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Comparison of cyclopentolate versus tropicamide cycloplegia in children
S M Egashira1, L L Kish, J D Twelker
1School of Optometry, University of California at Berkeley.
Insights
Tropicamide and cyclopentolate show similar refractive outcomes in children, though cyclopentolate more effectively inhibits accommodation. Both are useful for measuring hyperopia in pediatric eye exams.
Area of Science:
- Ophthalmology
- Pediatric Optometry
Background:
- Accurate refractive error measurement is crucial for diagnosing and managing pediatric vision disorders.
- Cycloplegic agents are essential for overcoming accommodation during refractive assessment in children.
Purpose of the Study:
- To compare the cycloplegic efficacy of tropicamide 1% and cyclopentolate 1% in children aged 6-12 years.
- To evaluate refractive error and accommodation using multiple methods after cycloplegic instillation.
Main Methods:
- A double-masked study involving 20 hyperopic children (mean refractive error +1.48 D).
- Comparison of cycloplegic effects using retinoscopy, subjective refraction, and autorefraction.
- Assessment of accommodation via subjective push-up and objective autorefraction.
Main Results:
- No significant difference in retinoscopy or subjective refraction between tropicamide and cyclopentolate.
- Autorefraction showed a minor bias toward hyperopia with cyclopentolate.
- Cyclopentolate demonstrated superior inhibition of accommodation compared to tropicamide.
Conclusions:
- Tropicamide is a viable cycloplegic agent for refractive error assessment in children with low to moderate hyperopia.
- While cyclopentolate offers stronger cycloplegia, tropicamide provides comparable refractive outcomes.
- Both agents effectively reveal latent hyperopia in the pediatric population.
Abstract:
This double masked study compares the cycloplegic effects of tropicamide 1% and cyclopentolate 1% in 20 nonstrabismic, nonamblyopic, hyperopic 6- to 12-year-old children with a mean refractive error = +1.48 +/- 1.10 diopters (D). Unlike previous studies which used only amplitude of accommodation to measure the depth of cycloplegia, this study compares refractive error as determined by retinoscopy, distance subjective refraction, and distance autorefraction (Canon R-1). In addition, we compare the amplitude of accommodation as measured by subjective push-up and objective autorefraction methods. There is no statistically significant difference between cyclopentolate and tropicamide for either cycloplegic retinoscopy or distance subjective refraction. Autorefraction measurement of refractive error shows a statistically significant but clinically unimportant bias (0.14 +/- 0.30 D) toward more hyperopia with cyclopentolate. Both drops reveal latent hyperopia, and the mean latencies are not statistically different between the two cycloplegic agents. Latent hyperopia is not systematically related to the degree of hyperopia after tropicamide, but this relation is significant after cyclopentolate. No differences were found between refractive results with either agent at 30 min compared to 60 min after drop instillation. When measured objectively with the autorefractor, accommodation is inhibited more effectively by cyclopentolate than by tropicamide. Our results suggest that although tropicamide is not as effective as cyclopentolate in inhibiting accommodation it is, nevertheless, a useful cycloplegic agent for measuring distance refractive error of low to moderate hyperopia in school-aged children.