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PubMed1993

Mydriatic efficacy of a cycloplegic spray in the pediatric population.

BACKGROUND: The topical administration of eyedrops is often an unpleasant procedure in the pediatric population. We sought to learn whether a combination mydriatic-cycloplegic solution would be an effective mydriatic if applied as a spray. METHODS: We used a prospective, examiner-masked, parallel-group study design and randomized 38 subjects (age range 6 months-12 years, mean = 7.3 years) into four groups such that the same combination mydriatic-cycloplegic solution was administered under the following conditions: 1) eyedrops to eyes that were closed; 2) eyedrops to eyes that were open; 3) spray to eyes that were closed; 4) spray to eyes that were open. Both eyes of each subject received the solutions administered under one of the four conditions. Photographs were taken of each subject's pupils at times 0, 5, 15, 25, 40, and 55 mins following administration of the medications. RESULTS: Repeated measures analysis of variance revealed no statistically significant difference (p > 0.05) in mydriatic efficacy among the four methods of drug administration. CONCLUSIONS: The results of this study suggest that the mydriatic efficacy of a mydriatic-cycloplegic spray is comparable to that associated with eyedrop instillation. Mydriatic sprays may have important clinical advantages over conventional ophthalmic solutions in the pediatric population.

Aerosols↗
PubMed2004

Clinical comparison of the Welch Allyn SureSight handheld autorefractor versus cycloplegic autorefraction and retinoscopic refraction.

PURPOSE: To investigate the accuracy of the Welch Allyn SureSight (WASS; Welch Allyn, Skaneateles Falls, New York) hand-held autorefractor in noncyclopleged children and to compare the results with those obtained in cyclopleged children using the Nidek AR-820 (NAR; Nidek, Aichi, Japan) and retinoscopic refraction (RR) of an experienced pediatric ophthalmologist. METHODS: Ninety-one children (mean age 97 months +/- 19, range 37 to 107) whose vision screening, performed by a school nurse and/or by their primary care provider, was unsuccessful were prospectively evaluated in the private practice of a university pediatric ophthalmologist. After completion of a history, each child was refracted using the WASS. A complete ophthalmic examination, including cycloplegic refraction using the NAR and retinoscopic refraction refined to obtain a visual acuity of at least 20/30 diopters, was then performed. The physician was masked to the previous WASS and NAR results. Analysis variables included race, age (months), refraction (sphere, cylinder, axis), and initial and final corrected visual acuity. Only WASS values for which reliability was > or = 8 were used. A coin toss determined which eye would be used for analysis. RESULTS: Using analysis of variance and Scheffé multiple comparison testing, sphere results obtained by the WASS indicated a statistical difference compared with those obtained using the NAR (P =.0027) and retinoscopy (P =.0088). Similarly, spherical equivalence results obtained by the WASS also indicated a statistical difference compared with that of the NAR (P =.0027) and retinoscopy (P =.0056). Myopic sphere and spherical equivalent values were recorded more frequently with the WASS than with the NAR or refined retinoscopy. Cylindrical values comparing the WASS with the NAR, the WASS with RR, and the NAR with RR were statistically similar to each other (P =.9993,.748, and.7261 respectively). Axial results for patients with +0.50 or more of astigmatism were also statistically similar by all 3 methods. CONCLUSIONS: Our data indicate that when the WASS is used on noncyclopleged children as suggested for primary care providers, myopia may be overdiagnosed.

Analysis of Variance↗
PubMed2003

Comparison of measurements of refractive errors between the hand-held Retinomax and on-table autorefractors in cyclopleged and noncyclopleged children.

