Atropine or Cyclopentolate to Diagnose Premyopia in Preschool Children
Haotian Wu1,2, Yanjiao Wang1, Qiuying Lu1
1Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China.
Insights
Atropine cycloplegia in preschool children resulted in less myopic refraction compared to cyclopentolate. This finding may help prevent overestimating premyopia in young patients.
Area of Science:
- Ophthalmology
- Pediatric Optometry
Background:
- Accurate refractive error assessment in young children is crucial for timely diagnosis and intervention.
- Cycloplegic agents are essential for achieving sufficient cycloplegia in preschool-aged children.
- The choice of cycloplegic agent can influence objective refraction outcomes and subsequent diagnostic conclusions.
Purpose of the Study:
- To compare objective refraction outcomes in preschool children following cycloplegia induced by either atropine or cyclopentolate.
- To evaluate the impact of different cycloplegic agents on the prevalence of various refractive states in young children.
Main Methods:
- A post hoc analysis was conducted using data from two population-based studies: the PRDP-IFS (atropine) and E-SCORDS (cyclopentolate).
- Propensity score matching was used to select comparable eyes from each study group.
- Objective refraction, including spherical equivalent and refractive state (hyperopia, premyopia, myopia), was determined using an autorefractor after cycloplegia.
Main Results:
- The mean difference in spherical equivalent (DSE) between noncycloplegic and cycloplegic states was significantly greater in the atropine group (1.56 D) compared to the cyclopentolate group (0.97 D).
- The atropine group showed a higher prevalence of moderate to high hyperopia (7.2% vs. 2.7%) and low hyperopia (82.8% vs. 74.0%) compared to the cyclopentolate group.
- Conversely, the cyclopentolate group exhibited a higher prevalence of premyopia (21.6% vs. 8.7%) than the atropine group.
Conclusions:
- Atropine-induced cycloplegia in preschool children is associated with a less myopic refractive outcome compared to cyclopentolate.
- Using atropine may help mitigate the potential overestimation of premyopia prevalence observed with cyclopentolate.
- Further research is needed as this study did not directly compare both agents within the same cohort of children.
Importance:
Sufficient cycloplegia is essential for reliable refraction in preschool children. The choice of cycloplegic agent may affect refraction and diagnosis outcomes.
Objective:
To evaluate the objective refraction outcomes after cycloplegia in preschool children given either atropine or cyclopentolate.
Design, Setting, And Participants:
This was a post hoc analysis of the 2024 Preschool Children Refractive Development Pattern and Influencing Factors Study (PRDP-IFS), in which children were given atropine, and the 2013 to 2014 Elaborative Shanghai Childhood Ocular Refractive Development Study (E-SCORDS), in which children were given cyclopentolate. These were population-based studies. Eyes in each group were included via propensity score matching. Study data were analyzed from December 2024 to July 2025.
Exposures:
Cycloplegia induced by either 1% atropine (twice daily for 4 days with an additional dose on day 5) or 1% cyclopentolate (dual administration 5 minutes apart) eye drops.
Main Outcomes And Measures:
Difference between the noncycloplegic and cycloplegic spherical equivalent (DSE) and the prevalence of refractive states were compared in the atropine and cyclopentolate groups. Refractive states (moderate to high hyperopia, low hyperopia, premyopia, and myopia) were determined by cycloplegic spherical equivalent (SE) using an autorefractor.
Results:
A total of 1761 children and their 3048 eyes were included in this study. There were 773 children (1524 eyes) in the atropine group (mean [SD] age, 4.62 [0.92] years; 406 male [52.5%]) and 988 children (1524 eyes) in the cyclopentolate group (mean [SD] age, 4.62 [0.93] years; 530 male [53.6%]). There were a total of 1524 eyes in each group. The mean (SD) noncycloplegic SE was 0.30 (0.92) diopters (D) and 0.31 (0.76) D in the atropine and cyclopentolate groups, respectively (mean difference, -0.01 D; 95% CI, -0.07 to 0.05 D; P = .72). Mean (SD) DSE in the atropine group was 1.56 (0.72) D and in the cyclopentolate group was 0.97 (0.70) D. The mean difference in DSE between the 2 groups was 0.59 D (95% CI, 0.54-0.64 D; P < .001). The difference in the percentages of refractive states between the atropine and cycloplegic groups was as follows: moderate to high hyperopia (7.2% vs 2.7% = 4.5%; 95% CI, 2.9%-6.0%; P < .001), low hyperopia (82.8% vs 74.0% = 8.8%; 95% CI, 6.0%-11.8%; P < .001), premyopia (8.7% vs 21.6% = -12.9%; 95% CI, -15.4% to -10.4%; P < .001), and myopia (1.3% vs 1.8% = -0.5%; 95% CI, -1.3% to 0.4%; P = .30).
Conclusions And Relevance:
This study found that use of atropine for cycloplegia in preschool children was associated with less myopic refraction compared with cyclopentolate and may potentially avoid overestimation of premyopia prevalence; however, this investigation did not evaluate each cycloplegic agent in the same children.
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