"Is using Dynamic Distant Direct Ophthalmoscope Refraction an Alternative to Cycloplegic Refraction in Children? – A Comparative Study"

Background: Cycloplegic refraction is both time-consuming and has post cycloplegic effects.Hence an alternate, quick but reliable method of refraction was conceptualized to determine whether dynamic distance direct ophthalmoscopy (DDDO) refraction is comparable and can be used as an alternative to cycloplegic refraction.Methods: A prospective observational cohort study was conducted by a single experienced blinded examiner in a community-based school screening.The subjects were between the ages of 5 to 7 years, without refractive errors, binocular vision anomalies, and other ocular defects from a semi-urban, middle-class population.A sample of 110 children was selected by cluster simple random sampling.Cycloplegic refraction was performed for all subjects followed by DDDO refraction.Results: The study included 100 children of which 56 were females and 44 were males.The mean age of the cohort was 6.01 ± 0.52 years.The mean refractive error measured through cycloplegic and DDDO refraction was 0.74D ± 0.234 (range -0.25 -1.25, 95% CL 0.046D) and 0.83D ± 0.238 (range 0.00 -1.25, 95% CL 0.047D) respectively.The Bland Altman analysis revealed a good agreement between the methods with a mean difference of 0.091 D (CI 0.52, -0.34).A Wilcoxon Signed-Rank test revealed a statistically significant difference between the methods with p = 0.00 (95% CL 0.062 -0.125) though it was not clinically significant. Conclusion:The DDDO method is swift and does not have any consequences similar to that of cycloplegia, and is an effective alternative, especially in screening programs.