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BACKGROUND: Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. METHODS: We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. RESULTS: Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearsons r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). CONCLUSIONS: Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.

Purpose: This study compared the efficacy of cyclopentolate hydrochloride at 10‐, 20‐ and 30‐min post‐instillation in White 6‐ to 7‐year‐olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30‐min post‐cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate. Methods: Participants were 112 White 6‐ to 7‐year‐olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non‐cycloplegic and cycloplegic refractive error (at 0, 10, 20 and 30 min) was measured using a binocular, open‐field autorefractometer. Data were analysed through paired t‐tests, concordance analysis, linear regression, equivalence testing and Bland–Altman analysis, using the 95% limits of agreement. Results: Mean spherical equivalent refraction (SER) (SD) in the right eye at 0‐, 10‐, 20‐ and 30‐min post‐instillation was 0.62 (1.45) D, 1.52 (1.80) D, 1.64 (1.81) D and 1.72 (1.80) D, respectively. Mean left eye SER (SD) were 0.68 (1.24) D, 1.42 (1.66) D, 1.56 (1.66) D and 1.68 (1.72) D, respectively. Bland–Altman analysis showed a high level of agreement, and equivalence testing confirmed that there was no clinically significant difference in SER at 20 and 30 min in both eyes (within ±0.50 D), with mean differences of 0.08 (0.23) D in the right eye and 0.13 (0.30) D in the left eye (p = 0.21). However, SER at 10 and 30 min were equivalent in the right eye only. Conclusions: Accurate autorefraction values can be obtained 20‐min post‐instillation of 1.0% cyclopentolate in white children aged 6–7 years, potentially reducing clinical testing times. Proxymetacaine pre‐instillation allows for reliable measurements as early as 10‐min post‐instillation of cyclopentolate. Further research is needed to validate these findings in non‐White populations and to determine the safe discharge time post‐proxymetacaine instillation. [ABSTRACT FROM AUTHOR]

Background: Cycloplegic refraction is crucial in pediatric eye assessments. While spherical refraction changes due to cycloplegia are well-documented, astigmatic alterations remain unclear. This study assessed the agreement between spherical and astigmatic refraction pre- and post-cycloplegia. Methods: We enrolled 96 patients (mean age: 12.5 ± 2.4 years), including 35 myopes, 30 emmetropes, and 31 hyperopes. Pre- and post-cycloplegia autorefraction and keratometry (Myopia Master) were conducted using 1% cyclopentolate. Ocular residual astigmatism (ORA) was calculated as the difference between refractive and keratometric astigmatism. Astigmatism was analyzed using Fourier analysis (J0 and J45). Results: Cycloplegia resulted in a more positive spherical equivalent (SE) (+0.80 D), with myopes showing the smallest (+0.38 D) and hyperopes showing the highest variation (+1.47 D) in SE. With-the-rule (WTR) astigmatism predominated in the refractive and keratometric measurements, while ORA was against-the-rule (ATR). Cycloplegia shifted the refractive J0 (+0.06 D) towards more WTR and decreased ORA J0 (+0.05 D). No effect was observed in the J45 component. About 25% of patients exhibited astigmatism changes above 0.25 D, with refractive J0 variation being positively correlated with accommodation relaxation (0.044 D per D of relaxation). Conclusion: Cycloplegia induces clinically significant changes in the spherical component, but minimal variations in astigmatic components, predominantly in hyperopic eyes, likely reflecting alterations in crystalline lens anatomy. [ABSTRACT FROM AUTHOR]

Background: Since accommodation may be a source of error affecting the inter-optometrist repeatability of subjective refraction, this study investigated whether the use of cycloplegia could improve this repeatability. Methods: A randomized cross-sectional study was conducted on 42 young hyperopes (18.2 ± 7.7 years, range 6 to 31 years). Subjective refraction was performed by two different optometrists in two measurement sessions: one day without cycloplegia and, on a different day, with cycloplegia, in random order. The inter-optometrist repeatability of all refractive variables (M, J0, and J45) was analyzed, selecting one eye randomly, in terms of the 95% confidence interval of repeatability (r). Results: No statistically significant differences were found between the optometrists for any refractive variable, both with and without cycloplegia (p ≥ 0.05). Furthermore, no correlation was found between participants' age and the refractive differences between optometrists under both cycloplegic conditions (p ≥ 0.05). However, the use of cycloplegia improved the inter-optometrist repeatability of M (r = 0.37 D) compared to the non-cycloplegic measurements (r = 0.62 D). Conclusions: These results suggest that accommodation in young hyperopes is likely a primary source of error that could explain the discrepancies in subjective refraction between optometrists. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to compare morphology and location of crystalline lens between acute acquired concomitant esotropia (AACE) patients and control subjects, both before and after cycloplegia. Methods: This is a prospective and observational clinical study. Morphological and locational parameters of the crystalline lens in 53 AACE patients and 32 control subjects were assessed before and after cycloplegia using CASIA2 system, which represents the latest swept-source anterior segment optical coherence tomography. Cycloplegic refraction was recorded by administering 1% atropine in patients younger than 12 years and 1% cyclopentolate in those > 12 years old. Morphological parameters included anterior radius of curvature (ARC), posterior radius of curvature (PRC), lens thickness (LTH), and equivalent diameter of lens (LED). Locational parameters comprised lens decentration (LD) and lens tilt (LT). Comparison of these parameters before and after cycloplegia were conducted between AACE and controls. Additionally, the study analyzed and compared the changes in these parameter post-cycloplegia. Results: Our findings suggest no significant difference in morphological parameters including ARC, PRC, LTH and LED between AACE patients and controls before or after cycloplegia. However, 2D-modeling data in the 0° meridian revealed that variation post-cycloplegia of LD (lens shift) in right eyes was different in AACE patients, measuring − 0.03(0.08) [median(interquartile range)] which was significantly distinct from the control group, exhibiting a measurement of 0.01(0.06) (z = − 2.373, p = 0.018). In left eyes, a similar trend was observed with lens shift in the 0° meridian being 0.02(0.06) in AACE, significantly differing from control group's measurement of − 0.02(0.08) (z = − 2.809, p = 0.005). Further, correlation analysis revealed that larger temporal shift of lens was associated with greater changes in ARC (r = 0.294, p = 0.006) and LTH (r = − 0.230, p = 0.031). Conclusions: The morphological features of the crystalline lens were similar in AACE patients and controls; however, the change of lens location by cycloplegia was observed only in AACE patients, suggesting an association with excessive accommodation. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Clinic Journal of Medical Sciences is the property of Hayat Saglik ve Sosyal Hizmetler Vakfi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. Methods A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). Results Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. Conclusions Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.

