A child who fails a screening chart may have uncorrected hyperopia, astigmatism or anisometropia rather than amblyopia, and accommodation in young children masks hyperopia on non-cycloplegic refraction. Cyclopentolate refraction reveals the full error.
Only after full correction has been worn for several weeks and acuity remains reduced should the diagnosis of amblyopia be made and patching or atropine started.
- Use cyclopentolate 1% (0.5% in infants) and wait 30–45 minutes before retinoscopy
- Examine the fundus and media at the same visit
- Prescribe full cycloplegic correction where indicated
- Recheck acuity after 6–12 weeks of spectacle wear before starting occlusion
Why it matters
Many children referred from screening need spectacles, not patching, and non-cycloplegic refraction misses them.
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