Similar Final Cycloplegic Refraction Is Seen with Tropicamide and Cyclopentolate

A randomized controlled trial compared final cycloplegic refraction with tropicamide 1% vs cyclopentolate 1% in a general population of children with brown irides.

Study Design

Ninety-four children aged 3–16 years (185 eyes) seen at 2 centers in Jordan underwent 2 cycloplegic refraction examinations between 1 and 12 weeks apart. One exam used cyclopentolate (after 60 minutes) and one exam used tropicamide (after 30 minutes). Refraction was obtained with an auto refractor, and the difference between spherical equivalents of the 2 agents was then calculated.

Outcomes

Spherical refraction after cyclopentolate was more hyperopic than the spherical refraction after tropicamide. However, the average difference was only 0.11 D, which while statistically significant was deemed clinically insignificant by the investigators. A greater difference in refraction between cyclopentolate and tropicamide was seen in children with preexisting hyperopia.

Limitations

The study did not include children aged <3 years. Children with strabismus were also excluded, so it is unclear whether either agent would be effective in this subpopulation. Furthermore, there was no mention of the potential effect of astigmatism, especially high amounts of astigmatism.

Clinical Significance

In the clinical setting, tropicamide 1% may be an effective replacement of cyclopentolate 1% for children without strabismus or intraocular diseases. This could potentially decrease wait times within pediatric ophthalmology practices for some children and shorten the time to recover from dilation.

Financial Disclosures: Dr. Brenda Bohnsack discloses no financial relationships.