PurposeWe evaluated the noninferiority of 10.4 μl of eye drops eluted with a commercially available eye drop adapter, the Nanodropper (Nanodropper, Inc), on pupillary dilation and cycloplegia in children compared with the standard of care (SOC), 50 μl of eye drops.DesignProspective randomized trial.ParticipantsPediatric patients scheduled for routine pupillary dilation at the University of California, San Francisco, at the Pediatric Ophthalmology Clinic were enrolled. Each participant provided 1 eye for the intervention group (Nanodropper) and 1 eye for the control group (SOC).MethodsParticipants were randomized to receive small-volume dilating drops in 1 eye (Nanodropper) and SOC dilating drops in the other eye. Dilation was performed using 1 drop each of 1% cyclopentolate, 1% tropicamide, and 2.5% phenylephrine. Refraction and pupillometry were obtained before and 30 minutes after dilation. A noninferiority analysis was performed to assess change from before to after dilation in spherical equivalent and in pupil constriction percentage and maximum pupil diameter after dilation.Main outcome measuresSpherical equivalent, maximum pupil diameter, and pupil constriction percentage.ResultsOne hundred eyes of 50 patients were included, with a mean ± standard deviation age of 9 ± 3 years. After controlling for baseline measurements, the spherical equivalent after dilation was 0.05 diopter (D) more (95% confidence interval [CI], -0.28 to 0.37 D) in the Nanodropper arm, which did not achieve noninferiority. Maximum pupil diameter after dilation was lower in the Nanodropper group (mean, -0.01 mm; 95% CI, -0.20 to -0.03), which did achieve noninferiority. Constriction percentage after dilation was 0.57 percentage points more (95% CI, -1.38 to 2.51 percentage points) in the Nanodropper group, which did not achieve noninferiority.ConclusionsAdministration of eye drops using a small-volume adapter demonstrated similar efficacy to SOC in a pediatric population. Strict noninferiority was met only for pupillary dilation and not for cycloplegia or constriction percentage; however, the small differences in the effect of the Nanodropper versus SOC on all primary outcomes were not clinically significant. We conclude that small-volume eye drops have the potential to decrease unnecessary medical waste and medication toxicity while maintaining therapeutic effect.Financial disclosure(s)Proprietary or commercial disclosure may be found after the references.

Purpose: To investigate the impact of accommodation function on the difference between cycloplegic and noncycloplegic subjective and automatic refraction in adult myopes. Methods: Myopic patients between 18 and 50 years old evaluated at Peking University Third Hospital who underwent cycloplegic and noncycloplegic automatic and subjective refraction were enrolled. Accommodation function, including negative and positive relative accommodation (PRA/NRA) and accommodation response (binocular cross cylinder, BCC) was examined. Results: Of the 3268 individuals enrolled, the mean age was 27.3 ± 6.9 years, and 34.8% of participants were male. The noncycloplegic spherical equivalent (SE) was 0.23 ± 0.29 D and 0.64 ± 0.61 D more myopic than cycloplegic subjective and automatic refraction. Adjusting for associated factors, participants with at least 0.50 D of more myopia SE refraction by noncycloplegic subjective refraction were more likely to be older (odds ratio [OR], 1.029; 95% confidence interval [CI], 1.013–1.045) and with insufficient (OR, 1.514; 95% CI, 1.093–2.096) and excessive (OR, 2.196; 95% CI, 1.538–3.137) NRA value. The automatic refraction SE difference of at least 1.00 D more myopia was more likely to be found in individuals with older age (OR, 1.036; 95% CI, 1.022–1.050) and accommodative lead (OR, 1.255; 95% CI, 1.004–1.568). Conclusion: A quarter of adult myopes had at least 0.50 and 1.00 D of subjective and automatic SE difference with cycloplegia. The accommodation function significantly affects the difference between cycloplegic and noncycloplegic refraction. Investigating the differences in refraction measurement guarantees the proper use of cycloplegia in adults for myopia correction. [ABSTRACT FROM AUTHOR]

Background: Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. Methods: A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). Results: Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. Conclusions: Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring. [ABSTRACT FROM AUTHOR]

Background: The American Optometric Association (AOA), in its 2017 Recommendation for Clinical Practice, proposed cycloplegic testing when initially screening preschool children to detect potential vision-impairing diseases such as strabismus, amblyopia and anisometropia. Aim: This study aims to detect the effect of cycloplegia on the measurement of refractive errors in children. Setting: Ophthalmology department, Al-Azhar University, Egypt. Methods: This retrospective interventional study included 388 children with refractive error attending our outpatient clinic in the ophthalmology department, at Al-Azhar University between January 2020 and April 2022. Cycloplegia was induced in each child with topical eye drops of 1% cyclopentolate instilled two times at 5-min intervals. The same optometrist repeated an auto-refraction 30 min after the last eye drop was applied. Results: We compared the pre- and post-cycloplegic refractions and found that the sphere, spherical equivalence and cylinder had significant hypermetropic shift after cycloplegia (P = 0.001). Conclusion: Cycloplegic refractions are more accurate and eliminate the risk of inaccurate refractive error findings, which is essential when managing children. Contribution: This article provides valuable insight, which may inform public health policy.

