Barriers and access to pediatric cycloplegic refraction: perspectives from eye care professionals in Kuala Lumpur

Abstract Background Uncorrected refractive errors are a significant cause of preventable vision impairment in children, particularly in urban regions with high rates of myopia. Cycloplegic refraction is the clinical gold standard for accurately assessing pediatric refractive errors, but it remains inconsistently used in practice. This qualitative study examines the perspectives and experiences of eye care professionals (ECPs) in Kuala Lumpur to understand the practical, regulatory, and systemic barriers that influence the use of cycloplegia, complementing prior quantitative findings on practice disparities. Methods A descriptive qualitative design was used. Semi-structured interviews were conducted with 20 ECPs (ophthalmologists, optometrists, and opticians) from both the public and private sectors. Interviews were transcribed verbatim and thematically analysed using an inductive–deductive approach with independent coding and AI-assisted verification. Five descriptive themes were synthesised and conceptually mapped into four higher-order domains: Environmental & Institutional Factors, Family & Socioeconomic Factors, Clinical & Case-Based Practices, and Communication & Collaboration. Results Participants described pediatric refraction as operationally complex and time-intensive, particularly for children under six. Use of cycloplegia varied according to patient age, case complexity, and practitioner confidence, with pragmatic decisions often replacing formal protocols. Regulatory ambiguity—especially the interplay between the Optical Act 1991 and the Poisons Act 1952—limits access to diagnostic drugs, particularly in the private sector. Some ECPs considered cycloplegia unnecessary in routine cases. Fragmented care pathways, multiple referrals, and out-of-pocket costs further constrained timely access for families, especially those on lower incomes. Conclusion This study examines the underlying factors driving disparities in pediatric cycloplegic refraction observed in related quantitative research. Addressing regulatory ambiguities, strengthening inter-professional collaboration, and developing integrated “one-stop” pediatric vision care models may enhance access, continuity, and equity of care. Policy action is needed to reduce avoidable childhood visual impairment through earlier and more accurate refractive correction.