Cycloplegic Autorefraction Versus Subjective Refraction: The Tehran Eye Study Publisher Pubmed



Hashemi H¹ ; Khabazkhoob M¹ ; Asharlous A² ; Soroush S² ; Yekta A³ ; Dadbin N² ; Fotouhi A⁴ Show Affiliations
Source: British Journal of Ophthalmology Published:2016

Abstract

Aim: To compare cycloplegic autorefraction with noncycloplegic subjective refraction across all age and refractive error groups. Methods: In a cross-sectional study with random stratified cluster sampling, 160 clusters were chosen from various districts proportionate to the population of each district in Tehran. Following retinoscopy and autorefraction with the 0.25 D bracketing (Topcon KR-8000, Topcon, Tokyo, Japan), all participants had a subjective refraction. Then all participants underwent cycloplegic autorefraction. Results: The final analysis was performed on 3482 participants with a mean age of 31.7 years (range 5-92 years). Based on cycloplegic and subjective refraction, mean spherical equivalent (SE) was +0.31±1.80 and -0.32±1.61 D, respectively (p<0.001). The 95% limits of agreement (LoA) between these two types of refraction were from-0.40 to 1.70 D. The largest difference between these two types of refraction was seen in the age group of 5-10 years (1.11±0.60 D), and the smallest difference was in the age group of >70 years (0.34±0.45 D). The 95% LoA was-0.52 to 0.89 D in patients with myopia and -0.12 to 2.04 D in patients with hyperopia. We found that female gender (coefficients=0.048), older age (coefficients=-0.247), higher education (coefficients=-0.043) and cycloplegic SE (coefficients=-0.472) significantly correlated with lower intermethod differences. Conclusions: The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclorefraction technique is highly recommended to exactly measure the refractive error in momentous conditions such as refractive surgery, epidemiological researches and amblyopia therapy, especially in hypermetropic eyes and paediatric cases.