Purpose: To assess and compare the effects of cycloplegia using 0.5% tropicamide and 1% tropicamide on intraocular pressure (IOP) in patients with diabetes mellitus, with and without considering adjustments for central corneal thickness (CCT). Methods: A total of 98 eyes of 98 patients with open angles were included. Patients were randomly assigned to receive either 0.5% tropicamide (49 eyes) or 1% tropicamide (49 eyes). IOP was measured by Goldmann applanation tonometry. Pupillary diameter and CCT were measured by a Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany) before and 30 min after tropicamide administration. Results: The mean IOP change was 0.12 ± 1.71 mmHg in the 0.5% tropicamide group and 0.25 ± 1.70 mmHg in the 1% tropicamide group. These two values were not significantly different, even after adjusting IOP for CCT using all formulae (P > 0.05). Without adjustment, the mean post-dilation IOP was similar to the mean pre-dilation IOP in both groups (P > 0.5), and none of the patients experienced an IOP increase of 5 mmHg or more. With adjustment, the mean IOP increased significantly after administration of 0.5% tropicamide, as determined by the Ehlers formula (P = 0.02). Similarly, the mean IOP increased significantly after administration of 1% tropicamide, as determined by the Ehlers formula (P = 0.008), the Doughty formula (P = 0.03), and the Kohlhaas formula (P = 0.04). In each study group, a single patient encountered an increase in IOP ≥5 mmHg when IOP adjustment was performed using the Ehlers formula. Conclusion: Cycloplegia with 0.5% and 1% tropicamide leads to similar mean changes in IOP in patients with diabetes. However, the statistical significance of the change and the occurrence of the significant increases in IOP, as determined by a predefined cut-off point, are dependent upon the method used to adjust the IOP.

Abstract Background Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. Methods We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. Results Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearson’s r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). Conclusions Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.

Background: Since accommodation may be a source of error affecting the inter-optometrist repeatability of subjective refraction, this study investigated whether the use of cycloplegia could improve this repeatability. Methods: A randomized cross-sectional study was conducted on 42 young hyperopes (18.2 ± 7.7 years, range 6 to 31 years). Subjective refraction was performed by two different optometrists in two measurement sessions: one day without cycloplegia and, on a different day, with cycloplegia, in random order. The inter-optometrist repeatability of all refractive variables (M, J0, and J45) was analyzed, selecting one eye randomly, in terms of the 95% confidence interval of repeatability (r). Results: No statistically significant differences were found between the optometrists for any refractive variable, both with and without cycloplegia (p ≥ 0.05). Furthermore, no correlation was found between participants’ age and the refractive differences between optometrists under both cycloplegic conditions (p ≥ 0.05). However, the use of cycloplegia improved the inter-optometrist repeatability of M (r = 0.37 D) compared to the non-cycloplegic measurements (r = 0.62 D). Conclusions: These results suggest that accommodation in young hyperopes is likely a primary source of error that could explain the discrepancies in subjective refraction between optometrists.

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value ≤0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p≤0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve.

Abstract Background Prevention of myopia should begin before school age. However, few population-based cohort studies have investigated refractive status in preschool children with cycloplegia. This study aimed to investigate the post-COVID-19 refraction and ocular biometric parameters of preschool children in Beijing Tongzhou District. Methods A population-based cohort study of kindergarten children in Tongzhou District, Beijing, commenced in November 2021. The present study reports data from the first year of the aforementioned population-based study. We selected children aged 3–6 years from nine kindergartens. Biometric parameters, including axial length (AL), anterior chamber depth (ACD), and corneal radius of curvature (CR), were collected before cycloplegia. Cycloplegic refraction was also measured. The spherical equivalent (SE), lens power (LP), and AL-to-CR ratio were calculated. Multiple linear regression analysis was used to analyse the correlation between refraction and ocular biometric parameters. Results A total of 1,505 children completed the examination, and a mean SE of 1.24 ± 0.91 D was found. The overall prevalence of myopia was 1.93%. The mean AL, ACD, CR, LP, and AL-to-CR ratio were 22.24 ± 0.70 mm, 3.28 ± 0.26 mm, 7.77 ± 0.26 mm, 26.01 ± 1.56 D, and 2.86 ± 0.07, respectively. Longer AL, deeper ACD, larger AL-to-CR ratio, and lower LP were associated with older age; the CR was not significantly different among different ages. In the multiple linear regression analysis, after adjusting for sex and age, the model that included AL, CR, and LP explained 87% of the SE variation. No differences were observed in the prevalence of myopia or the SE in this particular age range. Conclusion The findings of this study suggest that a large proportion of preschool children in Beijing are mildly hyperopic, with a considerably low prevalence of myopia. In preschool children, refractive development was found to present mild hyperopia rather than emmetropia or myopia, a phenomenon that is characteristic of this age range.

