Refractive Error Patterns and the Impact of Cycloplegia in Ametropic Children and Adolescents in Al-Baha, Saudi Arabia
TL;DR
Hyperopic astigmatism dominated the ametropic spectrum in this hospital-based sample of ametropic children and adolescents in Al-Baha, and cycloplegic refraction was essential to avoid misclassification.
Abstract
Background and Aim Ametropia is a leading cause of preventable visual impairment in children and adolescents, yet region-specific data from Al-Baha, Saudi Arabia remain limited. This study aims to characterise the patterns of refractive error and quantify the impact of cycloplegic refraction in a pediatric ametropic population in Al-Baha City. Methods This hospital-based, prospective, cross-sectional study enrolled 654 ametropic children and adolescents (1,308 eyes), aged 3–18 years, at King Fahad Hospital between November 2022 and November 2023. Participants underwent visual acuity testing, keratometry, and pre- and post-cycloplegic refraction. Data were analysed using SPSS v24 and Microsoft Excel with paired and independent-samples t-tests and Pearson correlations (p < 0.05). Results The cohort was 51.7% female and 48.3% male (mean age 9.17 ± 3.89 years). Post-cycloplegia, hyperopic astigmatism predominated (62.8%; 822/1,308 eyes), followed by myopic astigmatism (36.1%; 472/1,308). Cycloplegia produced a significant hyperopic shift in mean spherical equivalent, from –0.33 D dry to +0.54 D cycloplegic (paired mean difference +0.87 D, p < 0.001; r = 0.89), with 26.0% of pre-cycloplegic myopic eyes reclassified as hyperopic. Males were more hyperopic than females (+1.04 vs +0.07 D, p < 0.001), and females had steeper keratometry (43.63 vs 42.86 D, p < 0.001). Mean cycloplegic spherical equivalent (SPE) declined with age from +2.18 D at 3–5 years to –0.55 D at 15–18 years, while the proportion with myopia rose from 14.8% to 55.6%. Conclusion Hyperopic astigmatism dominated the ametropic spectrum in this hospital-based sample of ametropic children and adolescents in Al-Baha, and cycloplegic refraction was essential to avoid misclassification. The observed age-related shift in refractive status supports standardised cycloplegic protocols and region-specific vision screening, although the clinic-based design limits generalisation to the wider paediatric population.