Difference Between Cycloplegic and Non-Cycloplegic Refraction and Its Association with Longitudinal Refractive Changes in Chinese Children

To investigate the difference between cycloplegic and non-cycloplegic spherical equivalent refraction (DSE) as well as the association between baseline DSE and future refractive changes in Chinese children. We retrospectively reviewed the medical records of children aged 2–8 years who underwent auto-refraction at the Zhongshan Ophthalmic Center, Guangzhou, China, between 2009 and 2023. Cycloplegia was achieved with 1% atropine or 0.5% tropicamide. Participant demographics, cycloplegic and non-cycloplegic auto-refraction results and best-corrected visual acuity (BCVA), were extracted from the medical records. Multiple linear regression was used to identify the factors associated with the distribution and stability of DSE. A paired t-test was used to assess the stability of DSE over 6 months. Mixed-effect models were used to assess the association between baseline DSE and subsequent refractive changes. A total of 2909 children (mean age, 6.05 years; 45% girls) were included, with most children having a DSE between 0 and 1 D. Larger DSE was associated with younger age (β = -0.099; <i>p</i> &lt; 0.05) and more hyperopic SE (β = 0.495; <i>p</i> &lt; 0.05). A decline of DSE was observed after the age of 6. Stability analysis included 40 children (mean age, 5.63 years; 55% girls), with DSE showing stability over 6 months. Progression analysis of 752 children (mean age, 5.59 years; 46% girls) found no significant association between DSE and myopic shift. Younger and more hyperopic children exhibited larger DSE, DSE was not an independent risk factor for myopic shift.