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the effects of topical cyclopentolate hydrochloride-induced cycloplegia on anterior segment biomechanics in emmetropic eyes using anterior segment-optical coherence tomography (AS-OCT). Methods: Twenty-five emmetropic eyes of 25 volunteers were included. All underwent central corneal thickness (CCT) and anterior chamber depth (ACD) measurements. Anterior scleral thickness (AST) was measured at the level of the scleral spur (SS)(AST-0), 1,000 μm posterior of the SS (AST-1), and 2,000 μm posterior of the SS (AST-2) in the nasal and temporal quadrants using AS-OCT. All measurements were repeated after cycloplegia. Results: The mean age was 30.6 ± 12.4 (8–45) years. The mean CCT did not significantly change after cycloplegia (P = 0.7). The mean ACD was significantly increased [3.3 ± 0.2 (2.7–3.9) to 3.7 ± 0.3 (3–4.2) μm; P = 0.001]. In the nasal quadrant, the mean AST-1 and AST-2 were 512.3 ± 34.4 (433–570) and 529.6 ± 34.2 (449–599); decreased to 478 ± 26.8 (423–530) and 486.2 ± 28.3 (422–544) μm, respectively, after cycloplegia (P = 0.00; P = 0.00). In the temporal quadrant, the mean AST-1 and AST-2 were 522.5 ± 24.7 (473–578) and 527.2 ± 39.9 (450–604); decreased to 481.1 ± 33.7 (421–550) and 484.6 ± 26.6 (433–528) μm, respectively (P = 0.00; P = 0.00). There was no significant difference in AST-0 after cycloplegia in both quadrants [from 697.5 ± 46 (605–785) to 709.5 ± 64.7 (565–785) for nasal and from 718.4 ± 40.1 (632–796) to 722.9 ± 60.6 (596–838) for temporal; P = 0.2; P = 0.3, respectively]. Conclusion: After cycloplegia, there was a significant thinning of ASTs posterior to SS and a slight increase in AST in the SS level. ACD deepened after cycloplegia, and there was no significant change in CCT. Cycloplegic agents temporarily inhibit ciliary muscle contraction and may affect anterior segment parameters and sclera. Inhibition of forward–inward movement of the ciliary body by cycloplegia affects ASTs and ACD by causing a change in the mechanical force of the ciliary muscle on the sclera. [ABSTRACT FROM AUTHOR]

Purpose: Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy. Methods: In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland–Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted. Results: The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland–Altman plot revealed the limits of agreement as 1.06 and −0.71 D. Conclusion: Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the clinical information revealed after cycloplegia and assess how age and non-cycloplegic refractive status influence the classification of types of refractive error, as well as the relationship between age and cycloplegia-induced changes in the power of refractive errors. We analysed the records of 472 non-population-based ophthalmology practice patients aged 3–28 years (mean ± SD: 9.1 ± 4.6). Cycloplegia was induced with one drop of cyclopentolate 1% in each eye, and eye refraction was measured 30 ± 5 min later using an objective autorefractometer. Cycloplegia induced a clinically significant (≥0.50 D) hyperopic shift in the spherical equivalent of 60.2% of participants and a myopic shift in 1%, resulting in a 34.1% increase in the frequency of participants with hyperopia, while the frequency of those with myopia and emmetropia decreased by 5.5% and 23.3%, respectively. The average spherical equivalent difference (mean ± SD) induced by cycloplegia was 0.72 ± 0.73 D, with the highest difference observed in the 3–5 years age group (1.18 ± 0.85 D). The differences in astigmatism power (p = 0.84) and astigmatism axis (p = 0.97) between non-cycloplegic and cycloplegic conditions were not statistically significant.

Reducing the time between drop instillation and refraction reduces the time paediatric patients and young adults spend in practice, facilitating more eye examinations daily. The current procedure for paediatric cycloplegic refraction is to wait for at least 30-minutes post-instillation of a cycloplegic before measuring spherical equivalent refraction. This study compared cycloplegia at 20- and 30-minutes following 0.5% proxymetacaine and 1.0% cyclopentolate in 12-13-year-olds. Participants were 99 white 12-13-year-olds. One drop of proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) followed by one drop of cyclopentolate hydrochloride (Minims, 1.0% w/v, Bausch & Lomb, UK) was instilled into both eyes. Spherical equivalent refraction was measured by autorefraction (Dong Yang Rekto ORK-11 Auto Ref-Keratometer) at 20- and 30-minutes post-instillation. Data were analysed through paired t-testing, correlations, and linear regression analysis. There was no significant difference in level of cycloplegia achieved at 20- (Mean spherical equivalent refraction (standard deviation) 0.438 (1.404) D) and 30-minutes (0.487 (1.420) D) post-eyedrop instillation (t (98) = 1.667, p = 0.099). The mean spherical equivalent refraction difference between time points was small (0.049 (0.294) D, 95% confidence interval =-0.108 ̶ 0.009D). Agreement indices: Accuracy = 0.999, Precision = 0.973, Concordance = 0.972. Spherical equivalent refraction at 20- and 30-minutes differed by ≤0.50D in 92% of eyes, and by <1.00D in 95%. There was no clinically significant difference in spherical equivalent refraction or level of cycloplegia at 20- and 30-minutes post-eyedrop instillation. The latent time between drop instillation and measurement of refractive error may be reduced to 20 minutes in White 12-13-year-olds and young adults. Further studies must determine if these results persist in younger children and non-White populations. [ABSTRACT FROM AUTHOR]

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE's Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value =0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p=0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve. [ABSTRACT FROM AUTHOR]

Background: Prevention of myopia should begin before school age. However, few population-based cohort studies have investigated refractive status in preschool children with cycloplegia. This study aimed to investigate the post-COVID-19 refraction and ocular biometric parameters of preschool children in Beijing Tongzhou District. Methods: A population-based cohort study of kindergarten children in Tongzhou District, Beijing, commenced in November 2021. The present study reports data from the first year of the aforementioned population-based study. We selected children aged 3–6 years from nine kindergartens. Biometric parameters, including axial length (AL), anterior chamber depth (ACD), and corneal radius of curvature (CR), were collected before cycloplegia. Cycloplegic refraction was also measured. The spherical equivalent (SE), lens power (LP), and AL-to-CR ratio were calculated. Multiple linear regression analysis was used to analyse the correlation between refraction and ocular biometric parameters. Results: A total of 1,505 children completed the examination, and a mean SE of 1.24 ± 0.91 D was found. The overall prevalence of myopia was 1.93%. The mean AL, ACD, CR, LP, and AL-to-CR ratio were 22.24 ± 0.70 mm, 3.28 ± 0.26 mm, 7.77 ± 0.26 mm, 26.01 ± 1.56 D, and 2.86 ± 0.07, respectively. Longer AL, deeper ACD, larger AL-to-CR ratio, and lower LP were associated with older age; the CR was not significantly different among different ages. In the multiple linear regression analysis, after adjusting for sex and age, the model that included AL, CR, and LP explained 87% of the SE variation. No differences were observed in the prevalence of myopia or the SE in this particular age range. Conclusion: The findings of this study suggest that a large proportion of preschool children in Beijing are mildly hyperopic, with a considerably low prevalence of myopia. In preschool children, refractive development was found to present mild hyperopia rather than emmetropia or myopia, a phenomenon that is characteristic of this age range. [ABSTRACT FROM AUTHOR]

Highlights 1. Cycloplegic drugs have effects on the ocular biological parameters of children at different ages. 2. The effects of different types of cycloplegic drugs were almost the same in children within the same age groups. 3. There were significant differences in the effects of different types of cycloplegic drugs on ocular biological parameters in children of different age groups.

