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Purpose: This study was designed with the aim of providing practitioners with an evidence base to inform their clinical decision making as to when cycloplegic retinoscopy is necessary and when it might be appropriate to forgo. The study aimed to determine the age at which there ceases to be a clinically significant difference between cycloplegic and non‐cycloplegic retinoscopy and whether age, refractive error, habitual spectacle wear and accommodation influence the relationship. Methods: A single examiner carried out cycloplegic and non‐cycloplegic retinoscopy on 128 children stratified into four age groups (6–7, 8–9, 10–12 and 12–13 years). Cycloplegia was achieved using 1% cyclopentolate and retinoscopy carried out after 30 min. The examiner was masked to the lenses used and to habitual spectacle wear. Accommodation was assessed using dynamic retinoscopy prior to cycloplegia. Results: Cycloplegic and non‐cycloplegic sphere differed significantly (z = −9.18, p < 0.0001). Although the difference decreased significantly as age increased (χ2 = 16.57, p = 0.0009), cycloplegic retinoscopy revealed more hyperopia than non‐cycloplegic retinoscopy in all age groups (p < 0.0001). The difference between cycloplegic and non‐cycloplegic results was greater where 'high' hyperopia (≥+2.50DS) was present (F1,6 = 12.86, p = 0.0005), and as hyperopia increased the difference increased (Spearman's ρ = 0.55, p < 0.0001). Neither spectacle wear (p = 0.74) nor accommodation (p = 0.08) influenced the difference between spherical measures. Measures of astigmatic error did not differ significantly (z = −1.59, p = 0.11). A non‐cycloplegic sphere ≥+1.50DS was relatively sensitive (87%) and specific (96%) at indicating clinically significant hyperopia (≥+2.50D) as revealed by cycloplegic retinoscopy. Conclusions: Cyclopentolate 1% does not impact the cylindrical component of the retinoscopy result, but reveals significantly more hyperopia in the spherical component, both statistically and clinically in children aged 6–13 years. Differences between cycloplegic and non‐cycloplegic sphere increase significantly with increasing hyperopia, independent of spectacle wear and accommodation. A non‐cycloplegic retinoscopy result of ≥+1.50DS may be used by practitioners wishing to identify children aged 6–13 years at risk of clinically significant hyperopia (≥+2.50DS), but cycloplegia is required to accurately ascertain the full spherical error. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the intra- and inter-examiner repeatability of cycloplegic retinoscopy in young children aged 4-5 years old. Methods Examiner 1 refracted all children in the first sample ( n = 108); firstly with masked loose lenses, then using unmasked loose lenses (intra-examiner repeatability). Examiners 1 and 2 refracted all children in the second sample ( n = 97) using unmasked loose lenses, blind to the child's refractive error, presence/magnitude of habitual spectacle correction and to each other's findings (inter-examiner repeatability). Refractions were performed on one eye chosen at random. Mean differences, 95% limits of agreement ( LOAs) and confidence intervals were calculated for intra- and inter-examiner repeatability of sphere, cylinder and spherical equivalent refraction ( SER). Results Participants had a wide range of refractive errors (−1.50 DS to +7.25 DS; ≥4.50 DC). Mean differences (95% LOAs) were small for both intra- and inter-examiner repeatability [Intra: Sphere 0.00D (−0.85, +0.85D), Cylinder −0.03D (−0.68, +0.62D), SER −0.06D (−0.90, +0.78D); Inter: Sphere −0.08D (−0.92, +0.76D), Cylinder −0.08D (−0.75, +0.59D), SER −0.13D (−0.95, +0.69D). A statistically significant proportional bias was present for intra-examiner repeatability of cylinder (ρ = 0.20, p = 0.04) and SER measurement (ρ = 0.19, p = 0.049). Proportional bias was not present for any other measure ( p > 0.12). Examiners agreed on cylinder axis within ±20° in 71% of refractions where astigmatism of −0.75D or higher was present. 80% of intra- and inter-examiner measures fell within ±0.50D for spherical and cylindrical components. Conclusions Differences of ±1.00D and ±0.75D or more for spherical and cylindrical measures respectively can be considered significant when performing cycloplegic retinoscopy on young children. [ABSTRACT FROM AUTHOR]