Refractive Error Patterns and the Impact of Cycloplegia in Ametropic Children and Adolescents in Al-Baha, Saudi Arabia.

BACKGROUND AND AIM: Ametropia is a leading cause of preventable visual impairment in children and adolescents, yet region-specific data from Al-Baha, Saudi Arabia remain limited. This study aims to characterise the patterns of refractive error and quantify the impact of cycloplegic refraction in a pediatric ametropic population in Al-Baha City.

METHODS

This hospital-based, prospective, cross-sectional study enrolled 654 ametropic children and adolescents (1,308 eyes), aged 3-18 years, at King Fahad Hospital between November 2022 and November 2023. Participants underwent visual acuity testing, keratometry, and pre- and post-cycloplegic refraction. Data were analysed using SPSS v24 and Microsoft Excel with paired and independent-samples t-tests and Pearson correlations (p < 0.05).

RESULTS

The cohort was 51.7% female and 48.3% male (mean age 9.17 ± 3.89 years). Post-cycloplegia, hyperopic astigmatism predominated (62.8%; 822/1,308 eyes), followed by myopic astigmatism (36.1%; 472/1,308). Cycloplegia produced a significant hyperopic shift in mean spherical equivalent, from -0.33 D dry to +0.54 D cycloplegic (paired mean difference +0.87 D, p < 0.001; r = 0.89), with 26.0% of pre-cycloplegic myopic eyes reclassified as hyperopic. Males were more hyperopic than females (+1.04 vs +0.07 D, p < 0.001), and females had steeper keratometry (43.63 vs 42.86 D, p < 0.001). Mean cycloplegic spherical equivalent (SPE) declined with age from +2.18 D at 3-5 years to -0.55 D at 15-18 years, while the proportion with myopia rose from 14.8% to 55.6%.

CONCLUSION

Hyperopic astigmatism dominated the ametropic spectrum in this hospital-based sample of ametropic children and adolescents in Al-Baha, and cycloplegic refraction was essential to avoid misclassification. The observed age-related shift in refractive status supports standardised cycloplegic protocols and region-specific vision screening, although the clinic-based design limits generalisation to the wider paediatric population.