Pharmacologic mydriasis, or pupillary dilation, is achieved using various agents, and is an important component of a comprehensive eye examination. Of the medications available to achieve mydriasis, the most favourable are those with a rapid onset and a low risk of causing side effects. The current standard of care is to administer multiple drops of different medications to achieve mydriasis. However, a number of innovations in the field are addressing this shortcoming. Fixed-combination eyedrop therapy has been suggested as a more efficient method, with the potential to cause fewer side effects. Additionally, novel drug delivery devices have been devised to further improve efficiency and decrease waste by delivering smaller volume drops with greater precision. Two devices of current interest are the Nanodropper (Nanodropper, Inc., Rochester, MN, USA) and Optejet® (MydCombi™; Eyenovia, Inc., New York, NY, USA). Recent studies of these devices have shown their ability to achieve similar levels of mydriasis as conventional medications without additional side effects. Furthermore, the Optejet has shown in two phase III trials that fixed-combination therapy is able to achieve greater pupil dilation compared with the current standard. This review provides an overview of pharmacologic dilation and reviews these emerging technologies. [ABSTRACT FROM AUTHOR]

Purpose: To compare school-age children's objective and subjective refraction using a binocular wavefront optometer (BWFOM) with autorefraction and retinoscopy before and after cycloplegia. Methods: Eighty-six eyes from 86 children (6–15 years old) were enrolled in this cross-sectional study. BWFOM objective and subjective refractions were compared with autorefraction and retinoscopy under cycloplegia. BWFOM refraction was evaluated before and after cycloplegia. Measurements were compared using a paired t-test; agreement was assessed using Bland–Altman plots. Results: Under cycloplegia, the sphere, spherical equivalence, and J45 were significantly more negative on BWFOM objective refraction than autorefraction (− 1.39 ± 2.20 D vs. − 1.28 ± 2.23 D, P = 0.003; − 1.84 ± 2.38 D vs. − 1.72 ± 2.43 D, P = 0.001; − 0.02 ± 0.17 D vs. 0.03 ± 0.21 D, P = 0.004). The subjective sphere of BWFOM was less myopic, and the cylinder and the J45 were more negative than those with retinoscopy (− 1.17 ± 2.09 D vs. − 1.25 ± 2.20 D, P = 0.02; − 0.91 ± 0.92 D vs. − 0.76 ± 0.92 D, P < 0.001; − 0.01 ± 0.15 D vs. 0.03 ± 0.21 D, P = 0.028). For both BWFOM objective and subjective refraction, sphere and spherical equivalence with noncycloplegia were more myopic than those with cycloplegia (objective: − 1.76 ± 2.10 D vs. − 1.39 ± 2.20 D, − 2.21 ± 2.30 D vs. − 1.84 ± 2.38 D, P < 0.001; subjective: − 1.57 ± 1.92 D vs. − 1.17 ± 2.09 D, − 2.01 ± 2.13 D vs. − 1.62 ± 2.27 D, P < 0.001). Bland–Altman plots showed good agreement in spherical equivalence between BWFOM objective refraction and autorefraction (mean difference = 0.12 D, 95% confidence interval [CI] − 0.52 to 0.76), subjective refraction with retinoscopy (mean difference = − 0.01 D, 95% CI − 0.65 to 0.64), and BWFOM refractions with or without cycloplegia (objective: mean difference = − 0.37 D, 95% CI − 1.31 to 0.57; subjective: mean difference = − 0.39 D, 95% CI − 1.30 to 0.51). The time cost by BWFOM was significantly less than the total time of autorefraction and retinoscopy (264.88 ± 90.67 s vs. 315.89 ± 95.31 s, P < 0.001). Conclusion: BWFOM is a new device that realizes both objective and subjective refraction. For children's refractive errors, it is more convenient and quicker to obtain the proper prescription at a 0.05-D interval, and it is more accurate than autorefraction and retinoscopy under cycloplegia. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The effectiveness of cycloplegia in delaying the progression of myopia and its application in refractive examination in children have been extensively studied, but there are still few studies on the effects of atropine/tropicamide on ocular biological parameters. Therefore, the purpose of this study was to explore the effects of atropine/tropicamide on children's ocular biological parameters in different age groups and the differences between them. Methods: This was a prospective observational study in which all school children were examined for dioptres and ocular biological parameters in the outpatient clinic, and 1% atropine or tropicamide was used for treatment. After examination, we enrolled the patients grouped by age (age from 2 to 12 years treated by atropine, 55 cases; age from 2 to 10 years treated by tropicamide, 70 cases; age from 14 to 17 years treated by tropicamide, 70 cases). The ocular biological parameters of each patient before and after cycloplegia were measured, and the difference and its absolute value were calculated for statistical analysis using an independent-samples t test. Results: We compared the value and the absolute value of the differences in ocular biological parameters before and after cycloplegia in the same age group, and we found that the differences were not statistically significant (P > 0.05). There were significant differences in the corresponding values of AL, K1 and ACD among the different age groups (P < 0.05). Before cycloplegia, there were significant differences in AL, K, K1, K2 and ACD in different age groups (P < 0.05). However, the differences in AL, K, K1, K2 and ACD among different age groups disappeared after cycloplegia (P > 0.05). Conclusions: This study demonstrated that atropine/tropicamide have different effects on cycloplegia in children of different ages. The effects of atropine/tropicamide on ocular biological parameters should be fully considered when evaluating the refractive state before refractive surgery or mydriasis optometry for children of different ages. Highlights: 1. Cycloplegic drugs have effects on the ocular biological parameters of children at different ages. 2. The effects of different types of cycloplegic drugs were almost the same in children within the same age groups. 3. There were significant differences in the effects of different types of cycloplegic drugs on ocular biological parameters in children of different age groups. [ABSTRACT FROM AUTHOR]

