Acomparison of non - cyclopegic and cyclopegicautore fraction of African child renaged 5 - 1 5 years in Kwazulu-Natal

Abstract

Anecdotal evidence has revealed much debateabout the use of cycloplegia when screening children.The issue of precision versus practicalityremains an unresolved debate. In the developingworld, with huge disparities in eye care resourcesand services, there is a need to address this issueso as to ensure that access is not compromised inthe search for precision and vice versa. This studytherefore compared autorefraction measurementswith and without cycloplegia.Methods: One hundred and fifty childrenof 5 to 15 years of age were randomly selectedfrom a study population of 4890. Autorefractionwas conducted on the sample using the handheldNikon Retinomax autorefractor and thesereadings are referred to as the dry autorefractionreadings. Thereafter, readings were repeatedonce cycloplegia was reached following theinstillation of cyclopentolate and these arereferred to as the wet autorefraction readings.Of the 150 children, only 118 eyes met thefull cycloplegic criteria, that is, pupil diametergreater than 6 mm and absent light reflex.Results: Data analysis revealed a clinicallysignificant difference of 0.97 D between themean nearest equivalent sphere of the dry andwet readings with the majority of wet readingstending towards more positive values. This differencewas statistically significant to the 99%confidence interval (p = 0.00).Conclusions: Autorefraction with cycloplegiais the more reliable methodology of detectingrefractive error in screening or pre-examapplication. The difference is significant enoughto warrant the use of cycloplegics in children,given the minimal side-effects and despite theextra time and effort.