PURPOSE: To compare the measurement of refractive errors (sphere, cylinder, and axis) between the hand-held Retinomax and on-table Topcon autorefractors in cyclopleged and noncyclopleged young children. The average bias and measurement agreement were assessed. DESIGN: Observational cross-sectional study. METHODS: The study included 114 cyclopleged and 156 noncyclopleged young children. The mean difference between the two methods and the 95% limits of agreement were calculated to evaluate the average bias. Two types of analyses were conducted to assess the degree of agreement. First, the proportion of the absolute mean differences was presented in different ranges ( 1.0 diopters for sphere and cylinder; 0-10, 11-20 and >20 degrees for axis). Second, the paired t test was conducted to evaluate the consistency of two types of measurements. RESULTS: The data by the Retinomax had mild bias (0.59 diopters) toward a lower sphere data under noncycloplegia but no bias under cycloplegia. For cylinder and axis, there was either no bias or clinically acceptable bias (0.02-0.13 diopters for cylinder and 2-7 degrees for axis) regardless of cycloplegia. Besides the sphere data under noncycloplegia, in general 90% of the mean differences of sphere and cylinder were within 0.5 diopters. More than 97% of the difference in axis under cycloplegia and 68% under noncycloplegia were within 20 degrees. After adjusting for mild bias, the paired t test showed very consistent results. CONCLUSIONS: The data by the Retinomax were consistent with those by the Topcon. The Retinomax is a useful instrument to screen refractive errors in young children.

Child↗
PubMed2003

Acute psychotic reaction caused by topical cyclopentolate use for cycloplegic refraction before refractive surgery: case report and review of the literature.

A 56-year-old woman was evaluated for the surgical correction of hyperopia (+3.0 diopters). Two drops of cyclopentolate 1% were instilled in both eyes for measurement of the cycloplegic refraction and wavefront analysis. Immediately after the second instillation, the patient reported drowsiness, dizziness, nausea, and fatigue. Ten minutes later, stimulatory central nervous system symptoms in the form of restlessness, cheerfulness, and a 20-minute-long roar of laughter were observed, interrupted by a new sedative phase. Basic medical and neurologic examinations were unremarkable except for gait ataxia. Four hours later, the examination was continued uneventfully. As surgical treatment of refractive errors and measurement of cycloplegic refraction using cyclopentolate become more frequent, ophthalmologists should be aware of this unusual acute event.

Acute Disease↗
PubMed2002

Testing young infants with the Welch Allyn suresight non-cycloplegic autorefractor.

Both eyes of 74 healthy 2-12-month-old human infants were refracted twice with the new Welch Allyn SureSight non-cycloplegic autorefractor. At least one reliable estimate of sphere and cylinder was obtained from both eyes of all babies attempted, and 88% of infants contributed two estimates from each eye. These measurements were collected in less than 2 min. Although spherical estimates changed little over the first year (mean = +1.78 D), cylindrical error appeared to decrease from a mean of about 1.4 D (at 6 months) to 0.9 D (at 12 months). Refractive estimates and variability agreed well with published infant data obtained with traditional cycloplegic retinoscopy. Repeatability was excellent for measurement of cylinder but for sphere, 17% of infants' estimates differed by at least 1.0 D between tests. However, given its simplicity and time-efficiency, the SureSight should be a good candidate for the relatively easy screening of significant refractive error in non-verbal paediatric patients.

Age Factors↗
PubMed1992

[The cycloplegic effect of atropine in comparison with the cyclopentolate-tropicamide-phenylephrine combination].

Atropine is thought to produce the most effective cycloplegia in early childhood. Cyclopentolate and Tropicamide are the best known short acting cycloplegic agents. Phenylephrine is an adrenergic agent and has also a cycloplegic effect. In this study we compared a combination of Cyclopentolate, Tropicamide and Phenylephrine with Atropine and observed no difference between them.

Accommodation, Ocular↗
PubMed1998

How accurate is the hand-held refractor Retinomax(R) in measuring cycloplegic refraction: a further evaluation.

