Cycloplegic Refraction in Children: A Complete Audit Cycle

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 under-standing 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 aide-memoires of the dilatation protocol were introduced; a second audit cycle was carried out after 3 months. Re-sults: First and second audit cycle included 334 children (mean age 6.2 ± 2.2 years) and 436 chil-dren (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 im-provement in all four parameters related to cycloplegic refraction in children. Regular auditing coupled with targeted interventions aimed to maintain the " best practice guidelines " for determi-nation of refractive errors in children could prove effective in improving standards of clinical practice.