Discrepancies in Children's Vision Test Results

Children's Vision Screening Issues

Hello Doctor, my child is currently nine years old.
Yesterday, at a large hospital, a vision test was conducted, and the nurse recorded a visual acuity of 0.3 with a refraction of approximately -1.00 diopters and -1.25 diopters (with astigmatism).
After administering a cycloplegic agent for the examination, the doctor indicated my child has myopia of -1.00 diopters and -0.75 diopters.
Today, we visited another large hospital for a follow-up examination, where the unaided visual acuity was measured at 0.7 and 0.8, with a refraction showing myopia of approximately -1.50 diopters and -2.00 diopters.
The doctor did not administer a cycloplegic agent today and mentioned that no treatment is necessary at this time, suggesting a follow-up in three to four months.

I would like to ask why there is such a significant difference in the refraction data between the two examinations (before cycloplegia)? Could today's unaided visual acuity be influenced by the residual effects of the cycloplegic agent administered yesterday? Since the cycloplegic agent was administered three times yesterday, could it still affect the measurements this morning? Based on the current test results, what steps should we take? Thank you very much for your patient response, Doctor.

nancy, 0~9 year old female. Ask Date: 2019/01/29

Dr. Cai Wenyuan reply Ophthalmology

Hello, the data from the eye examination (prior to dilation) can indeed vary.
It is important to pay attention to children's eye habits and to conduct regular follow-ups.
Wishing you safety and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2019/01/29

More Info

Understanding discrepancies in children's vision test results can be quite challenging, especially when multiple tests yield different outcomes. This situation is not uncommon, and several factors can contribute to the variations in visual acuity and refractive error measurements.

Firstly, it is essential to understand that vision tests can be influenced by various elements, including the testing environment, the equipment used, and the child's condition during the examination. For instance, if a child is anxious or not fully cooperative, this can affect their performance during the test, leading to discrepancies in the results. Additionally, the time of day can also play a role; for example, if a child is tired or has been using their eyes extensively before the test, this may impact their visual acuity.

In your case, the first examination involved the use of a cycloplegic agent (the dilating drops), which temporarily paralyzes the ciliary muscle of the eye, preventing it from adjusting the lens for focusing. This is typically done to obtain a more accurate measurement of refractive error, especially in children, as it helps to eliminate the influence of accommodation (the eye's ability to focus on near objects). However, the effects of the drops can last several hours, and if the second examination was conducted too soon after the first, it is possible that the residual effects of the drops could have influenced the results.
The differences in the measured refractive errors (100 degrees vs. 150 degrees and 125 degrees vs. 200 degrees) could also be attributed to the fact that different clinics may use different methods or equipment for refraction. Automated refraction machines, which are often used in clinics, can yield varying results based on calibration and the specific algorithms they use to determine the prescription. Moreover, the experience of the technician or optometrist performing the test can also lead to variations in the results.

Regarding your concern about the visual acuity measurements (0.3 vs. 0.7 and 0.8), it is important to note that these values represent the clarity of vision at a distance. The significant difference in visual acuity could be due to the effects of the cycloplegic drops still being present during the first test, as well as the child's performance on that day.
As for the next steps, it is advisable to follow the recommendation of the second clinic, which suggested monitoring the child's vision over the next few months. Regular follow-ups are crucial, especially in children, as their vision can change rapidly. During these follow-ups, the eye care professional may decide to perform additional tests, including cycloplegic refraction, to obtain a clearer picture of the child's refractive status.

In summary, discrepancies in children's vision test results can arise from a combination of factors, including the effects of dilating drops, the testing environment, and the methods used by different clinics. It is essential to maintain regular follow-ups with an eye care professional to monitor any changes in vision and to ensure that the child receives appropriate care. If there are ongoing concerns about the child's vision or if significant changes occur, further evaluation may be warranted to rule out any underlying conditions.

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