The following is a summary of “Tropicamide Versus Cyclopentolate For Cycloplegic Refraction in Pediatric Patients with Brown Irides: A Randomized Clinical Trial,” published in the October 2023 issue of Opthalmology by Al-Thawabieh et al. 

Researchers performed a prospective study to assess the efficacy of tropicamide 1% and cyclopentolate 1% for cycloplegic refraction in children 3 to 16 years old with brown eyes.

Patients were randomly assigned to receive either cyclopentolate 1% or tropicamide 1% during the initial visit, with autorefraction measurements taken. Subsequently, each subject underwent a second cycloplegic refraction using the alternate agent during a separate visit, with a minimum interval of 1 week and a maximum of 12 weeks. The spherical equivalent (ΔSE) change for each eye was determined by subtracting the spherical equivalent (SE) measurement before cycloplegia from the SE measurement after cycloplegia.

The study analyzed 185 eyes from 94 children aged 3 to 16 years (average= 8.79 ±3.11 years). The average SE of both eyes before cycloplegia was -0.082±4.8 diopter. Following cyclopentolate and tropicamide instillation, the SE 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 in ΔSE between cyclopentolate and tropicamide was statistically significant at 0.11±1.2 (P-value= 0.000) but clinically insignificant. The ΔSE between the two drops before and after cycloplegia in both eyes was clinically insignificant for all refractive error groups. The most significant impact of cyclopentolate and tropicamide was observed in hyperopic eyes, with ΔSE of 1.54±1.4 and 1.39±1.4, respectively. 

The study found tropicamide may be a safe and effective alternative to cyclopentolate for cycloplegic refraction in non-strabismic children aged 3-16, regardless of refractive error.

Source: ajo.com/article/S0002-9394(23)00403-8/fulltext