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Purpose  To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors ( RE ) in children and to determine if the predictive value of noncycloplegic  RE  in categorizing  RE  can be improved.    Methods  Random cluster sampling was used to select 6825 children aged 4–15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent ( SE )  RE  were determined. A general linear model was developed to determine whether cycloplegic  SE  can be predicted using noncycloplegic  SE , age and uncorrected visual acuity ( UCVA ).    Results  Compared to cycloplegia, noncycloplegia resulted in a more myopic  SE  (paired difference: −0.63 ± 0.65D, 95%  CI : −0.612 to −0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic  RE  and smaller  AL . Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected  VA  in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic  SE  continued to show large residual errors for low myopic to hyperopic  RE . Applying the model to only those eyes with uncorrected  VA  <6/6 resulted in an improvement ( R  2  = 0. 93), with 80% of the eyes correctly classified. A higher  VA  cut‐off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly.    Conclusion  Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic  RE . Adjusting for age and applying uncorrected  VA  cut‐offs to noncycloplegic assessments improves detection of myopic  RE  and may help in identifying myopic  RE  in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value.

Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children