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Cycloplegic autorefraction versus subjective refraction: the Tehran Eye Study
  1. Hassan Hashemi1,
  2. Mehdi Khabazkhoob1,
  3. Amir Asharlous2,
  4. Sara Soroush2,
  5. AbbasAli Yekta3,
  6. Nooshin Dadbin2,
  7. Akbar Fotouhi4
  1. 1Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
  2. 2Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
  3. 3Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
  4. 4Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  1. Correspondence to Professor Akbar Fotouhi, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 14155-6446, Iran; afotouhi{at}


Aim To compare cycloplegic autorefraction with non-cycloplegic subjective refraction across all age and refractive error groups.

Methods In a cross-sectional study with random stratified cluster sampling, 160 clusters were chosen from various districts proportionate to the population of each district in Tehran. Following retinoscopy and autorefraction with the 0.25 D bracketing (Topcon KR-8000, Topcon, Tokyo, Japan), all participants had a subjective refraction. Then all participants underwent cycloplegic autorefraction.

Results The final analysis was performed on 3482 participants with a mean age of 31.7 years (range 5–92 years). Based on cycloplegic and subjective refraction, mean spherical equivalent (SE) was +0.31±1.80 and −0.32±1.61 D, respectively (p<0.001). The 95% limits of agreement (LoA) between these two types of refraction were from −0.40 to 1.70 D. The largest difference between these two types of refraction was seen in the age group of 5–10 years (1.11±0.60 D), and the smallest difference was in the age group of >70 years (0.34±0.45 D). The 95% LoA was −0.52 to 0.89 D in patients with myopia and −0.12 to 2.04 D in patients with hyperopia. We found that female gender (coefficients=0.048), older age (coefficients=−0.247), higher education (coefficients=−0.043) and cycloplegic SE (coefficients=−0.472) significantly correlated with lower intermethod differences.

Conclusions The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclorefraction technique is highly recommended to exactly measure the refractive error in momentous conditions such as refractive surgery, epidemiological researches and amblyopia therapy, especially in hypermetropic eyes and paediatric cases.

  • Optics and Refraction

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