PurposeTo predict the need for cycloplegic assessment, as well as refractive state under cycloplegia, based on non-cycloplegic ocular parameters in school-age children.DesignRandom cluster sampling.MethodsThe cross-sectional study was conducted from December 2018 to January 2019. Random cluster sampling was used to select 2,467 students aged 6–18 years. All participants were from primary school, middle school and high school. Visual acuity, optical biometry, intraocular pressure, accommodation lag, gaze deviation in primary position, non-cycloplegic and cycloplegic autorefraction were conducted. A binary classification model and a three-way classification model were established to predict the necessity of cycloplegia and the refractive status, respectively. A regression model was also developed to predict the refractive error using machine learning algorithms.ResultsThe accuracy of the model recognizing requirement of cycloplegia was 68.5–77.0% and the AUC was 0.762–0.833. The model for prediction of SE had performances of R^2 0.889–0.927, MSE 0.250–0.380, MAE 0.372–0.436 and r 0.943–0.963. As the prediction of refractive error status, the accuracy and F1 score was 80.3–81.7% and 0.757–0.775, respectively. There was no statistical difference between the distribution of refractive status predicted by the machine learning models and the one obtained under cycloplegic conditions in school-age students.ConclusionBased on big data acquisition and machine learning techniques, the difference before and after cycloplegia can be effectively predicted in school-age children. This study provides a theoretical basis and supporting evidence for the epidemiological study of myopia and the accurate analysis of vision screening data and optometry services.

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Background/aimsTo evaluate the influence of cycloplegia on lens refractive parameters in 6–12-year-old children with myopia and hyperopia for exploring the pathogenesis of myopia.MethodsOne hundred eyes of 100 patients (50 boys) were included. In the myopic group, 50 subjects (25 boys and 25 right eyes) were enrolled with a mean age of 9.20 ± 1.69 years. IOLMaster 700 measurements were performed pre- and post-cycloplegia. The pictures were marked using semi-automatic software. The lens curvature and power were obtained using MATLAB image processing software. Paired and independent sample t-tests were used for data analysis. Statistical significance was set at P < 0.05.ResultsAnterior and posterior lens curvature radius in myopic eyes were larger than those in hyperopic eyes, both pre- and post-cycloplegia (both P < 0.001). The refractive power in myopic eyes was lower than that in hyperopic eyes without cycloplegia, both pre- and post-cycloplegia (both P < 0.001). The changes in anterior lens curvature and refractive power between pre- and post-cycloplegia in hyperopic eyes were larger than those in myopic eyes (both P < 0.05). No significant difference was found in the change in posterior lens curvature and refractive power after cycloplegia in hyperopic and myopic eyes (P > 0.05).ConclusionAnterior and posterior surfaces of the lens were flatter, and the refractive power was lower in the myopia group than in the hyperopia group. Myopic and hyperopic patients showed a tendency for lens flattening and refractive power decrease after cycloplegia. Hyperopic patients had more changes in anterior lens curvature and refractive power after cycloplegia.

Objective: To determine the diagnostic agreement of non‐cycloplegic and cycloplegic refraction in children. Method: The study methodology followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Electronic databases were searched for comparative studies exploring refraction performed on children under non‐cycloplegic and cycloplegic conditions. There was no restriction on the year of publication; however, only publications in the English language were eligible. Inclusion criteria consisted of children aged ≤12 years, any degree or type of refractive error, either sex and no ocular or binocular co‐morbidities. The QUADAS‐2 tool was used to evaluate the risk of bias. Meta‐analysis was conducted to synthesise data from all included studies. Subgroup and sensitivity analyses were undertaken for those studies with a risk of bias. Results: Ten studies consisting of 2724 participants were eligible and included in the meta‐analysis. The test for overall effect was not significant when comparing non‐cycloplegic Plusoptix and cycloplegic autorefractors (Z = 0.34, p = 0.74). The pooled mean difference (MD) was −0.08 D (95% CI −0.54 D, +0.38 D) with a prediction interval of −1.72 D to +1.56 D. At less than 0.25 D, this indicates marginal overestimation of myopia and underestimation of hyperopia under non‐cycloplegic conditions. When comparing non‐cycloplegic autorefraction with a Retinomax and Canon autorefractor to cycloplegic refraction, a significant difference was found (Z = 9.79, p < 0.001) and (Z = 4.61, p < 0.001), respectively. Discussion: Non‐cycloplegic Plusoptix is the most useful autorefractor for estimating refractive error in young children with low to moderate levels of hyperopia. Results also suggest that cycloplegic refraction must remain the test of choice when measuring refractive error ≤12 years of age. There were insufficient data to explore possible reasons for heterogeneity. Further research is needed to investigate the agreement between non‐cycloplegic and cycloplegic refraction in relation to the type and level of refractive error at different ages. [ABSTRACT FROM AUTHOR]

