Evaluation of the Necessity for Cycloplegia During Refraction of Chinese Children Between 4 and 10 Years Old

Purpose: To determine the effect of atropine cycloplegia on the refractive status of children aged 4 to 10 years and to evaluate the necessity of cycloplegia for different refractive states and ages during refractive correction. Methods: This retrospective study included patients with low, moderate, and high myopia and hyperopia who were divided into two groups by age: 4 to 6 years (n = 5,320) and 7 to 10 years (n = 6,475). Every patient underwent cycloplegia with atropine sulphate. Refractive errors were measured by retinoscopy. Results: Within each group, the differences between cycloplegic and non-cycloplegic refractive errors (DIFF C-N ) were significant. DIFF C-N was negatively correlated with age ( r = −0.356, P < .001). The differences in refractive error between prescribed glasses and non-cycloplegic refraction (DIFF G-N ) were largest in the groups with high myopia (0.83 ± 1.15 diopters [D] in the 4 to 6 years group and 0.60 ± 1.47 D in the 7 to 10 years group). After cycloplegia, 62.5% of the patients with mild myopia became emmetropic or hyperopic in the 4 to 6 years group, and 11.3% of the patients with mild myopia became emmetropic or hyperopic in the 7 to 10 years group. Conclusions: Without cycloplegia, autorefraction tends to overestimate refractive error in children with myopia. For accurate glasses prescriptions, cycloplegia should be used for children between 4 and 10 years, especially for children with high myopia. [ J Pediatr Ophthalmol Strabismus . 2020;57(4):257–263.]