The British journal of ophthalmology · 2026
Cycloplegic autorefraction doubles diagnostic yield of myopia compared to vision testing: findings from a decade-long screening programme.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Wang Chiao-Yu, Yang Yu-Chieh, Yang Hsin-Yu, Fang Shao-You, Shyong Mong-Ping, Lee Chia-Wei, Huang Pei-Wei, Chen Yen-Lin, Hsu Nai-Wei, Tsai Der-Chong
Аннотация
BACKGROUND: Cycloplegic autorefraction may offer higher diagnostic accuracy than uncorrected visual acuity (VA) screening. We aimed to evaluate diagnostic yield and risk factors for previously unrecognised myopia.
METHODS: This repeated cross-sectional study analysed data from 33 642 kindergarteners aged 5-6 years enrolled in the Yilan Myopia Prevention and Vision Improvement Program from 2014 to 2024. Participants underwent uncorrected VA testing and on-site cycloplegic autorefraction. Caregivers completed questionnaires on myopia-related behaviours. Previously unrecognised or newly detected myopia (NDM), defined as spherical equivalent ≤-0.50 dioptres without prior diagnosis. The main outcome was diagnostic yield, defined as the proportion of NDM among at-risk participants by different screening methods.
RESULTS: Among 33 642 participants (mean age, 5.23±0.41 years; 51.7% boys), 3206 (9.5%) were identified myopic, including 2303 (6.8%) who were newly detected through cycloplegic autorefraction, yielding a diagnostic rate of 7.03% (95% CI 6.76% to 7.32%). Only 47.9% children with NDM met the reduced VA referral criterion (uncorrected VA <6/7.5 in either eye), and the diagnostic yield of VA screening was 3.37% (95% CI 3.18% to 3.57%; area under the ROC curve: 0.743). NDM was significantly associated with weekend behaviours including digital screen time ≥2 hours/day (OR, 1.13; 95% CI 1.03 to 1.23) and outdoor time ≥2 hours/day (OR, 0.85; 95% CI 0.78 to 0.94). In contrast, previously detected myopia showed no association with these modifiable factors.
CONCLUSIONS: Preschool myopia screening using cycloplegic autorefraction significantly improves early detection compared with VA screening. Timely diagnosis raises parental awareness and empowers children to modify myopia-related behaviours.
METHODS: This repeated cross-sectional study analysed data from 33 642 kindergarteners aged 5-6 years enrolled in the Yilan Myopia Prevention and Vision Improvement Program from 2014 to 2024. Participants underwent uncorrected VA testing and on-site cycloplegic autorefraction. Caregivers completed questionnaires on myopia-related behaviours. Previously unrecognised or newly detected myopia (NDM), defined as spherical equivalent ≤-0.50 dioptres without prior diagnosis. The main outcome was diagnostic yield, defined as the proportion of NDM among at-risk participants by different screening methods.
RESULTS: Among 33 642 participants (mean age, 5.23±0.41 years; 51.7% boys), 3206 (9.5%) were identified myopic, including 2303 (6.8%) who were newly detected through cycloplegic autorefraction, yielding a diagnostic rate of 7.03% (95% CI 6.76% to 7.32%). Only 47.9% children with NDM met the reduced VA referral criterion (uncorrected VA <6/7.5 in either eye), and the diagnostic yield of VA screening was 3.37% (95% CI 3.18% to 3.57%; area under the ROC curve: 0.743). NDM was significantly associated with weekend behaviours including digital screen time ≥2 hours/day (OR, 1.13; 95% CI 1.03 to 1.23) and outdoor time ≥2 hours/day (OR, 0.85; 95% CI 0.78 to 0.94). In contrast, previously detected myopia showed no association with these modifiable factors.
CONCLUSIONS: Preschool myopia screening using cycloplegic autorefraction significantly improves early detection compared with VA screening. Timely diagnosis raises parental awareness and empowers children to modify myopia-related behaviours.