AIM: To evaluate related factors with the change of spherical equivalents (ΔSE) and determine the suitable predictor of clinically significant ΔSE (≥0.50 D) with cyclopentolate hydrochloride on Chinese children. METHODS: A total of 145 right eyes of 145 children aged 4 to 15y were enrolled. Intraocular pressure, axial length and lag of accommodation (LOA) were assessed before cycloplegia induced by 3 drops of 1% cyclopentolate at 5-minute intervals. SE was measured before and 1h after the first drop of cyclopentolate. ΔSE was compared between different gender groups and among refractive groups. Multivariate linear regression analysis was performed to find related factors with ΔSE. ROC analysis was used to figure out the suitable predictor of clinically significant ΔSE. RESULTS: For the total 145 eyes, the mean SE reached up to -0.70±1.86 D from -1.30±1.62 D, with the mean ΔSE of 0.60±0.55 D. The mean ΔSE were 0.63±0.55 D and 0.57±0.56 D respectively in the male and female group (P=0.40). The mean ΔSE was significantly different among different refractive groups (P

To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences. Cross-sectional, retrospective study. Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye. Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least –0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models. Differences between noncycloplegic and cycloplegic autorefraction measurements. The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18–1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18–1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10–1.36) and those with hyperopia (OR range, 4.20–13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild–moderate–high myopia or moderate–high hyperopia. Three quarters of school-aged individuals had < 1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to evaluate the shape of the crystalline lens in terms of biometry and diopters before and after cycloplegia using the CASIA2 swept-source (SS) optical coherence tomography (OCT) system on the anterior segment. Methods This was a retrospective study. Children and adolescents (26 males and 29 females, aged 4–21 years) with simple ametropia were selected for optometry and CASIA2 imaging at 2 separate visits before and after cycloplegia. Diopter values were derived from the spherical power (S) obtained by optometry. Biometric parameters of the crystalline lens, including the anterior chamber depth (ACD), anterior and posterior curvature of the lens (ACL and PCL), lens thickness (LTH), lens decentration (LD), lens tilt (LT), and equivalent diameter of the lens (LED), were measured by the CASIA2 system. The differences in these parameters after compared with before cycloplegia were determined, and their relationships were analyzed. Results Fifty-five participants (106 eyes) were initially enrolled. There was a significant difference (P 0.05). There was a significant (P

We aimed to evaluate the time needed for effective cycloplegia after instillation of cyclopentolate 1% in patients with brown irides. A prospective analytical study involving 161 patients (322 eyes) with a mean (SD) age of 9.0 (3.1) years (range: 3-16 years), who attended outpatient eye clinic. All had brown irides, cyclopentolate 1% was instilled two times, 10 minutes apart, spherical equivalent (SE) was calculated using readings taken by Nidek AR-1000 autorefractometer before the first drop and at 15, 30, 45 and 60 minutes after the first drop. The time for effective cycloplegia was determined from the time point at which the 95% confidence interval of the differences between the average spherical equivalent (SE) at each point and its final value at 60 minutes was reached and remained within ±0.25 D. We found that maximum cycloplegia was reached 30 minutes after the instillation of first drop of cyclopentolate 1% in all refractive error categories (emmetropia, hyperopia and myopia) with the exception of high hyperopia subgroup (SE ≥ +6.0D) where at least 45 minutes were needed to achieve cycloplegia. Additionally no clinically significant difference in the minimum time required to achieve maximum cycloplegia was noticed in subjects under 10 years old and those aged 10 years or older with both groups needed at least 30 minutes to achieve maximum cycloplegia after the instillation of first drop of cyclopentolate 1%. In this group of patients with brown irides, most children reached maximum cycloplegia after 30 minutes of instillation of cyclopentolate 1% eye drops. [ABSTRACT FROM AUTHOR]

Erin Major,1 Thomas Dutson,2 Majid Moshirfar2– 4 1Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA; 2Hoopes Vision, Draper, UT, USA; 3John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 4Utah Lions Eye Bank, Murray, UT, USACorrespondence: Thomas DutsonHoopes Vision, Draper, UT, USAEmail dutson@hoopesvision.comPurpose: To determine the current scope of practice with regards to cycloplegic examinations, specifically in the pediatric population.Methods: A comprehensive literature review was conducted using PubMed, ScienceDirect, Elsevier, and Google Scholar databases using keywords such as “cyclopentolate”; “tropicamide”; “pediatric”; “cycloplegia”; “atropine”; and “cycloplegic” from inception to October 2019.Results: Atropine has the strongest cycloplegic effect and is recommended for cases of large accommodative esotropia. Because of the undesired side effects and risks from atropine, cyclopentolate has been found to offer a very effective cycloplegia even for moderate to high hyperopia and has become the standard of care for traditional pediatric cycloplegic exams. Tropicamide has also been shown to offer adequate cycloplegia with less toxicity and side effects. Of all agents, tropicamide presents the least side effects and toxicity, whereas atropine presents the greatest. Cyclopentolate is a very safe cycloplegic agent that has risk of toxicity which increases with higher doses and concentrations.Conclusion: The American Optometric Association’s current pediatric cycloplegic guidelines have proven both safe and effective, as they recommend a conservative approach of using cyclopentolate 0.5% in infants and cyclopentolate 1% in those older than one-year old to avoid undesired side effects. Topical ophthalmic drops and spray instillation have both proved equally efficacious and therefore each have their place within a clinical setting. Using Cycolmydril under six months old and cyclopentolate 1% over 6 months old as recommended by the AAO, also provides a safe and effective guideline for cycloplegic examinations within the pediatric population.Keywords: cycloplegic, cycloplegia, pediatric

