Hendicott P, Lacherez P, Wood JM. Refraction in children: a comparison of two methods of accommodation control. Optom Vis Sci. 2012;89:1734–9.

    Article  Google Scholar 

  26. Funarunart P, Tengtrisorn S, Sangsupawanich P, Siangyai P. Accuracy of non-cycloplegic refraction in primary school children in Southern Thailand. J Med Assoc Thai. 2009;92:806–11.

    PubMed  Google Scholar 

  27. Lin Z, Vasudevan B, Ciuffreda KJ, Zhou HJ, Mao GY, Wang NL, et al. The difference between cycloplegic and non-cycloplegic autorefraction and its association with progression of refractive error in Beijing urban children. Ophthalmic Physiol Opt. 2017;37:489–97.

    Article  Google Scholar 

  28. Sankaridurg P, He X, Naduvilath T, Lv M, Ho A, Smith E 3rd, et al. Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children. Acta Ophthalmol. 2017;95:e633–40.

    Article  CAS  Google Scholar 

  29. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J chiropr med. 2016;15:155–63.

    Article  Google Scholar 

  30. Fotedar R, Rochtchina E, Morgan I, Wang JJ, Mitchell P, Rose KA. Necessity of cycloplegia for assessing refractive error in 12-year-old children: a population-based study. Am J Ophthalmol. 2007;144:307–9.

    Article  Google Scholar 

  31. Zhu D, Wang Y, Yang X, Yang D, Pan CW. Pre- and postcycloplegic refractions in children and adolescents. PLoS ONE. 2016;2016:11. https://doi.org/10.1371/journal.

    Article  Google Scholar 

  32. Yingyan MXH, Haidong Z, Lina L, Xiaomei Q, Jianfeng Z. Myopia screening: combining visual acuity and noncycloplegic autorefraction. Optom Vis Sci. 2013;90:1479–85.

    Article  Google Scholar 

  33. Wu JF, Bi HS, Wang SM, Hu YY, Wu H, Sun W, et al. Refractive error, visual acuity and causes of vision loss in children in Shandong, China. The Shandong Children Eye Study. PLoS ONE. 2013;8:e82763. https://doi.org/10.1371/journal.pone.0082763.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lian-Hong PLC, Qin L, Ning K, Jing F, Shu Z, Jun X, Wei-Jiang Y, Yan X, Hui SZ-QY. Refractive status and prevalence of refractive errors in suburban school-age children. Int J Med Sci. 2010;7:342–53.

  35. Tideman JWL, Polling JR, Hofman A, Jaddoe VW, Mackenbach JP, Klaver CC. Environmental factors explain socioeconomic prevalence differences in myopia in 6-year-old children. Br J Ophthalmol. 2018;102:243–7.

    Article  Google Scholar 

  36. O’Donoghue L, McClelland JF, Logan NS, Rudnicka AR, Owen CG, Saunders KJ. Refractive error and visual impairment in school children in Northern Ireland. Br J Ophthalmol. 2010;94:1155–9.

    Article  CAS  Google Scholar 

  37. Yingyan MXQ, Xiaofeng Z. Age-specific prevalence of visual impairment and refractive error in children aged 3–10 years in Shanghai. China Invest Ophthalmol Vis Sci. 2016;57:6188–96.

    Article  Google Scholar 

  38. He JMZ, Yizhi L. Refractive error and visual impairment in urban children in Southern China. Invest Ophthalmol Vis Sci. 2004;45:793–9.

    Article  Google Scholar 

  39. You QS, Wu LJ, Duan JL, Luo YX, Liu LJ, Li X, et al. Prevalence of myopia in school children in greater Beijing: the Beijing Childhood Eye Study. Acta Ophthalmol. 2014;92:e398–406.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful for the support from the Lhasa city government and the Beijing Hoson Foundation for helping organize the survey. The study is supported by Special Topic of Clinical Application Research with Capital Characteristics (Z171100001017066); High-level health technicians in Beijing health system- Backbone of discipline (2015-3-023). I thank Professor Morgan IG, who gave advice on paper writing.

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Authors and Affiliations

  1. Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People’s Republic of China

    Lei Li, Jing Fu, Weiwei Chen, Zhaojun Meng, Yunyun Sun, Han Su, Yao Yao & Wei Dai

  2. Beijing Institute of Ophthalmology, Beijing, China

    Weiwei Chen

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  1. Lei Li
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Correspondence to Jing Fu.

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L. Li, None; J. Fu, None; W. Chen, None; Z. Meng, None; Y. Sun, None; H. Su, None; Y. Yao, None; W. Dai, None.

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Corresponding Author: Jing Fu

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Li, L., Fu, J., Chen, W. et al. Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study. Jpn J Ophthalmol 65, 526–536 (2021). https://doi.org/10.1007/s10384-021-00828-6

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  • DOI: https://doi.org/10.1007/s10384-021-00828-6

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