A clearer vision: unveiling the importance of cycloplegic refraction and the pseudomyopia prevalence in Chinese preschoolers.
COVID-19
Cycloplegic
Preschool children
Pseudomyopia
Refraction
Journal
BMC ophthalmology
ISSN: 1471-2415
Titre abrégé: BMC Ophthalmol
Pays: England
ID NLM: 100967802
Informations de publication
Date de publication:
12 Aug 2024
12 Aug 2024
Historique:
received:
18
07
2023
accepted:
01
07
2024
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
12
8
2024
Statut:
epublish
Résumé
This study aimed to investigate the difference between cycloplegic and noncycloplegic refraction and evaluate the pseudomyopia prevalence in Chinese preschool children during the outbreak of COVID-19. A cross-sectional study was conducted in the Tongzhou District of Beijing, China. Refractive error was measured under both noncycloplegic and cycloplegic conditions with autorefraction. The difference between noncycloplegic and cycloplegic spherical equivalent refraction (SER) and pseudomyopia prevalence were analyzed. Pseudomyopia was defined as SER ≤-0.50D in precycloplegic assessments and >-0.50D in post-cycloplegic assessments. Out of the 1487 participants who were enrolled in the study, 1471 individuals (98.92%) between the ages of 3-6 years completed all required procedures. A statistically significant difference in refraction was observed between noncycloplegic and cycloplegic measurements, the median of difference in spherical equivalent refraction (SER) of 0.88D (dioptre)(0.50,1.38). There was a high intraclass correlation (ICC) between these two methods for cylinders (ICC = 0.864; 95% CI, 0.850-0.877). The median DSE for myopia, emmetropia and hyperopia were 0.25D (0.00, 0.38),0.25D (0.06, 0.50) and 1.00D (0.62, 1.38), an hypermetropes showed considerably greater differences than myopes and emmetropes (Kruskal-Wallis test, H = 231.023, P = 0.000). Additionally, girls displayed a greater DSE than boys. Furthermore, when comparing against-the-rule (ATR) and oblique astigmatism, it was found that with-the-rule (WTR) astigmatism had the largest DSE. The study found varying prevalence rates of myopia, emmetropia, and hyperopia with and without cycloplegia, which were 1.90% vs. 10.06%, 11.49% vs. 50.31%, and 86.61% vs. 39.63%, respectively. Additionally, the overall prevalence of pseudomyopia was determined to be 8.29%. Participants with pseudomyopia had a significantly higher mean difference in SER (DSE) compared to non-pseudomyopic participants. Cycloplegic refraction is more sensitive than a noncycloplegic one for measuring refractive error in preschool children. Pseudomyopia is prevalent in preschool children during the COVID-19 outbreak period. Our study indicates the possibility that cycloplegic refraction should be performed in preschool children routinely.
Sections du résumé
BACKGROUND
BACKGROUND
This study aimed to investigate the difference between cycloplegic and noncycloplegic refraction and evaluate the pseudomyopia prevalence in Chinese preschool children during the outbreak of COVID-19.
METHODS
METHODS
A cross-sectional study was conducted in the Tongzhou District of Beijing, China. Refractive error was measured under both noncycloplegic and cycloplegic conditions with autorefraction. The difference between noncycloplegic and cycloplegic spherical equivalent refraction (SER) and pseudomyopia prevalence were analyzed. Pseudomyopia was defined as SER ≤-0.50D in precycloplegic assessments and >-0.50D in post-cycloplegic assessments.
RESULTS
RESULTS
Out of the 1487 participants who were enrolled in the study, 1471 individuals (98.92%) between the ages of 3-6 years completed all required procedures. A statistically significant difference in refraction was observed between noncycloplegic and cycloplegic measurements, the median of difference in spherical equivalent refraction (SER) of 0.88D (dioptre)(0.50,1.38). There was a high intraclass correlation (ICC) between these two methods for cylinders (ICC = 0.864; 95% CI, 0.850-0.877). The median DSE for myopia, emmetropia and hyperopia were 0.25D (0.00, 0.38),0.25D (0.06, 0.50) and 1.00D (0.62, 1.38), an hypermetropes showed considerably greater differences than myopes and emmetropes (Kruskal-Wallis test, H = 231.023, P = 0.000). Additionally, girls displayed a greater DSE than boys. Furthermore, when comparing against-the-rule (ATR) and oblique astigmatism, it was found that with-the-rule (WTR) astigmatism had the largest DSE. The study found varying prevalence rates of myopia, emmetropia, and hyperopia with and without cycloplegia, which were 1.90% vs. 10.06%, 11.49% vs. 50.31%, and 86.61% vs. 39.63%, respectively. Additionally, the overall prevalence of pseudomyopia was determined to be 8.29%. Participants with pseudomyopia had a significantly higher mean difference in SER (DSE) compared to non-pseudomyopic participants.
