Effectiveness of Tropicamide vs Cyclopentolate Eye Drop Use for Cycloplegic Refraction in Pediatric Patients With Brown Irides
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To compare the final cycloplegic refraction of tropicamide 1% and cyclopentolate 1% in children 3 to 16 years of age with brown irides.
DESIGN
Randomized, controlled, multicenter prospective clinical trial.
METHODS
Included patients were randomized to either cyclopentolate 1% or tropicamide 1% in the first visit with autorefraction measurements. Each subject underwent a second cycloplegic refraction using the other agent on a separate visit with a minimum of one-week interval and a maximum of 12 weeks. We measured the change in SE (ΔSE) for each eye by deducting the SE before cycloplegia from the SE after cycloplegia RESULTS: : A total of 185 eyes from 94 children aged 3 to 16 years old (average= 8.79 ±3.11 years) were included. The average SE of both eyes before cycloplegia was -0.082±4.8 diopter. The SE after instillation of cyclopentolate and tropicamide in both eyes was 1.07±5.2 and 0.96±5.1 respectively (P-value= 0.000). The average ΔSE after cycloplegia was 1.15±1.2 for cyclopentolate and 1.04±1.2 for tropicamide (P-value= 0.000). The difference between ΔSE of cyclopentolate and tropicamide was found statistically significant at 0.11±1.2 (P-value= 0.000), however clinically insignificant. The ΔSE between the two drops before and after cycloplegia in both eyes for all refractive error groups was clinically insignificant. The greatest effect of cyclopentolate and tropicamide was in hyperopic eyes with ΔSE of 1.54±1.4 and 1.39±1.4 respectively.
CONCLUSIONS
Tropicamide might be an effective and safe replacement for cyclopentolate in refracting non-strabismic pediatric population 3 to 16 years of age regardless of their refractive error status.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Disclosure statements are available on the authors' profiles:
Tropicamide Versus Cyclopentolate For Cycloplegic Refraction in Pediatric Patients with Brown Irides: A Randomized Clinical Trial
Am J Ophthalmol 2023 Oct 03;[EPub Ahead of Print], W Al-Thawabieh, R Al-Omari, DW Abu-Hassan, MT Abuawwad, A Al-Awadhi, HA SerhanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The purpose of this study was to compare the outcomes of cycloplegic autorefraction using cyclopentolate versus tropicamide in a pediatric population (age, 3–16 years) with brown irides residing in Jordan. The authors provided a concise overview of information regarding cycloplegic agents, the preference for cyclopentolate use over the last >70 years as the standard of care for pediatric cycloplegic examination, and the rationale for this study, including the benefits of using a shorter-acting agent such as tropicamide. All participants were randomized to receive cycloplegic autorefraction with the administration of cyclopentolate 1% or tropicamide 1% in each eye at the first visit, followed by the administration of the other agent in each eye at the second visit within a 12-week period. Refractive errors were then assessed, and patients were divided into five subgroups based on spherical equivalent with full cycloplegia, three subgroups based on age, and two subgroups based on sex. The benefits of tropicamide are expanded in the author's discussion and include potentially shorter wait times to peak cycloplegia, a shorter duration of cycloplegia, and reduced side effects, including a potential for allergic reactions, along with a more in-depth review of the literature. The authors found the greatest effect of tropicamide and cyclopentolate in eyes with hyperopia and the smallest effect in eyes with high myopia, with no statistically significant differences between these two agents. They concluded that, overall, tropicamide was as effective as cyclopentolate as a cycloplegic agent in the studied population of children. The authors indicated the need for further research in younger children under 3 years of age and in those with strabismus and/or esodeviations with an underlying accommodative component, as these groups were not included in the present study. The findings of this clinical trial can provide guidance to clinicians and researchers when deciding which cycloplegic agents to use in the pediatric population.