AIMS To assess the agreement between the hand-held autorefractor Retinomax(R) and three different on-table autorefractors when measuring cycloplegic refraction in subjects with small and high ametropia. To assess the agreement between the cycloplegic refraction using the Retinomax(R) and by retinoscopy in children with small and high ametropia. METHODS Part A.276 subjects were refracted under cycloplegia using both the Retinomax(R) and an on-table infrared automated refractor (Topcon RM-A 6000, Nidek AR 800 or Nikon NR 5000). They were separated into subjects withsmall ametropia (mean sphere </= 3.5 D hyperopia, </= 3 D myopia) and high ametropia (mean sphere > 3.5 D hyperopia, > 3 D myopia). The agreement between both types of refractors regarding the different refractive components was assessed for the whole group and for the two subgroups of small and high ametropia. Part B. 48 infants were refracted under cycloplegia by retinoscopy and by the Retinomax(R). The agreement between both methods of refraction was analyzed in the same manner as in part A. RESULTS Part A. No significant bias was found between the two types of refractors with regard to the spherical equivalent. The 95% limits of agreement were +/- 1 D. Although no clinically significant bias was found with regard to the cylinder power in the 276 subjects, it was found that the 95% limits of agreement were much better (+/- 0.75 D) in small ametropia subjects than in high ametropia subjects (-2.1 to +1.3 D). No significant bias was found with regard to the axis determination. Part B. No significant bias was found between the Retinomax(R) and retinoscopic measurements with regard to the spherical equivalent. The 95% limits of agreement were -1.36 to +1.76 D. However, the mean difference for spheres and cylinders showed a positive bias and a negative bias, respectively, suggesting more positive spheres and larger cylinders when measured by the Retinomax(R) compared to retinoscopy. This was particularly obvious in cases of high ametropia. CONCLUSION Compared to retinoscopy and on-table autorefraction, the hand-held refractor Retinomax(R) is accurate in any ametropia with respect to the spherical equivalent. In small ametropia, there is a good accuracy when measuring the three refractive components (sphere, cylinder and axis). The accuracy decreases in high ametropia, especially with regard to the cylinder power.

Journal Article↗
PubMed1979

Near retinoscopy and cycloplegic retinoscopy in early primary grade schoolchildren.

Retinoscopy under cycloplegia with various agents can yield varied results. Additionally, cycloplegics and produce adverse local as well as central nervous system disturbances. A noncycloplegic near retinoscopy technique as promulgated by Mohindra is compared with cycloplegic retinoscopy on schoolchildren in early grades. Results obtained by a study utilizing the two techniques show that they yield similar objective measurements of refraction.

Child↗
PubMed1992

Comparison between near retinoscopy and cycloplegic retinoscopy in the refraction of infants and children.

We investigated the validity of replacing cycloplegic retinoscopy with a noncycloplegic, "near" retinoscopy technique. We refracted a group of 31 infants (less than 2 years) and 43 children (greater than 2 years) with both techniques, grading our level of confidence in the result. Near retinoscopy gave on average a less hypermetropic result than cycloplegic retinoscopy by 0.39 D. The difference was significant in infants and for low levels of examiner confidence. However, a repeatability study showed that much of the variability in the infant group could be attributed to the poor repeatability of either retinoscopy technique. Agreement between the two techniques is improved by changing the suggested adjustment factor from 1.25 to 1.00 D for children and to 0.75 D for infants.

Adolescent↗
PubMed1988

Status of cyclopentolate as a cycloplegic in children: a comparison with atropine and homatropine.

We compared the cycloplegic effects of cyclopentolate, homatropine and atropine by the retinoscopy findings and residual accommodation left following their use in the same individual. The mean residual accommodation measured after the use of cyclopentolate, homatropine and atropine was 1.48 +/- 0.33 D, 2.32 +/- 0.37 D and 1.10 D +/- 0.28 D, respectively, and the mean difference in retinoscopy readings between cyclopentolate and homatropine, homatropine and atropine, and atropine and cyclopentolate was 0.46 +/- 0.21, 0.71 +/- 0.23 and 0.26 +/- 0.14, respectively. We further observed that a tonus allowance of about +0.75 D would suffice for cyclopentolate. The merits for recommending cyclopentolate as a routine cycloplegic in children are discussed.

Accommodation, Ocular↗
PubMed2001

Non-cycloplegic screening for amblyopia via refractive findings with the Nikon Retinomax hand held autorefractor in 3 year old kindergarten children.

AIMS: To assess non-cycloplegic screening for amblyopia with the hand held Nikon Retinomax autorefractor in 3 year old kindergarten children. METHODS: 427 three year old children were examined in kindergarten with the Retinomax without cycloplegia. A gold standard was established in all children by two orthoptic examinations in kindergarten. If there were missing, abnormal, or inconsistent findings, children were referred for ophthalmological examination. If, by the ophthalmological examination, a new case of amblyopia requiring treatment was diagnosed, the gold standard was set "positive." RESULTS: In 404 children the gold standard was obtained. 10 children (2.5%) had a "positive" gold standard of unknown and untreated amblyopia. Screening sensitivity was 0.80, specificity 0.58, accuracy 0.58, and the likelihood ratio 1.89. CONCLUSION: Non-cycloplegic refractive screening with the Retinomax led to many false positive referrals due to instrument myopia and "inconclusive" results. Hence specificity, accuracy, and the likelihood ratio were too low to conduct screening effectively.

