Case report Open Access Paradoxical myopic shift following cycloplegia in retinopathy of prematurity patients: a case series Nikolas JS London 1,2 *, Susan M Carden 3 and William V Good 1,2 Addresses: 1 Department of Ophthalmology, California Pacific Medical Center, 2340 Clay St. 5th Floor, San Francisco, CA 94115, USA 2 Smith Kettlewell Eye Research Institute, 2318 Fillmore St, San Francisco, CA 94115, USA 3 Department of Ophthalmology, Royal Children’s Hospital, Melbourne, Victoria, 3052, Australia Email: NJSL* - nik.london@gmail.com; SMC - smcarden@aol.com; WVG - good@ski.org * Corresponding author Received: 6 January 2009 Accepted: 11 August 2009 Published: 25 August 2009 Cases Journal 2009, 2:8970 doi: 10.4076/1757-1626-2-8970 This article is available from: http://jmedicalcasereports.com/jmedicalcasereports/article/view/8970 © 2009 London et al.; licensee Cases Network Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction: Spectacle non-compliance is a significant problem in pediatric patients, and may have a variety of consequences. Non-compliance with myopic refractive correction could be secondary to a variety of issues, including age, discomfort, gender, urban vs. rural residence, presenting visual acuity, and degree of refractive error. We observed a phenomenon in our pediatric patients with retinopathy of prematurity that may add another possible explanation: incorrect prescription due to measures of increased, rather than decreased, myopia after cycloplegia. Case presentation: An unmasked, prospective study of 8 consecutive patients seen in a single practice. Retinoscopic refraction measurements were obtained before and after pharmacologic cycloplegia. In all 13 eyes, there was either no change (2 eyes) or a myopic shift (11 eyes) in the measured refractive error. The average change in refraction was -1.58 and -1.54 for the right and left eyes, respectively (range 0 to -3.00 OD and 0 to -3.00 OS). Conclusions: The contribution of ocular components to refractive status differs between ROP and non-ROP eyes. Unanticipated myopic shift following cycloplegia in ROP patients may result in inappropriate glasses prescription with poor correction of visual acuity. This may contribute to spectacle noncompliance in this group. Introduction Spectacle non-compliance is occasionally encountered in pediatric patients [1,2], even though refractive errors may have significant functional, economic, medical, and educational consequences. Non-compliance with myopic refractive correction could be secondary to a variety of issues, including age, discomfort, gender, urban vs. rural residence, presenting visual acuity, and degree of refractive error [2,3]. In pediatric patients with retinopathy of prematurity (ROP), we found increased rather than Page 1 of 3 (page number not for citation purposes)