PurposeTo report the design and baseline data of a 3-year cohort study in Beijing Pinggu District primary school students in China after COVID-19.MethodsNoncycloplegic and cycloplegic spherical equivalent refraction (SER) were measured, ocular biometry, including the axial length (AL), anterior chamber depth (ACD) and corneal power (CP), were collected before cycloplegia. Corneal radius (CR), AL-to-CR ratio, and lens power (LP) were calculated.ResultsAmong the 4,806 (89.1%) eligible students (51.5% male), the prevalence of emmetropia, myopia, mild hyperopia, and mild-to-high hyperopia was 12.8, 30.8, 53.0, and 3.3% after cycloplegia, respectively. Myopia increased from 2.5% in 6- to 71.6% in 12-year-old students, with 9- and 10-year-olds showing the most prominent increases. The median of cycloplegic SER was 0.50 (IQR = 1.63), and the noncycloplegic SER was −0.38 D (IQR = 1.50), which is more negative than the cycloplegic refraction. The mean AL increased with age, from 22.46 ± 0.70 mm to 24.26 ± 1.07 mm. The ACD increased from 3.38 ± 0.28 mm to 3.70 ± 0.30 mm, and the AL-to-CR ratio increased from 2.91 ± 0.08 to 3.12 ± 0.13 between 6- and 12-year-old students. AL, CR and LP explained the SER variance with R2 of 86.4% after adjusting the age and gender.Conclusions and RelevanceThe myopia prevalence since emergence of COVID-19 rapidly increased from 6- to 12-year primary school Chinese children, especially after 7 years of age. The non-cycloplegia SER overestimated the prevalence of myopia, and the cycloplegic SER is a more accurate and reliable method to assess the prevalence of refractive status.

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In children under 20 years, refractive development targets a cycloplegic refractive error of +0.5 to +1.5D , while presbyopes over 40 years generally have non-cycloplegic errors of ≥ +1D. Some papers suggest these periods are separated by a period of myopic refractive error (i.e., ≤ –0.50D), but this remains unclear. Hence, this work investigates the mean cycloplegic refractive error in adults aged between 20 – 40 years. In 2002 a cross-sectional study with stratified cluster sampling was performed on the population of Tehran, providing cycloplegic and non-cycloplegic refractive error data for the right eyes of 3,576 participants, aged 30.6 ± 18.6 years (range: 1–86 years). After grouping these data into age groups of 5 years, the refractive error histogram of each group was fitted to a Bigaussian function. The mean of the central, emmetropized peak was used to estimate the mean refractive error without the influence of myopia. The mean cycloplegic refractive error at the emmetropized peak decreased from +1.10 ± 0.11D (95 % confidence interval) to +0.50 ± 0.04D before 20 years and remains stable at that value until the age of 50 years. The non-cycloplegic refractive error also sees a stable phase at 0.00 ± 0.04D between 15 – 45 years. After 45 – 50 years both cycloplegic and non-cycloplegic refractive error become more hypermetropic over time, +1.14 ± 0.12D at 75 years. The cycloplegic refractive error in adults is about +0.50D between 20 – 50 years, disproving the existence of the myopic period at those ages. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study is to explore short-term refractive and ocular parameter changes and their correlations after cycloplegia with atropine. METERIALS AND METHODS: This is a prospective clinical trial that enrolled 96 eyes of 96 participants (mean age, 8.5 ± 2.1 years). Spherical equivalent refractive error (SER), axial length (AL), mean keratometric value (mean-K), anterior chamber depth (ACD), and intraocular pressure (IOP) were measured at baseline and 1 week after topical use of 0.125% atropine. Postcycloplegic changes of refractive error and ocular parameters were evaluated, and their correlations were analyzed with multiple linear regression models. RESULTS: After topical atropine use, the mean AL decreased by 0.016 mm (P = 0.008), and the mean ACD increased by 0.58 mm (P < 0.0001). There was no significant change in the Mean-K or IOP. Eighty-two eyes (85%) had an emmetropic or hyperopic shift, and 14 (15%) had a myopic shift. Those with an emmetropic or hyperopic shift had their mean AL shortened by 0.023 mm, whereas the eyes with myopic shifts had their mean AL lengthened by 0.026 mm (P = 0.003). Change in SER was negatively correlated with change in AL (−2.57 D for an increase of 1 mm in AL, P < 0.001) and positively correlated with change in ACD (+0.96 D for an increase of 1 mm in ACD, P = 0.013). CONCLUSION: Most eyes had emmetropic or hyperopic changes after short-term topical atropine use, and AL shortening and anterior chamber deepening both contributed to the hyperopic changes. Meanwhile, myopic change may be observed in some eyes (15%), which were related to transient AL elongation but not invalid myopic control. This encouraged clinicians to sustain the atropine treatment for a longer period before switching to other modalities for myopic control in clinical practice. The clinical trial registration number NCT03839888 (clinicaltrials.gov).

Andrew W Arnold,1 Stephanie L Arnold,1 Jacob H Sprano,2 Robert W Arnold3 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Kansas City University of Osteopathic Medicine, Kansas City, MO, USA; 3Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, AK, USACorrespondence: Robert W ArnoldAlaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561 1917Fax +1 907 563 5373Email eyedoc@alaska.netObjective: Accurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia.Methods: Design: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve.Results: Of 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (−1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific.Conclusion: Accommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia.Clinical Trials Registry: NCT03668067.Keywords: hyperopia, retinoscopy, cycloplegia, skiascopy

Abstract Introduction To evaluate the effects of cycloplegia on the biometric components and anterior segment parameters of the eye. Methods In this cross-sectional study, changes to axial length (AL), anterior chamber depth (ACD) lens thickness, anterior chamber angle (ACA) and volume, corneal thickness in the pupil center (PC), corneal curvature (CC) and white-to-white (WTW) following cycloplegia induced by tropicamide 1% in 42 eyes of patients aged 23–58 years were assessed. Biometric components and anterior segment parameters were measured using an IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany) and a Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany), respectively. Results Significant statistical changes in ACD (increased by 0.06 ± 0.05 mm; p 0.05). Also, a significant inferior displacement of the PC along the vertical axes was seen (p = 0.020). Conclusion Cycloplegia resulted in a deeper ACD and thinner lens thickness. These changes should be considered in determining intraocular lens (IOL) power to prevent refractive surprises in cataract surgery and also in the phakic IOL implantation.