TITLE:
Cycloplegic Refraction in Children: A Complete Audit Cycle
AUTHORS:
Suma Ganesh, Priyanka Arora, Sumita Sethi, Chandra Gurung
KEYWORDS:
Cycloplegic Refraction, Audit, Children
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.5 No.1,
February
15,
2015
ABSTRACT: Purpose: Use of appropriate cycloplegic agent is an essential area of management in children with strabismus and refractive error. This study was designed to audit our own department’s understanding and practice with respect to cycloplegia. Methods: Children in age group of 0 - 12 years with refractive errors and strabismus were evaluated with respect to four parameters: adherence to cycloplegic refraction (group-I), choice of cycloplegic agent (group-II), dosage of cycloplegia (group-III) and duration of cycloplegia (group-IV). Following the initial audit, the hospital audit committee evaluated the results; thereafter concerned staff was educated and aidememoires of the dilatation protocol were introduced; a second audit cycle was carried out after 3 months. Results: First and second audit cycle included 334 children (mean age 6.2 ± 2.2 years) and 436 children (mean age 7.25 ± 2.9 years) respectively. A statistically significant improvement was found in all four parameters in the second audit cycle: adherence to dilation protocol (82.3% in first cycle to 94.3% in second cycle; p = 0.001), choice of cycloplegic agent (77% in the first cycle to 94.8% in the second cycle; p = 0.001), dosage of cycloplegic agent (84% in the first cycle to 96.3% in the second cycle; p = 0.001) and duration of cycloplegic agents (65% in the first cycle to 97.5% in the second cycle; p = 0.001 for CTC and 71.8% in the first cycle to 98% in the second cycle; p = 0.001 for Tropicamide). Conclusions: A complete audit cycle demonstrated a statistically significant improvement in all four parameters related to cycloplegic refraction in children. Regular auditing coupled with targeted interventions aimed to maintain the “best practice guidelines” for determination of refractive errors in children could prove effective in improving standards of clinical practice.