关键词: 近视, 调节功能, 睫状肌麻痹验光, 配镜处方

Abstract: Objective To investigate the difference of the diopter between non-cycloplegic refraction and cycloplegic refraction in 7-17 years old myopic children with different accommodation conditions, and to analyze the feasibility of prescription of glasses according to non-cycloplegic refraction. Design Matched case-control study. Participants The adolescents and children aged 7 to 17 years old with  equivalent spherical lens ≤-0.75 D (cycloplegia refraction) and cylindrical lens diopter ≤1 D (non-cycloplegia refraction and cycloplegia refraction) who underwent cyclopletic optometry using compound tropicamine eye drops from January 2015 to April 2022 in the optometry Department of Jinan Aier Eye Hospital. Methods The medical records of the optometry outpatient department were reviewed. All subjects underwent comprehensive refraction, NRA (negative relative accommodation), BCC (binocular cross-cylinder), PRA (positive relative accommodation) before cycloplegia, and comprehensive refraction after cycloplegia. Patients with BCC ≥0.25 and NRA ≥1.75 were taken as group A (normal or large-behind accommodation), and BCC ≤0 or NRA ≤1.5 were taken as group B (super-normal accommodation). The data of the two groups were obtained by propensity score matching. 884 cases (1310 eyes) were screened to meet the requirements, including 416 males and 468 females. After grouping, there was no significant difference in age, diopter after cycloplegia and PRA between the two groups (472 cases with 650 eyes in group A and 412 cases with 660 eyes in group B), which was comparable (P>0.05). Main Outcome Measure The diopter before and after ciliary paralysis and the difference between them. Results After cycloplegia, the spherical and equivalent spherical mirrors of the eyes were significantly lower than those before cycloplegia (the spherical t=23.318, P<0.001, the equivalent spherical t=19.871, P<0.001). Bland Altman pairing analysis was used to test the consistency of the optometry results before and after cycloplegia in the two groups. The results showed that the diopters before and after cycloplegia in the two groups A and B were consistent; When the change of spherical lens diopter before and after ciliary paralysis was ≥0.5 d, 11.54% and 12.58% of the eyes in groups A and B had changes in diopter between non-cycloplegic and cycloplegic, and there was no significant difference between the two groups (X²=0.332, P=0.564). Conclusion It should be cautious to take the accommodation conditions as the basis of whether the cycloplegia optometry is required when prescribing glasses, and it should be made with caution in combination with other factors even it’s adjustment function is normal or large-behind. (Ophthalmol CHN, 2023, 32: 492-495)

Key words: myopia, accommodation, cycloplegic refraction, spectacles prescription