Cycloplegic Autorefraction Versus Subjective Non-Cycloplegic Refraction In Adult Refractive Candidates

To explore the difference between cycloplegic autorefraction and subjective non-cycloplegic refraction as well as their influencing demographic factors in adult Caucasian refractive candidates.

Department of Ophthalmology, LMU University Hospital, Munich, Germany and Auge Laser Chirurgie, Linz, Austria.

All patients examined at the LMU University Hospital and the Auge Laser Chirurgie Eye Clinic, who underwent non-cycloplegic and cycloplegic automatic as well as noncycloplegic subjective refraction, were enrolled. All participants were at least 18 years old with a minimum visual acuity of 20/25 (0.10 logMAR).

In total, 4395 eyes of 2221 individuals with a mean age of 38.1 ± 12.4 years (range 18 - 76 years) were included. Based on cycloplegic autorefraction and subjective refraction (SR), the mean spherical equivalent (SE) was -3.00 ± 3.52 D and -3.36 ± 3.52 D, respectively (mean difference: 0.37 ± 0.48; p < 0.0001). The most pronounced difference with 0.75 ± 0.88 D was found in young (≤ 35 years), hyperopic (≥ 2 D spherical equivalent) eyes (p < 0.0001) as well as in eyes with an astigmatism of ≥ 2 D (mean difference: 0.46 ± 0.43 D; p < 0.0001). The lowest difference was observed in individuals older than 50 years (0.22 ± 0.32; p < 0.0001) and eyes with an astigmatism ≤ 0.25 D (0.30 ± 0.54; p < 0.0001).

Non-cycloplegic refraction results in a more myopic refractive error, which is more pronounced in young, hyperopic individuals as well as in eyes with higher astigmatism. Thus, those individuals should be evaluated more precise before clearing them for refractive surgery.