Cycloplegic autorefraction doubles diagnostic yield of myopia compared to vision testing: findings from a decade-long screening programme

BACKGROUND: Cycloplegic autorefraction may offer higher diagnostic accuracy than uncorrected visual acuity (VA) screening. We aimed to evaluate diagnostic yield and risk factors for previously unrecognised myopia. METHODS: This repeated cross-sectional study analysed data from 33 642 kindergarteners aged 5-6 years enrolled in the Yilan Myopia Prevention and Vision Improvement Program from 2014 to 2024. Participants underwent uncorrected VA testing and on-site cycloplegic autorefraction. Caregivers completed questionnaires on myopia-related behaviours. Previously unrecognised or newly detected myopia (NDM), defined as spherical equivalent ≤-0.50 dioptres without prior diagnosis. The main outcome was diagnostic yield, defined as the proportion of NDM among at-risk participants by different screening methods. RESULTS: Among 33 642 participants (mean age, 5.23±0.41 years; 51.7% boys), 3206 (9.5%) were identified myopic, including 2303 (6.8%) who were newly detected through cycloplegic autorefraction, yielding a diagnostic rate of 7.03% (95% CI 6.76% to 7.32%). Only 47.9% children with NDM met the reduced VA referral criterion (uncorrected VA