Author ORCID Identifier

0000-0003-0024-8922

Document Type

Article

Disciplines

Ophthalmology

Publication Details

Clinical & Experimental Optometry

Abstract

Clinical Relevance: Cycloplegic refraction remains crucial in young adults, where accommodative activity can obscure accurate refractive status. Autorefractor repeatabil­ity is essential for precise optical correction and refractive error categorisation in clinical and research settings.

Background: Cycloplegic autorefraction is recommended for individuals up to 20 years to prevent hyperopia underestimation and myopia overestimation. This study evaluated differences between non-cycloplegic and cycloplegic spherical equivalent refraction following cyclopentolate hydrochloride (cycloplegic agent) administration in young adults. This study also explored whether this difference varied by refractive status (hyperopia (≥1.00D), emmetropia ( >−0.50, < 1.00D), myopia (≤-0.50D)) or pre- instillation of proxymetacaine hydrochloride and whether cycloplegia improved autorefractor repeatability.

Methods: Participants were 182 young adults (17–30 years) (mean (standard deviation): 21.66 (2.86) years). The right eye received 0.5% proxymetacaine hydrochloride and one (blue/green irides) or two drops (brown/hazel irides) of 1.0% cyclopentolate hydrochlor­ide. The left eye received cyclopentolate hydrochloride only. Autorefraction was per­formed before and after cycloplegia. Analysis included paired t-testing, Deming regression, Bland-Altman analysis and equivalence testing.

Results: Cycloplegic autorefraction was significantly more hyperopic than non- cycloplegic autorefraction (mean difference: 0.68(0.71) D in right eyes, 0.53(0.53) D in left eyes; p < 0.001) with 48.4% of participants exhibiting clinically significant differences of ≥ 0.50D. Agreement between non-cycloplegic and cycloplegic measurements was poor (limits of agreement: −0.71 D to +2.07 D, right eye). Hyperopes showed the greatest shift (1.39(0.91) D), compared to emmetropes (0.66(0.47) D) and myopes (0.31 (0.34) D). Cycloplegia improved repeatability, narrowing limits of agreement (−0.16 D to +0.15 D vs −0.24 D to +0.21 D). Proxymetacaine hydrochloride pre-instillation enhanced cyclo­plegic effect (+0.15 (0.07) D), particularly in hyperopic participants.

Conclusions: A clinically significant difference was observed between non-cycloplegic and cycloplegic autorefraction in young adult participants, particularly among hype­ropes. Cycloplegic measurements showed better repeatability, supporting their use for accurate refraction. Further research is needed on potential enhancing effects of prox­ymetacaine hydrochloride, particularly in diverse populations.

DOI

10.1080/08164622.2025.2542321

Funder

Technological University Dublin, Optometry Ireland

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Download
Contact the Author


Included in

Optometry Commons

Share

COinS