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A comparison of drop instillation and spray application of 1% cyclopentolate hydrochloride
E E Ismail1, M W Rouse, P N De Land
1Southern California College of Optometry, Fullerton.
Insights
Spray administration of cyclopentolate hydrochloride eye drops is an effective and easier alternative for cycloplegic refractive error assessment in hyperopic children. This method offers comparable accuracy to traditional drop instillation.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Assessment
Background:
- Accurate refractive error assessment is crucial for diagnosing and managing pediatric eye conditions.
- Cycloplegia is essential for objective refractive error measurement in children, particularly those with hyperopia.
- Traditional eye drop instillation for cycloplegia can be challenging in young children.
Purpose of the Study:
- To compare the efficacy and administration ease of spray versus drop application of cyclopentolate hydrochloride for cycloplegic refractive error assessment in hyperopic children.
- To determine if spray cycloplegia yields comparable refractive error measurements to drop cycloplegia.
- To evaluate patient and examiner experience with both administration methods.
Main Methods:
- A randomized, masked study involving 37 hyperopic children (18 months to 6 years).
- Cycloplegia induced by either spray or drop application of 1% cyclopentolate hydrochloride, administered in random order.
- Objective cycloplegic retinoscopy performed by a masked examiner 20-40 minutes post-administration.
- Patient response and ease of administration rated using a standardized scaling system.
Main Results:
- Mean spherical equivalent refractive error was similar between spray (1.76 D) and drop (1.78 D) methods, with no statistically significant difference (p=0.82).
- 93% of eyes showed an absolute difference in spherical equivalent of 0.50 D or less between methods.
- Spray administration was rated as significantly easier and better tolerated by patients (p=0.038).
Conclusions:
- Spray application of cyclopentolate hydrochloride is a safe, effective, and well-tolerated alternative to traditional eye drops for inducing cycloplegia in young hyperopic children.
- The spray method simplifies the administration process and may improve compliance in pediatric eye examinations.
- This novel approach offers a practical advancement in pediatric refractive error assessment.
Abstract:
We compared the objective cycloplegic refractive error of 37 hyperopic children (ages 18 months to 6 years). Cycloplegia was by spray application to the closed eye, or by a one-drop instillation to the open eye. Patients were initially screened for hyperopia using a masked noncycloplegic retinoscopy with loose trial lenses. Spray and drop cycloplegias (1% cyclopentolate hydrochloride; 1% Spectro Pentolate) were administered to each patient in random order within a 2-week period. A masked cycloplegic retinoscopy was performed 20 min after drug administration for patients with "light" iris coloration and after 40 min for those with "dark" irides. One examiner conducted all cyclopentolate administrations; a separate examiner (masked to application method) conducted all refractive testing. For right eyes, the mean spherical equivalent refractive error after spray application was 1.76 D (SD = 1.63 D) and after drop instillation 1.78 D (SD = 1.85 D). Results were similar for the left eyes. These small differences were not statistically significant (ANOVA, F = 0.05, p = 0.82). The absolute difference in spherical equivalent was 0.50 D or less in 93% of all subject eyes. A scaling system was used to rate the ease of administration and the patient's response to each method. Using an exact test of marginal homogeneity, the response rating for the spray method was significantly better (p = 0.038). The spray application of cyclopentolate hydrochloride is easier to administer and is an effective alternative to traditional drop instillation.