CONCLUSIONS
CONCLUSIONS
Cycloplegic refraction is more sensitive than a noncycloplegic one for measuring refractive error in preschool children. Pseudomyopia is prevalent in preschool children during the COVID-19 outbreak period. Our study indicates the possibility that cycloplegic refraction should be performed in preschool children routinely.
Identifiants
pubmed: 39134974
doi: 10.1186/s12886-024-03551-1
pii: 10.1186/s12886-024-03551-1
doi:
Substances chimiques
Mydriatics
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
338Subventions
Organisme : National Natural Science Foundation of China
ID : 82070998
Organisme : Key research projects in the capital's health development scientific research
ID : first launch 2022-1-2053
Organisme : Program of Beijing Hospitals Authority
ID : XMLX202103
Informations de copyright
© 2024. The Author(s).
Références
García-Montero M, Felipe-Márquez G, Arriola-Villalobos P, Garzón N, Pseudomyopia. Rev Vis. 2022;6:17.
Lin Z, Vasudevan B, Ciuffreda KJ, et al. The difference between cycloplegic and non-cycloplegic autorefraction and its association with progression of refractive error in Beijing urban children. Ophthalmic Physiological Opt. 2017;37:489–97.
doi: 10.1111/opo.12381
Kang M, Jan C, Li S, et al. Prevalence and risk factors of pseudomyopia in a Chinese children population: the Anyang Childhood Eye Study. Brit J Ophthalmol. 2021;105:1216–21.
doi: 10.1136/bjophthalmol-2020-316341
MEI Q. Early signs of Myopia in Chinese Schoolchildren. Optometry Vis Sci. 1994;71:14–6.
doi: 10.1097/00006324-199401000-00003
Mutti DO, Mitchell GL, Hayes JR, et al. Accommodative lag before and after the Onset of Myopia. Invest Opthalmology Visual Sci. 2006;47:837.
doi: 10.1167/iovs.05-0888
Ip JM, Saw S, Rose KA, et al. Role of Near Work in Myopia: findings in a sample of Australian School Children. Invest Opthalmology Visual Sci. 2008;49:2903.
doi: 10.1167/iovs.07-0804
Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020;395:945–7.
doi: 10.1016/S0140-6736(20)30547-X
pubmed: 32145186
pmcid: 7124694
Ramamurthy D, Lin Chua SY, Saw SM. A review of environmental risk factors for myopia during early life, childhood and adolescence. Clin Exp Optom. 2015;98(6):497–506.
doi: 10.1111/cxo.12346
pubmed: 26497977
Morgan IG, Iribarren R, Fotouhi A, Grzybowski A. Cycloplegic refraction is the gold standard for epidemiological studies. Acta Ophthalmol. 2015;93:581–5.
doi: 10.1111/aos.12642
pubmed: 25597549
Li L, Fu J, Chen W, et al. Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study. Jpn J Ophthalmol. 2021;65:526–36.
doi: 10.1007/s10384-021-00828-6
pubmed: 33656708
Hu YY, Wu JF, Lu TL, et al. Effect of Cycloplegia on the refractive status of children: the Shandong Children Eye Study. PLoS ONE. 2015;10:e0117482.
doi: 10.1371/journal.pone.0117482
pubmed: 25658329
pmcid: 4319948
Sankaridurg P, He X, Naduvilath T, et al. Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children. Acta Ophthalmol. 2017;95:e633–40.
doi: 10.1111/aos.13569
pubmed: 29110438
pmcid: 5698763
Wang J, Li Y, Musch DC, et al. Progression of myopia in school-aged children after COVID-19 home confinement. Jama Ophthalmol. 2021;139:293.
doi: 10.1001/jamaophthalmol.2020.6239
pubmed: 33443542
pmcid: 7809617
Lan W, Zhao F, Lin L, et al. Refractive errors in 3–6 year-old Chinese children: a very low prevalence of myopia? PLoS ONE. 2013;8:e78003.
doi: 10.1371/journal.pone.0078003
pubmed: 24205064
pmcid: 3813538
Choi MY, Choi JA. Ocular Dominance in Open-angle Glaucoma: The Shifting Trend Depending on Stage of the Disease. Korean J Ophthalmol. 2022;36(3):236–243.
