RT null
T1 Instrument-based, non-cycloplegic versus cycloplegic refraction in pediatric and young adult populations (≤25 years): A systematic review and meta-analysis
A1 Roque, Ana
A1 Fernandes Nunes, Amélia
A1 Nascimento, Henrique
A1 Martínez Pérez, Clara
K1 Cycloplegia
K1 Autorefraction
K1 Photoscreener
K1 Pediatric refractive error
K1 Spherical equivalent
K1 Vision screening
K1 Meta-analysis
K1 Amblyopia
K1 Hyperopia
K1 Instrument-based refraction
AB BackgroundAccurate refractive assessment in children and young adults is critical to prevent amblyopia and strabismus, conditions that may arise from uncorrected hyperopia. Although non-cycloplegic autorefractors and photoscreeners are increasingly used for vision screening due to their practicality and high testability, residual accommodation often introduces systematic measurement bias. The debate regarding the necessity of cycloplegia has intensified, particularly in large-scale epidemiological studies and screening programs, highlighting the need for an evidence-based synthesis.MethodsThis systematic review and meta-analysis, conducted according to PRISMA and AMSTAR-2 standards and registered in PROSPERO (CRD420251134665), synthesized data from 54 comparative studies, with 24 included in quantitative analyses.ResultsCompared with cycloplegic reference methods, non-cycloplegic autorefractors and photoscreeners consistently underestimated refractive error, showing pooled mean differences of −0.65 D (95% CI: −0.84 to −0.45; 95% PI: −1.50 to +0.20 D) and −0.78 D (95% CI: −1.12 to −0.44; 95% PI: −1.70 to +0.10 D), respectively. These prediction intervals illustrate the wide variability expected across future studies and populations. The bias was most pronounced in younger children and hyperopic eyes, reflecting the impact of accommodative tone. Despite device-specific differences, no method fully corrected this systematic error. Testability exceeded 95% across most devices, reinforcing their feasibility for population-level screening. However, the certainty of evidence was rated as low due to heterogeneity and observational design limitations.ConclusionsNon-cycloplegic methods systematically underestimate hyperopia and therefore cannot replace cycloplegia for definitive diagnosis or spectacle prescription in pediatric populations. Cycloplegic assessment remains essential to detect amblyogenic refractive errors accurately. Non-cycloplegic methods may be integrated into large-scale screening programs for initial case detection, but positive or borderline cases must undergo cycloplegic confirmation to ensure safe and effective clinical management
PB Elsevier
YR 2025
FD 2025-11-14
LK https://hdl.handle.net/10347/45753
UL https://hdl.handle.net/10347/45753
LA eng
NO Ana Roque, Amélia Fernandes Nunes, Henrique Nascimento, Clara Martinez-Perez, Instrument-based, non-cycloplegic versus cycloplegic refraction in pediatric and young adult populations (≤25 years): A systematic review and meta-analysis, Advances in Ophthalmology Practice and Research, Volume 6, Issue 1, 2026, Pages 56-67, ISSN 2667-3762, https://doi.org/10.1016/j.aopr.2025.11.004
DS Minerva
RD 27 abr 2026