Lag of accommodation predicts clinically significant change of spherical equivalents after cycloplegia

AIM: To evaluate related factors with the change of spherical equivalents (Delta SE) and determine the suitable predictor of clinically significant Delta SE (>= 0.50 D) with cyclopentolate hydrochloride on Chinese children. METHODS: A total of 145 right eyes of 145 children aged 4 to 15y were enrolled. Intraocular pressure, axial length and lag of accommodation ( LOA) were assessed before cycloplegia induced by 3 drops of 1% cyclopentolate at 5-minute intervals. SE was measured before and 1h after the first drop of cyclopentolate. Delta SE was compared between different gender groups and among refractive groups. Multivariate linear regression analysis was performed to find related factors with Delta SE. ROC analysis was used to figure out the suitable predictor of clinically significant Delta SE. RESULTS: For the total 145 eyes, the mean SE reached up to -0.70 +/- 1.86 D from -1.30 +/- 1.62 D, with the mean Delta SE of 0.60 +/- 0.55 D. The mean Delta SE were 0.63 +/- 0.55 D and 0.57 +/- 0.56 D respectively in the male and female group (P=0.40). The mean Delta SE was significantly different among different refractive groups (P<0.0001), with the Delta SE of hyperopia group (1.12 +/- 0.64 D) larger than that of the emmetropia (0.56 +/- 0.43 D, P=0.001) and myopia group (0.32 +/- 0.28 D, P<0.0001). The Delta SE was correlated with LOA (B=-0.54, P<0.0001), cycloplegic SE (B=0.10, P<0.0001) and age (B=-0.04, P=0.015). ROC curve indicated that LOA predicted clinically significant Delta SE by 82% [area under the curve (AUC)=0.82] alone, while the value was slightly improved to 85% (AUC=0.85) in combination with axial length and 86% (AUC=0.86) in association with axial length as well as age. CONCLUSION: After cycloplegia with cyclopentolate, the Delta SE decreases with larger LOA, longer axial length and older age. Specifically, LOA plays a more vital role in predicting clinically significant Delta SE.