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The most common cause of visual disability worldwide is refractive errors, and their prompt diagnosis and timely treatment are essential in preventing irreversible visual sequelae, such as amblyopia. Refraction can be divided into cycloplegic and non-cycloplegic. Cycloplegic refraction is the gold standard investigation in children and adults with active accommodation as it paralyzes ciliary muscle and prevents over minus correction because of the accommodative component. The disadvantage can be time-consuming, costly, patient discomfort because of dilatation, and the need for an optometrist to perform a retinoscopy. Non-cycloplegic refraction includes retinoscopy, auto-refraction, and objective and subjective refraction, which are less time-consuming and more comfortable for the patient. Non-cycloplegic refraction is very helpful in vision screening in large volume centers and research settings. This activity highlights the clinical significance of non-cycloplegic and cycloplegic refraction for utility by an interprofessional team. Objectives: Describe the difference between cycloplegic and non-cycloplegic refraction. Review the clinical significance of non-cycloplegic and cycloplegic refraction. Identify the issue of concern with cycloplegic and non-cycloplegic refraction. Summarize the procedure of cycloplegic and non-cycloplegic refraction. Access free multiple choice questions on this topic.

Refractive errors are an important common cause of visual disturbance worldwide.[1] The prevalence of types and degree of refractive errors may vary from region to region.[2] Vitale et al., in their analysis of the United States, found astigmatism as the most common refractive error with a prevalence of 36.2%, followed by myopia with a prevalence of 33.1%, and least being hyperopia with a prevalence of 3.6%.[3] Further, myopia was more prevalent in females (39.9%) than males (32.6%). Sethu et al. found the prevalence of refractive error of at least 0.50 diopter (D) spherical, equivalent to 53.1%. Myopia and hypermetropia were found to be the most common refractive errors accounting for 27.7% and 22.9%, respectively.[4] Symptoms related to refractive errors are quite disturbing and may even disrupt the normal lifestyle of individuals. Refractive error patients form the majority of outpatient patients visiting an optometrist or ophthalmology clinic. A study by Schiefer et al. found refractive errors accounted for 21.1% of the patients presenting to an ophthalmologist.[5] The evaluation of these patients can be occasionally aided by topical agents called cycloplegic drugs.[6] Thus refraction can be broadly divided into cycloplegic and non-cycloplegic refraction. Cycloplegic drugs are often used to evaluate patients for underlying refractive errors. Cycloplegics cause temporary paralysis of ciliary muscles allowing the determination of total refractive errors.[7] Cycloplegic retinoscopy is also known as wet retinoscopy. Cycloplegics have been used since the 19 century to assess refractive errors by relaxing the accommodation.[8] Noncycloplegic refraction is performed without any drug administration. It doesn't affect the accommodation and pupil dilatation.[9] The various listed methods of non-cycloplegic refraction are retinoscopy, autorefraction, and objective and subjective refraction. A detailed description of how to perform retinoscopy and refraction is beyond the scope of this chapter and is discussed in separate chapters. Difference between Cycloplegic and Noncycloplegic Refraction Table S. No Characteristic

Pediatric patients below 13 to 14 years of age presenting with defective vision and having underlying refractive error should be subjected to cycloplegic refraction.[24] Patients in the age group of 14 to 35 years should be evaluated with tropicamide refraction. After cycloplegic or tropicamide refraction, the final contact lens or glass prescription should be given. All ophthalmologists and optometrists must know the indications and importance of cycloplegic and non-cycloplegic refraction to avoid the progression of refractive error.[25] The optometrists play a crucial role in explaining and performing non-cycloplegic and cycloplegic refraction. Ophthalmologists play a vital role in treatment, counseling, and explaining the prognosis to the patients.[26]

The nursing and the allied staff play a vital role in receiving the patient to the clinic, registering basic ophthalmic complaints, explaining to the patient the methodology and duration of a cycloplegic refraction, the need for cycloplegic refraction, and the side effects of instilling side effects. The nursing team also helps in counseling and procuring spectacle for the patients in cases of refractive error.[27]

The nursing and the allied staff help monitor the progress of cycloplegic refraction by instilling cycloplegic drugs at regular intervals and assessing the pupillary dilatation. They also help patients' regular and smooth flow in the clinics without prolonged wait time.[28]