A To Compare the Accuracy of the Borish Delayed Technique and Cycloplegic Refraction in Determining Refractive Errors among Children Aged 6–18 Years

Abstract

Aim: To compare spherical equivalent refractive measurements obtained using the Borish delayed technique and cycloplegic refraction in children and to assess the agreement between the two techniques. Settings and design: Comparative Cross-Sectional Study Methods and materials: A comparative cross-sectional study was done among 51 children who were 7-16 years of age. Each participant underwent comprehensive ocular examination followed by dry refraction, Borish delayed refraction, and cycloplegic refraction. Spherical equivalent values obtained by the Borish delayed technique and cycloplegic refraction were compared for both eyes. Normality of the data was assessed using the Shapiro–Wilk test. As the data were nonnormally distributed, non-parametric statistical analyses were performed. The Wilcoxon signedrank test was used to compare paired measurements, the Mann–Whitney U test was used for gender-wise comparisons, and Spearman’s rank correlation coefficient was used to evaluate associations. Results: 51 participants were included in the study. The mean SE refractive power revealed a progressive unmasking of latent hyperopia across techniques with Cycloplegic Refraction: 1.53 ± 3.08 (RE) and 1.36 ± 2.79 (LE) and Borish delayed technique: 1.01 ± 3.03 (RE) and 1.03 ± 2.72 (LE) Wilcoxon Signed-Rank tests showed a statistically significant difference between Cycloplegic Refraction and the Borish Delayed Technique for both the Right Eye (W = 1172, p < 0.05, Effect Size = 0.993) and Left Eye (W = 978, p < 0.05, Effect Size = 0.809). Cycloplegic refraction revealed a mean additional latent hyperopia of +0.52 D in RE and +0.33 D in LE. Conclusion: The Borish delayed technique may be considered an adjunctive approach when cycloplegic refraction is not feasible, but it should not be regarded as interchangeable with cycloplegic refraction on the basis of statistical difference testing alone. Nevertheless, cycloplegic refraction remains the gold standard for accurate assessment of pediatric refractive errors, particularly for detecting latent hyperopia.