Refractive SE progression was less after two years in children when the baseline cycloplegic refraction value was hyperopic. Photo: Getty Images.

Although it is agreed that cycloplegic refraction is essential in children, side effects such as difficulty in near work, photophobia and long waiting times can be frustrating. In actual clinical practice, when noncycloplegic refraction results show emmetropia and uncorrected visual acuity is good, it’s debatable whether or not cycloplegic refraction should be performed in these children. Researchers recently assessed the necessity in such patients by comparing the difference in spherical equivalent (SE) progression between children with emmetropic and hyperopic cycloplegic refraction over a two-year period. They found that, even if noncycloplegic refraction showed emmetropia, children with baseline cycloplegic values of emmetropia showed greater SE progression compared with those with hyperopia.

This retrospective medical record review evaluated 59 children under 10 years old. Refractive error was calculated as the average of the SE values of both eyes. According to the cycloplegic refraction results, children with emmetropia (-0.50D to 1.00D) were assigned to group one (n = 29), and those with hyperopia (≥1.00D) were assigned to group two (n=30). The prevalence of myopic progression was compared over two years. Correlations between final SE progression and baseline age and refractive error were analyzed, and multiple regression analysis was conducted.

Group one showed significant myopic changes compared with baseline at the one-year follow-up and was significantly myopic compared with group two at the two-year follow-up. Myopia prevalence was 51.7% in group one and 6.7% in group two after one year, and 61.1% and 16.7% after two years, respectively.

Correlation analysis showed that baseline age, baseline cycloplegic refraction and difference between cycloplegic refraction and noncycloplegic refraction showed significant correlations with the two-year SE progression. However, noncycloplegic refraction refractive error showed no significant correlation. In multiple regression analysis, baseline age and cycloplegic and noncycloplegic refraction difference showed a significant effect on SE progression for two years. When a noncycloplegic refraction value of 0.20D was set as the cutoff value to distinguish between the groups, sensitivity of 70% and specificity of 92% was obtained.

“Even if noncycloplegic refraction shows emmetropia, the prognosis of SE progression may differ depending on the cycloplegic refraction value, which must be performed when diagnosing refractive errors and predicting SE progression in children,” the authors concluded in their paper.

Kim Y, Kim T. Analysis of two-year spherical equivalent progression in emmetropic children with non-cycloplegic refraction: a retrospective chart review. BMC Ophthalmol. 2023;23(1):131.