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Published: 29.04.2021

Cycloplegic refraction is the gold standard for epidemiological studies

Ian G. Morgan,Rafael Iribarren, Akbar Fotouhi, Andrzej Grzybowski

First published: 18 January 2015

https://doi.org/10.1111/aos.12642

Abstract

Many studies on children have shown that lack of cycloplegia is associated with slight overestimation of myopia and marked errors in estimates of the prevalence of emmetropia and hyperopia. Non‐cycloplegic refraction is particularly problematic for studies of associations with risk factors. The consensus around the importance of cycloplegia in children left undefined at what age, if any, cycloplegia became unnecessary. It was often implicitly assumed that cycloplegia is not necessary beyond childhood or early adulthood, and thus, the protocol for the classical studies of refraction in older adults did not include cycloplegia. Now that population studies of refractive error are beginning to fill the gap between schoolchildren and older adults, whether cycloplegia is required for measuring refractive error in this age range, needs to be defined. Data from the Tehran Eye Study show that, without cycloplegia, there are errors in the estimation of myopia, emmetropia and hyperopia in the age range 20–50, just as in children. Similar results have been reported in an analysis of data from the Beaver Dam Offspring Eye Study. If the only important outcome measure of a particular study is the prevalence of myopia, then cycloplegia may not be crucial in some cases. But, without cycloplegia, measurements of other refractive categories as well as spherical equivalent are unreliable. In summary, the current evidence suggests that cycloplegic refraction should be considered as the gold standard for epidemiological studies of refraction, not only in children, but in adults up to the age of 50.

Prevalence, incidence and epidemiology of childhood uveitis

Mira Siiskonen,Iida Hirn, Roosa Pesälä, Timo Hautala, Pasi Ohtonen, Nina Hautala

First published: 26 June 2020

https://doi.org/10.1111/aos.14535

Abstract

Purpose

To analyse the prevalence, incidence and aetiology of paediatric uveitis.

Methods

A retrospective, population‐based cohort study of Finnish children with uveitis in Northern Ostrobothnia Hospital District in 2008–2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution of the disease, aetiology and systemic association.

Results

One hundred fifty patients aged <16 years (mean age 6.9 ± 3.9 years) with uveitis were included, out of whom 53% were girls. The first uveitis episode occurred at 1–6 years in 59%, and 62% of them were girls. In the age group of 7–15 years, boys were diagnosed with uveitis more frequently than girls (61% versus 39%, respectively). Seventy percent of the girls were diagnosed with their first uveitis episode at the age of 1–6 years, whereas only 48% of the boys were diagnosed at that age. The prevalence of uveitis increased from 64/100 000 children <16 years in 2008 (95% CI, 47.7–84.2) to 106/100 000 in 2017 (95% CI, 84.6–130.2). The incidence of childhood uveitis in 2008–2017 was 14/100 000 person‐years in children <16 years (95% CI, 11.3–16.5). Eighty‐seven percent of the cases were non‐infectious, 9% were infectious, and 3% had masquerade syndromes. Sixty‐one percent of patients had juvenile idiopathic arthritis (JIA).

Conclusion

The prevalence of paediatric uveitis has increased during the last decade in both genders. Uveitis is more frequent in girls, and they were diagnosed at a younger age than boys. Idiopathic cases and JIA accounted for a majority of aetiological features.

Validation of the Retinopathy of Prematurity Activity Scale (ROPActS) using retrospective clinical data

Aldina Pivodic, Staffan Nilsson, Andreas Stahl, Lois E.H. Smith, Ann Hellström

First published: 26 June 2020

https://doi.org/10.1111/aos.14532

Abstract

Purpose

The International Neonatal Consortium recently published a proposed retinopathy of prematurity (ROP) activity scale intended for use in clinical trials after validation. The aim of this study was to validate the ROP activity scale (ROP‐ActS) in a ROP screened cohort with protocol based collected data by evaluating the ability of the ROP‐Act scores to predict ROP treatment. In addition, we aimed to evaluate the scale’s sensitivity characteristic of disease severity by studying association with gestational age (GA) in comparison with conventionally used ROP stage and zone.

Methods

A cohort of 535 preterm infants with 3324 ROP examinations with an end‐point of ROP treatment or end of screening in Gothenburg, Sweden, was included. Median GA was 28.1 weeks, 47.5% were girls, and 74 (13.8%) infants were treated for ROP. The validation was performed by estimating probabilities for ROP treatment, and by applying logistic and linear regression.

Results

The original ROP‐ActS was overall well‐ordered with respect to ability to predict ROP treatment but could be improved by re‐ordering score 3 (zone II stage 1) and 5 (zone III stage 3) based on our clinical cohort data. The modified ROP‐ActS was superior to ROP stage and zone in the prediction analysis of ROP treatment. Modified ROP‐ActS was more strongly related to GA than currently used ROP stage, but not zone.

Conclusion

In the studied cohort, the modified ROP‐ActS could better predict ROP treatment compared to ROP stage and zone. Retinopathy of Prematurity Activity Scale (ROP‐ActS) had a superior sensitivity characteristic studied through association to GA than conventionally used ROP stage.