Amblyopia↗
PubMedDate not supplied

Topical mydriatic and cycloplegic spray for Chinese children.

PURPOSE: To assess the efficacy and tolerance of mydriatic and cycloplegic spray versus drops for Chinese children. METHODS: The effects of the spray (cyclopentolate 0.25%, phenylephrine 0.625%, and tropicamide 0.5%) and the drops (cyclopentolate 1%, phenylephrine 0.5%, and tropicamide 0.5%) were evaluated in 29 children (58 eyes) in two separate sessions. There was a 1-week period between the applications of the spray and the drops. Dilated pupil size and refraction after cycloplegia were the primary outcome variables used to assess the efficacy. A subjective discomfort score was used to assess acceptance of the spray and the drops. RESULTS: The mean age of the study population was 4.33 +/- 1.39 years (range, 3 to 8 years). The mean pupil size was 6.9 mm for the spray and 6.6 mm for the drops. The spray appeared to be slightly more effective than the drops, with a mean difference of 0.3 mm that was statistically significant (P = .001, two-tailed t test). No statistically significant difference in cycloplegic response was found between the spray and the drops (P = .535, two-tailed t test). Administration of the spray caused less discomfort than did administration of the drops (P < .001, Wilcoxon signed-rank test). CONCLUSIONS: The spray system appears to be clinically equivalent to the drops for achieving effective pupil dilation and cycloplegia, even in a population with dark irides such as ours. Tolerability and acceptance improved because the spray was applied to the closed eyelids.

Administration, Inhalation↗
PubMed1998

Could a cycloplegic agent be replaced by a fogging or a corrective lens in the biometric measurement of the crystalline lens?

This study investigated whether a fogging or a corrective lens could be used to replace a cycloplegic agent in the ultrasonic measurement of crystalline lens thickness in myopia. A group of 28 Hong Kong Chinese adults with myopia was recruited. The crystalline lens thickness of the examined eye was measured by A-scan ultrasonography while the fixating eye was in one of three conditions: fog (+2.00 D fogging lens), full corrective lens, or cycloplegia (50 minutes after instillation of 1% cyclopentolate HCl). We found that the mean lens thickness was significantly different between the three conditions in our myopic subjects. The mean crystalline lens thickness under fogging and corrective lens conditions was significantly greater than the cycloplegic condition by 0.09 mm and 0.11 mm, respectively. The 95% limits of agreement compared to cycloplegia (fogging: -0.32 to +0.14; corrective: -0.35 to +0.13) showed marked intersubject variability, indicating that there is a risk of overestimating the lens thickness when substituting cycloplegia with either a fogging or a corrective lens.

Accommodation, Ocular↗
PubMed1999

A randomized comparison study of drop versus spray topical cycloplegic application.

PURPOSE: To evaluate the acceptance of ocular spray administration. METHODS: A randomized, single-masked comparison in a cohort of children from 3 to 13 years. Assessment of patient pain was recorded on a visual analog scale. Cycloplegia was assessed by an ophthalmologist masked to the assignment. A questionnaire was used to assess patient acceptance. 126 patients participated. The average age was 7.7 years for spray, 7.1 for drops. RESULTS: Pain (higher number = more painful): means: 41/100 for spray; 35/100 for drops (P=0.28). No difference in cycloplegia noted (i.e., satisfactory in all subjects). Subjective acceptance: high in both patient groups, but a preference for spray was noted (P=0.06). No untoward drug reactions occurred with either method. CONCLUSIONS: Cycloplegic spray was as acceptable, or more acceptable than drops. Cycloplegia was comparable for the two methods. Spray application of cycloplegic drugs is a satisfactory route of topical administration for children.

Administration, Topical↗
PubMed2001

Tropicamide (1%): an effective cycloplegic agent for myopic children.

