Instrument-Based, Non-Cycloplegic Versus Cycloplegic Refraction in Pediatric and Young Adult Populations (≤25 years): A Systematic Review and Meta-Analysis

Ana Roque, Amélia Fernandes Nunes, Henrique Nascimento, Clara Martinez-Perez

Abstract

Background: Accurate refractive assessment in children and young adults is critical to prevent amblyopia and strabismus, conditions that may arise from uncorrected hyperopia. Although noncycloplegic autorefractors and photoscreeners are increasingly used for vision screening due to their practicality and high testability, residual accommodation often introduces systematic measurement bias. The debate regarding the necessity of cycloplegia has intensified, particularly in large-scale epidemiological studies and screening programs, highlighting the need for an evidence-based synthesis.