Cycloplegic autorefraction doubles diagnostic yield of myopia compared to vision testing: findings from a decade-long screening programme.

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.