Standardised Manifest Refraction Protocol Versus 1% Tropicamide Cycloplegia In Young Hyperopes: Agreement And Implications For Surgical Planning
Published 2026 - 44th Congress of the ESCRS
Reference: POREF206 | Type: Free paper | DOI: 10.82333/wdtd-w910
Authors: Ms Sharon Ritchie* 1 , Prof. Dan Reinstein 2 , Dr Timothy Archer 1 , Mr Joseph Potter 1 , Ms Ruchi Gupta 1
1London Vision Clinic,London,United Kingdom, 2London Vision Clinic,London,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom
Purpose
To compare manifest and 1% tropicamide-induced cycloplegic refraction in young hyperopic patients and assess whether standardised manifest refraction (LoVCRP) can guide hyperopic refractive surgery planning without commonly used arbitrary arithmetic splitting between manifest and cycloplegic refractions.
Setting
Private Practice Academic Unit Reinstein Vision, London Vision Clinic, EuroEyes Group, UK
Methods
This retrospective study included consecutive patients treated between 2017 and 2025. Inclusion criteria were: age <40 years; cycloplegic spherical hyperopia +3.00 to +8.00 D; CDVA 20/25 or better; contact lenses stopped ≥24 h; and two refractions available. Visit 1: optometrist manifest refraction by the London Vision Clinic Refraction Protocol (LoVCRP) followed the same day by 1% tropicamide cycloplegic refraction. Visit 2 (within 3 months): surgeon manifest refraction by LoVCRP, with access to all visit-1 refractions. Analyses compared (1) visit-1 optometrist manifest vs cycloplegic and (2) visit-1 cycloplegic vs visit-2 surgeon manifest.
Results
A total of 612 eyes were analysed. The mean optometrist manifest sphere was +4.52 ± 1.14 D (range +2.00 to +7.50 D), the optometrist cycloplegic sphere was +5.09 ± 1.10 D (range +3.00 to +8.00 D), and the surgeon manifest sphere was +4.65 ± 1.11 D (range +1.75 to +7.50 D). Comparison 1 (same optometrist, same day): cycloplegic–manifest differences were within ±0.50 D in 79.3% of eyes and within ±1.00 D in 88.5%. Comparison 2 (visit-1 cycloplegic refraction vs visit-2 surgeon manifest refraction, performed with visibility of all visit-1 refractions): agreement was within ±0.50 D in 85.7% and within ±1.00 D in 94.4%.
Conclusions
In young hyperopic patients, LoVCRP manifest refraction closely approximates 1% tropicamide-induced cycloplegic refraction in most eyes. Agreement between visit-1 cycloplegic and visit-2 surgeon manifest refractions suggests that, when the LoVCRP is used, hyperopic refractive surgery planning can rely on manifest refraction without arbitrary arithmetic splitting.