Paediatric refraction practices: access to cyclopegia, barriers, and disparities among eye care professionals in Kuala Lumpur.

BACKGROUND: Accurate paediatric refraction is essential for detecting and managing vision issues, including latent hyperopia, amblyopia, accommodative esotropia, and progressive myopia. Cycloplegic agents are critical for obtaining precise measurements in children, yet their use varies due to professional, regulatory, and systemic barriers. In Malaysia, where refractive services are divided between the public and private sectors, limited data exist on how eye care professionals implement cycloplegic refraction in paediatric practice.

METHODS: This cross-sectional study employed a self-administered questionnaire to survey licensed ophthalmologists, optometrists, and opticians within a 50-km radius of Kuala Lumpur. Participants were recruited through electronic invitations and purposive field visits. Descriptive statistics summarised paediatric refraction practices by profession and sector, and exploratory chi-square, Fisher's Exact, and trend analyses assessed sectoral differences.

RESULTS: Among 222 respondents (61.3% private; 38.7% public), analysis revealed a statistically significant sectoral divide in practice patterns (p < 0.001). Public-sector optometrists administered cycloplegia to 82.3% of children aged 5-9 years, compared with 15.7% in private practice, representing an Odds Ratio of 24.97 (95% CI 10.35-60.21; χ² = 63.84, df = 1, p < 0.001). Private opticians reported 0% cycloplegia use across all age groups, while 79.5% of private optometrists who never used cycloplegia cited 'prohibited by law.' Public ophthalmologists commonly delegated refraction, with only 8.3% performing refraction in children aged 5-9 years. Free-text responses highlighted additional barriers, including workflow constraints, limited training, and misconceptions about the role of cycloplegia.

CONCLUSIONS: Paediatric refraction practices in Kuala Lumpur vary substantially across sectors and professional groups. Despite its clinical importance, cycloplegia remains under-utilised-particularly in private practice. These exploratory findings highlight the need to improve access to cycloplegic agents, clarify professional scope, and address legal and institutional barriers as priorities for strengthening paediatric eye care in Malaysia.