Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children
Purpose To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved. Methods Random cluster sampling was used to select 6825 children aged 4–15 yea...
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| Veröffentlicht in: | Acta ophthalmologica (Oxford, England) Jg. 95; H. 7; S. e633 - e640 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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England
Wiley Subscription Services, Inc
01.11.2017
John Wiley and Sons Inc |
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| ISSN: | 1755-375X, 1755-3768, 1755-3768 |
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| Abstract | Purpose
To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved.
Methods
Random cluster sampling was used to select 6825 children aged 4–15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent (SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity (UCVA).
Results
Compared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: −0.63 ± 0.65D, 95% CI: −0.612 to −0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement (R2 = 0. 93), with 80% of the eyes correctly classified. A higher VA cut‐off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly.
Conclusion
Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut‐offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value. |
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| AbstractList | To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved.PURPOSETo systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved.Random cluster sampling was used to select 6825 children aged 4-15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent (SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity (UCVA).METHODSRandom cluster sampling was used to select 6825 children aged 4-15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent (SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity (UCVA).Compared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: -0.63 ± 0.65D, 95% CI: -0.612 to -0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement (R2 = 0. 93), with 80% of the eyes correctly classified. A higher VA cut-off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly.RESULTSCompared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: -0.63 ± 0.65D, 95% CI: -0.612 to -0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement (R2 = 0. 93), with 80% of the eyes correctly classified. A higher VA cut-off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly.Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut-offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value.CONCLUSIONNoncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut-offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value. Purpose To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved. Methods Random cluster sampling was used to select 6825 children aged 4–15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent (SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity (UCVA). Results Compared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: −0.63 ± 0.65D, 95% CI: −0.612 to −0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement (R2 = 0. 93), with 80% of the eyes correctly classified. A higher VA cut‐off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly. Conclusion Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut‐offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value. To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved. Random cluster sampling was used to select 6825 children aged 4-15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent (SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity (UCVA). Compared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: -0.63 ± 0.65D, 95% CI: -0.612 to -0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement (R = 0. 93), with 80% of the eyes correctly classified. A higher VA cut-off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly. Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut-offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value. Purpose To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved. Methods Random cluster sampling was used to select 6825 children aged 4-15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent (SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity (UCVA). Results Compared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: -0.63 ± 0.65D, 95% CI: -0.612 to -0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement (R2 = 0. 93), with 80% of the eyes correctly classified. A higher VA cut-off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly. Conclusion Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut-offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value. |
| Author | Naduvilath, Thomas Lv, Minzhi Zou, Haidong Sankaridurg, Padmaja Erickson, Paul Xu, Xun Zhu, Jianfeng Ho, Arthur Smith, Earl He, Xiangui |
| AuthorAffiliation | 4 School of Public Health Fudan University Shanghai China 2 School of Optometry and Vision Science University of New South Wales Sydney New South Wales Australia 5 College of Optometry University of Houston Houston Texas USA 3 Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai China 6 Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University Shanghai China 1 Brien Holden Vision Institute Sydney New South Wales Australia |
| AuthorAffiliation_xml | – name: 1 Brien Holden Vision Institute Sydney New South Wales Australia – name: 4 School of Public Health Fudan University Shanghai China – name: 3 Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai China – name: 5 College of Optometry University of Houston Houston Texas USA – name: 6 Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University Shanghai China – name: 2 School of Optometry and Vision Science University of New South Wales Sydney New South Wales Australia |
| Author_xml | – sequence: 1 givenname: Padmaja surname: Sankaridurg fullname: Sankaridurg, Padmaja organization: University of New South Wales – sequence: 2 givenname: Xiangui orcidid: 0000-0002-8938-1879 surname: He fullname: He, Xiangui email: xianhezi@163.com organization: Fudan University – sequence: 3 givenname: Thomas surname: Naduvilath fullname: Naduvilath, Thomas organization: University of New South Wales – sequence: 4 givenname: Minzhi surname: Lv fullname: Lv, Minzhi organization: Shanghai Eye Hospital – sequence: 5 givenname: Arthur surname: Ho fullname: Ho, Arthur organization: University of New South Wales – sequence: 6 givenname: Earl surname: Smith fullname: Smith, Earl organization: University of Houston – sequence: 7 givenname: Paul surname: Erickson fullname: Erickson, Paul organization: Brien Holden Vision Institute – sequence: 8 givenname: Jianfeng surname: Zhu fullname: Zhu, Jianfeng email: jfzhu1974@hotmail.com organization: Shanghai Eye Hospital – sequence: 9 givenname: Haidong surname: Zou fullname: Zou, Haidong organization: Shanghai Jiao Tong University – sequence: 10 givenname: Xun orcidid: 0000-0002-4246-4343 surname: Xu fullname: Xu, Xun organization: Shanghai Jiao Tong University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29110438$$D View this record in MEDLINE/PubMed |
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| Copyright | 2017 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation. Copyright © 2017 Acta Ophthalmologica Scandinavica Foundation |
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| Keywords | myopia cycloplegic refraction children non cycloplegic refraction refractive errors |
| Language | English |
| License | Attribution-NonCommercial 2017 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Financial support are given by Three‐year Action Program of Shanghai Municipality for Strengthening the Construction of the Public Health System (2015–2017) (Grant No. GWIV‐13.2); Key Discipline of Public Health–Eye Health in Shanghai (Grant No. 15GWZK0601); Overseas High‐end Research Team–Eye Health in Shanghai (GWTD2015S08); National Natural Science Foundation of China for Young Staff (Grant No. 81402695); Shanghai Natural Science Foundation (Grant No. 15ZR1438400); Brien Holden Vision Institute, Sydney, Australia. |
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To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive... To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive value of... Purpose To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors (RE) in children and to determine if the predictive... |
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| SubjectTerms | Acuity Age Children cycloplegic refraction Myopia non cycloplegic refraction Original refractive errors |
| Title | Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children |
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