Panel AOAC. Care of the patient with hyperopia. 2008. http://www.aoaorg/documents/optometrists/CPG-16.pdf . Accessed 30 Oct 2015.
Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research [published correction appears in J Chiropr Med. 2017;16(4):346]. J Chiropr Med. 2016;15(2):155–163.
Zhu D, Wang Y, Yang X, et al. Pre- and postcycloplegic refractions in children and adolescents. PLoS ONE. 2016;11(12):e0167628.
doi: 10.1371/journal.pone.0167628
pubmed: 27907165
pmcid: 5132192
Fotouhi A, Morgan IG, Iribarren R, Khabazkhoob M, Hashemi H. Validity of noncycloplegic refraction in the assessment of refractive errors: the Tehran Eye Study. Acta Ophthalmol. 2012;90(4):380–6.
doi: 10.1111/j.1755-3768.2010.01983.x
pubmed: 20977697
Fotedar R, Rochtchina E, Morgan I, Wang JJ, Mitchell P, Rose KA. Necessity of cycloplegia for assessing refractive error in 12-year-old children: a population-based study. Am J Ophthalmol. 2007;144(2):307–9.
doi: 10.1016/j.ajo.2007.03.041
pubmed: 17659966
Guo X, Shakarchi AF, Block SS, Friedman DS, Repka MX, Collins ME. Noncycloplegic compared with cycloplegic refraction in a Chicago School-aged Population. Ophthalmology. 2022;129:813–20.
doi: 10.1016/j.ophtha.2022.02.027
pubmed: 35245603
Zhang L, He X, Qu X, et al. Refraction and ocular biometry of Preschool Children in Shanghai, China. J Ophthalmol. 2018;2018:1–10.
Guo X, Fu M, Ding X, Morgan IG, Zeng Y, He M. Significant Axial elongation with minimal change in refraction in 3- to 6-Year-old Chinese preschoolers. Ophthalmology. 2017;124:1826–38.
doi: 10.1016/j.ophtha.2017.05.030
pubmed: 28711218
Dirani M, Chan Y, Gazzard G, et al. Prevalence of refractive error in Singaporean Chinese children: the Strabismus, Amblyopia, and refractive error in Young Singaporean Children (STARS) study. Invest Opthalmology Visual Sci. 2010;51:1348.
doi: 10.1167/iovs.09-3587
Giordano L, Friedman DS, Repka MX, et al. Prevalence of refractive error among Preschool Children in an Urban Population: the Baltimore Pediatric Eye Disease Study. Ophthalmology. 2009;116:739–e7464.
doi: 10.1016/j.ophtha.2008.12.030
pubmed: 19243832
Ma M, Xiong S, Zhao S, Zheng Z, Sun T, Li C. COVID-19 Home Quarantine accelerated the progression of myopia in children aged 7 to 12 years in China. Invest Opthalmology Visual Sci. 2021;62:37.
doi: 10.1167/iovs.62.10.37
Zhang XJ, Zhang Y, Kam KW, et al. Prevalence of myopia in children before, during, and after COVID-19 restrictions in Hong Kong. JAMA Netw Open. 2023;6:e234080.
doi: 10.1001/jamanetworkopen.2023.4080
pubmed: 36947037
pmcid: 10034576
Yang YC, Tsai DC, Wang CY, Chen YL, Shyong MP, Hsu NW. The prevalence of myopia remains stable under tighter COVID-19 social restriction in preschoolers receiving a school‐based eyecare program. Acta Ophthalmol 2023.
Chang HY, Park E, Yoo H, Lee JW, Shin Y. Electronic media exposure and use among toddlers. Psychiat Invest. 2018;15:568–73.
doi: 10.30773/pi.2017.11.30.2
Sanfilippo PG, Chu B, Bigault O, et al. What is the appropriate age cut-off for cycloplegia in refraction? Acta Ophthalmol. 2014;92:e458–62.
doi: 10.1111/aos.12388
pubmed: 24641244
Fan Q, Wang H, Kong W, Zhang W, Li Z, Wang Y. Online learning-related visual function impairment during and after the COVID-19 pandemic. Front Public Health 2021;9.