Comparison of retinoscopy results with and without 1% cyclopentolate in school-aged children.

PURPOSE: This study was designed with the aim of providing practitioners with an evidence base to inform their clinical decision making as to when cycloplegic retinoscopy is necessary and when it might be appropriate to forgo. The study aimed to determine the age at which there ceases to be a clinically significant difference between cycloplegic and non-cycloplegic retinoscopy and whether age, refractive error, habitual spectacle wear and accommodation influence the relationship.
METHODS: A single examiner carried out cycloplegic and non-cycloplegic retinoscopy on 128 children stratified into four age groups (6-7, 8-9, 10-12 and 12-13 years). Cycloplegia was achieved using 1% cyclopentolate and retinoscopy carried out after 30 min. The examiner was masked to the lenses used and to habitual spectacle wear. Accommodation was assessed using dynamic retinoscopy prior to cycloplegia.
RESULTS: Cycloplegic and non-cycloplegic sphere differed significantly (z = -9.18, p < 0.0001). Although the difference decreased significantly as age increased (χ2  = 16.57, p = 0.0009), cycloplegic retinoscopy revealed more hyperopia than non-cycloplegic retinoscopy in all age groups (p < 0.0001). The difference between cycloplegic and non-cycloplegic results was greater where 'high' hyperopia (≥+2.50DS) was present (F1,6  = 12.86, p = 0.0005), and as hyperopia increased the difference increased (Spearman's ρ = 0.55, p < 0.0001). Neither spectacle wear (p = 0.74) nor accommodation (p = 0.08) influenced the difference between spherical measures. Measures of astigmatic error did not differ significantly (z = -1.59, p = 0.11). A non-cycloplegic sphere ≥+1.50DS was relatively sensitive (87%) and specific (96%) at indicating clinically significant hyperopia (≥+2.50D) as revealed by cycloplegic retinoscopy.
CONCLUSIONS: Cyclopentolate 1% does not impact the cylindrical component of the retinoscopy result, but reveals significantly more hyperopia in the spherical component, both statistically and clinically in children aged 6-13 years. Differences between cycloplegic and non-cycloplegic sphere increase significantly with increasing hyperopia, independent of spectacle wear and accommodation. A non-cycloplegic retinoscopy result of ≥+1.50DS may be used by practitioners wishing to identify children aged 6-13 years at risk of clinically significant hyperopia (≥+2.50DS), but cycloplegia is required to accurately ascertain the full spherical error.