PURPOSE: To evaluate the cycloplegic effect of 1% tropicamide in myopic children and to determine whether its efficacy is associated with age, gender, iris color, ethnicity, magnitude of the refractive error, or latent error. METHODS: Four hundred sixty-nine children enrolled in the Correction of Myopia Evaluation Trial (COMET; a multicenter, randomized, double-masked clinical trial evaluating the rate of progression of juvenile-onset myopia in children wearing progressive-addition versus single-vision lenses) were given 1 drop of proparacaine in each eye followed 1 minute later by 1 drop of 1% tropicamide and then a second drop of 1% tropicamide 4 to 6 minutes later. Five accommodative responses to 20/100 letters located at 4 m and 33 cm were obtained in each eye with an autorefractor, 20 minutes after the second drop. Residual accommodation was calculated as the difference between the mean spherical equivalent responses obtained at the two distances. An examiner graded iris color, and ethnicity was reported by the children's parents or guardians. RESULTS: The mean residual accommodation was small: 0.38 +/- 0.41 diopters (D) in the right eye and 0.30 +/- 0.41 D in the left eye. Small but statistically significant differences in residual accommodation were associated with ethnicity, but not with any of the other factors. CONCLUSIONS: Tropicamide (1%) is an effective cycloplegic agent in myopic children.

Accommodation, Ocular↗
PubMedDate not supplied

[Neurotoxic effects induced by the topical administration of cycloplegics. A case report and review of the literature].

INTRODUCTION: We report a patient who developed an acute confusional state with hallucinations after exposure to cycloplejic eye drops, and review the current literature regarding neurotoxicity due to this type of eye drops. CASE REPORT: A 61 year-old man who developed in two occasions confusion, disorientation and vivid visual hallucinations following exposure to a cyclopejic eye drop containing atropine 2%, scopolamine 0.5% and phenylephrine 4%. We performed a literature search regarding neurological complications of cycloplegic eye drops using the PubMed Database and the services of the Virtual Library 'Agencia Lain Entralgo'. The clinical features of all reports in which the original document was obtained are analyzed and summarized. We have summarized the clinical features of 29 patients with neurotoxicity due to cyclopentolate, 19 to atropine, 18 to scopolamine, 7 to homatropine, and 2 to tropicamide. Our patient should be the fourth reported in Spain, being the offending drug in the four cases the same eye drop. The most commonly reported symptoms are visual hallucinations, behavioral disorders/acute psychosis, alterations of consciousness/confusion, restlessness/hyperactivity, ataxia and speech disorders. Many of the patients reported are children and elder. There have been reported some fatal cases, specially related with atropine. CONCLUSIONS: Neurotoxicity related with anticholinergic effects of cycloplegic agents is not infrequent, although it is not well known in our setting; and can cause death in some cases. Exposure to these drugs should be taken in account in the differential diagnosis of acute confusional syndromes.

Administration, Topical↗
PubMed1988

Relationship of glare to uncorrected visual acuity and cycloplegic refraction 1 year after radial keratotomy in the prospective evaluation of radial keratotomy (PERK) study.

This study examines the relationship of subjective glare to refraction and visual acuity, respectively, 1 year after surgery in 435 patients who underwent radial keratotomy for nearsightedness in the Prospective Evaluation of Radial Keratotomy (PERK) study. Patients were asked if they experienced glare in bright light. Of the 425 responding, 200 patients responded "no" and 225 patients responded "yes." We found no statistically significant difference in the mean value of the cycloplegic refraction 1 year after surgery in these two patient groups. (Mean cycloplegic refraction: no = -.48, yes = -.52, p = .73). We also found no difference between these groups with respect to the percent of patients with uncorrected visual acuity of 20/40 or better 1 year after surgery (no = 79%, yes = 76%, p = .46).

Clinical Trials as Topic↗
PubMed1986

A comparison of the effects of cycloplegics on accommodation ability for distance vision and on the apparent near point.

The relationship between distance accommodation ability and the near point of accommodation (NPA) was investigated following the instillation of a cycloplegic. A high correlation between the two parameters was found (p less than 0.001). It is suggested that the effect of a cycloplegic may be more directly assessed using distance accommodation measurement and, in the case of young children, with more ease. A limit of 0.75 D of distance accommodation ability is suggested as a threshold for satisfactory cycloplegia.

Accommodation, Ocular↗