Accuracy of noncycloplegic autorefraction in school-age children in China

Optom Vis Sci. 2004 Jan;81(1):49-55. doi: 10.1097/00006324-200401000-00010.


Purpose: To evaluate the accuracy of noncycloplegic autorefraction in a representative sample of school-age children in China.

Methods: Refractive error was measured with an autorefractor, both before and after cycloplegia induced with cyclopentolate, in a population-based sample of 4973 children between the ages of 7 and 18 years. Spherical equivalent refractive error and astigmatism as represented by Jackson crossed-cylinders (J0 and J45) were the main outcome measures.

Results: Noncycloplegic measurements of equivalent spheres were consistently more negative or less positive than those after cycloplegia, with mean +/- SD differences of -1.23 +/- 0.97 D. The differences were particularly large for hyperopic eyes (mean difference of -2.98 +/- 1.65 D for hyperopia of at least +2.00 D) while becoming progressively smaller for emmetropic eyes, and smaller yet for myopic eyes (mean difference of -0.41 +/- 0.46 D for myopia of -2.00 D or more). Increasing age was associated with increased, but clinically insignificant, differences. Little difference was found between noncycloplegic and cycloplegic measurements of astigmatism: mean J0 and J45 differences were -0.08 +/- 0.13 D and -0.01 +/- 0.09 D, respectively.

Conclusions: Noncycloplegic autorefraction was found to be highly inaccurate in school-age children and, thus, not suitable for studies of refractive error or for prescription of glasses in this population.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • China
  • Cyclopentolate / administration & dosage
  • Female
  • Humans
  • Male
  • Mydriatics / administration & dosage
  • Pupil / drug effects
  • Refraction, Ocular*
  • Refractive Errors / diagnosis*
  • Reproducibility of Results
  • Vision Tests / standards*


  • Mydriatics
  • Cyclopentolate