Difference Between Cycloplegic and Non-Cycloplegic Refraction and Its Association with Longitudinal Refractive Changes in Chinese Children

To investigate the difference between cycloplegic and non-cycloplegic spherical equivalent refraction (DSE) as well as the association between baseline DSE and future refractive changes in Chinese children. We retrospectively reviewed the medical records of children aged 2-8 years who underwent auto-refraction at the Zhongshan Ophthalmic Center, Guangzhou, China, between 2009 and 2023. Cycloplegia was achieved with 1% atropine or 0.5% tropicamide. Participant demographics, cycloplegic and non-cycloplegic auto-refraction results and best-corrected visual acuity (BCVA), were extracted from the medical records. Multiple linear regression was used to identify the factors associated with the distribution and stability of DSE. A paired t-test was used to assess the stability of DSE over 6 months. Mixed-effect models were used to assess the association between baseline DSE and subsequent refractive changes. A total of 2909 children (mean age, 6.05 years; 45% girls) were included, with most children having a DSE between 0 and 1 D. Larger DSE was associated with younger age (β = -0.099; p < 0.05) and more hyperopic SE (β = 0.495; p < 0.05). A decline of DSE was observed after the age of 6. Stability analysis included 40 children (mean age, 5.63 years; 55% girls), with DSE showing stability over 6 months. Progression analysis of 752 children (mean age, 5.59 years; 46% girls) found no significant association between DSE and myopic shift. Younger and more hyperopic children exhibited larger DSE, DSE was not an independent risk factor for myopic shift.