Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P. R. China.
Northwestern University School of Medicine, Chicago, Illinois, USA.
Ophthalmic Epidemiol. 2022 Dec;29(6):629-639. doi: 10.1080/09286586.2021.1999986. Epub 2021 Nov 12.
To determine differences in cycloplegic vs. non-cycloplegic refractive error and factors associated with these differences in Chinese school students.
In this cross-sectional school-based study, refractive error was measured in school students using a NIDEK autorefractor before and after administration of 0.5% tropicamide. Spherical equivalent (SER) in diopters (D) was calculated as sphere plus half cylinder. SER differences before vs. after cycloplegia were evaluated using mean, standard deviation (SD), 95% limits of agreement. Univariable and multivariable regression models were used to determine factors associated with SER differences.
Among 3604 students, 3450 (95.7%) provided data for analysis. Mean age (SD) was 9.7 (3.6) years. The mean SER (SD) was -1.12 (1.97) D before cycloplegia, and -0.20 (2.19) D after cycloplegia, with a mean difference of 0.92 D (95% limits of agreement: -0.93 to 2.78 D). Among 196 eyes with non-cycloplegic SER -6.0 D or worse (e.g., met high myopia definition), 71.4% had cycloplegic SER -6.0 D or worse, and among 3607 eyes with non-cycloplegic SER -0.5 D or worse (e.g., met myopia definition), 62.1% eyes had cycloplegic SER -0.5 D or worse. Cycloplegic SER was more correlated with axial length than non-cycloplegic SER (Pearson r = 0.82 vs. 0.72, < .0001). In multivariable analysis, larger SER differences were associated with more hyperopic refractive error and smaller axial length (all < .0001).
Non-cycloplegic refractive error overestimates myopia by approximately one diopter. This overestimation increases with more hyperopic refractive error and smaller axial length. Non-cycloplegic refractive error should not be used for evaluating pediatric myopia.
BCVA = best corrected visual acuity; D = diopter; SD = standard deviation; SE = standard error; SER = spherical equivalent; CI = confidence interval.
确定中国在校学生中睫状肌麻痹与非睫状肌麻痹状态下的屈光不正差异，以及与这些差异相关的因素。
在这项横断面学校基础研究中，使用 NIDEK 自动折射仪在使用 0.5%托吡卡胺前后对学生进行屈光不正测量。球镜等效（SER）以屈光度（D）表示，计算方法为球镜加半柱镜。使用平均值、标准差（SD）和 95%一致性界限评估睫状肌麻痹前后 SER 的差异。使用单变量和多变量回归模型确定与 SER 差异相关的因素。
在 3604 名学生中，有 3450 名（95.7%）提供了分析数据。平均年龄（SD）为 9.7（3.6）岁。睫状肌麻痹前的平均 SER（SD）为-1.12（1.97）D，睫状肌麻痹后的平均 SER 为-0.20（2.19）D，平均差异为 0.92 D（95%一致性界限：-0.93 至 2.78 D）。在 196 只非睫状肌麻痹状态下 SER 为-6.0 D 或更差（例如，符合高度近视定义）的眼中，有 71.4%的眼在睫状肌麻痹状态下 SER 为-6.0 D 或更差，在 3607 只非睫状肌麻痹状态下 SER 为-0.5 D 或更差（例如，符合近视定义）的眼中，有 62.1%的眼在睫状肌麻痹状态下 SER 为-0.5 D 或更差。睫状肌麻痹状态下的 SER 与眼轴长度的相关性大于非睫状肌麻痹状态下的 SER（Pearson r = 0.82 比 0.72， < 0.0001）。在多变量分析中，更大的 SER 差异与更远视的屈光不正和更小的眼轴长度相关（均 < 0.0001）。
非睫状肌麻痹状态下的屈光不正大约高估了 1 个屈光度的近视。这种高估随着更远视的屈光不正和更小的眼轴长度而增加。不应使用非睫状肌麻痹状态下的屈光不正来评估儿童近视。
BCVA = 最佳矫正视力；D = 屈光度；SD = 标准差；SE = 标准误差；SER = 球镜等效；CI = 置信区间。
