Is Cycloplegia Always Necessary In Transepithelial Prk Planning? Evaluation Of The Clinical Reliability Of Habitual Eyeglass Prescription

To compare different preoperative refraction measurement methods and to evaluate the reliability of the habitual eyeglass prescription (EP) as a reference value in preoperative assessment of patients with low-to-moderate myopia undergoing transepithelial photorefractive keratectomy (TransPRK).

Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey

Medical records of 45 patients (90 eyes) who underwent TransPRK between 2024 and 2025 were reviewed retrospectively. Preoperative autorefraction (AR), cycloplegic autorefraction (CAR), subjective refraction (SR), and eyeglass prescription (EP) were recorded and analyzed as spherical equivalent (SE). Only patients with stable refraction for ≥6 months and active eyeglass use were included; regular contact lens users or those alternating between glasses and contact lenses were excluded. Repeated measures ANOVA with Bonferroni correction, intraclass correlation coefficient (ICC), and Bland–Altman analyses were performed.

Mean preoperative SE values were −2.85±0.72 D (AR), −2.46±0.69 D (CAR), −2.64±0.63 D (SR), and −2.45±0.64 D (EP). Significant differences were found among the four methods (F(3,267)=45.17, p<0.001). No significant difference was observed between CAR and EP (p>0.05). ICC analysis showed the highest agreement between SR and CAR (ICC=0.93), followed by SR and EP (ICC=0.86). Bland–Altman analysis revealed the narrowest limits of agreement between CAR and SR (−0.30 to +0.67 D) and similar consistency for EP (−0.46 to +0.85 D). At postoperative month 1, mean SE was −0.14 ± 0.48 D, indicating high refractive predictability.

The habitual eyeglass prescription demonstrated good agreement with subjective refraction and comparable accuracy to cycloplegic autorefraction. In patients with stable myopia and consistent eyeglass use, the eyeglass prescription may serve as a clinically reliable reference for preoperative refraction assessment before TransPRK, offering a practical and time-efficient strategy for surgical planning.