Hyperopic Surprises in Children Undergoing Cycloplegic Autorefraction: A Cross-Sectional Study from an Eye Clinic in Jalalpur Jattan, Pakistan

Abstract

Purpose:  To determine the frequency and magnitude of hyperopic surprises in children and to evaluate associated demographic and clinical correlates. Study Design:  Descriptive observational study. Place and Duration of Study:  EyeclinicinJalalpurJattan,Pakistan, from March 2025 to August 2025. Methods:  A total of 410 consecutive pediatric patients, 1–16 years of age were included. Non-cycloplegic auto refraction followed by cycloplegic autorefraction was performed after instillation of cyclopentolate hydrochloride 1%. A cycloplegic shift of ≥+0.50 diopters (D) wereconsidered a clinically significant hyperopic surprise. Data were analyzed using paired t-test, one-way ANOVA, McNemar's test, and Pearson's correlation (SPSS v26;p < 0.05). Results:  Mean agewas8.6 ± 3.9 years and 52.2%were male.Ahyperopicsurprisewas identifiedin 61.7% (95% CI: 57.0–66.4%). Mean cycloplegic SE shift was +0.73 ± 0.67 D. Hyperopia frequency rose from 18.6% to 53.2% post-cycloplegia (p < 0.001). Children aged 1–5 years showedthegreatestmeanshift(1.18±0.85D)versus6–10years(0.74±0.63D)and11–16years (0.52±0.48D;ANOVA,p<0.001).Amongchildrenclassifiedasmyopicoremmetropicwithout cycloplegia,65.3%werereclassifiedashyperopic.Nosignificantsex-baseddifferencewasfound (p = 0.617). A moderate negative correlation existed between hyperopic surprise magnitude and uncorrected visual acuity (r = −0.47, p < 0.001). Conclusion:  Non-cycloplegic autorefraction substantially underestimates hyperopia in children and produces clinically significant refractive miscalculations. Cycloplegic refraction is indispensable for accurate pediatric refractive assessment, particularly in preschoolchildren.