Refractive Astigmatism Consistency Pre- and Post-Cycloplegia in Pediatric Population

Background: Cycloplegic refraction is crucial in pediatric eye assessments. While spherical refraction changes due to cycloplegia are well-documented, astigmatic alterations remain unclear. This study assessed the agreement between spherical and astigmatic refraction pre- and post-cycloplegia. Methods: We enrolled 96 patients (mean age: 12.5 ± 2.4 years), including 35 myopes, 30 emmetropes, and 31 hyperopes. Pre- and post-cycloplegia autorefraction and keratometry (Myopia Master) were conducted using 1% cyclopentolate. Ocular residual astigmatism (ORA) was calculated as the difference between refractive and keratometric astigmatism. Astigmatism was analyzed using Fourier analysis (J0 and J45). Results: Cycloplegia resulted in a more positive spherical equivalent (SE) (+0.80 D), with myopes showing the smallest (+0.38 D) and hyperopes showing the highest variation (+1.47 D) in SE. With-the-rule (WTR) astigmatism predominated in the refractive and keratometric measurements, while ORA was against-the-rule (ATR). Cycloplegia shifted the refractive J0 (+0.06 D) towards more WTR and decreased ORA J0 (+0.05 D). No effect was observed in the J45 component. About 25% of patients exhibited astigmatism changes above 0.25 D, with refractive J0 variation being positively correlated with accommodation relaxation (0.044 D per D of relaxation). Conclusion: Cycloplegia induces clinically significant changes in the spherical component, but minimal variations in astigmatic components, predominantly in hyperopic eyes, likely reflecting alterations in crystalline lens anatomy.