Cycloplegic Refraction in Hyperopic Children: Effectiveness of a 0.5% Tropicamide and 0.5% Phenylephrine Addition to 1% Cyclopentolate Regimen

Abstract

PurposeTo evaluate the effectiveness of a cycloplegic regimen using 0.5% tropicamide and 0.5% phenylephrine (Tropherine, Hanmi Pharm), in addition to 1% cyclopentolate, in hyperopic children.MethodsThe medical records of hyperopic patients below the age of 14 years who had undergone cycloplegic retinoscopy were retrospectively reviewed. Cycloplegic refractions were performed using one of two cycloplegic regimens. Regimen 1 was a Tropherine-added regimen comprising the administration of one drop of 1% cyclopentolate followed by two to three drops of Tropherine added at 15-minute intervals. Regimen 2 was a cyclopentolate-only regimen comprising the administration of three to four drops of 1% cyclopentolate at 15-minute intervals. The mean difference between noncycloplegic and cycloplegic refraction was compared between the two regimens.ResultsA total of 308 eyes of 308 hyperopic children were included. The mean difference (±standard deviation) in the spherical equivalent (SE) between cycloplegic and noncycloplegic refraction was significantly larger in regimen 2 than in regimen 1, with values of +1.70 ± 1.03 diopters (D) and +1.25 ± 0.89 D, respectively (p=0.001). The SE change after cycloplegia was significantly different between the two regimens only in patients aged 5 years or younger (p=0.001), particularly in those with high hyperopia with an SE ≥5 D (p=0.005) or fully accommodative esotropia (p=0.009). There was no significant difference between the two regimens in patients older than 5 years, regardless of the presence of high hyperopia or fully accommodative esotropia.ConclusionsThe Tropherine-added regimen exerted a weaker cycloplegic effect than the cyclopentolate-only regimen, particularly in children under the age of 5 years with high hyperopia or fully accommodative esotropia. However, the difference in refraction between the two regimens was small. A Tropherine-added regimen can be effective in hyperopic children, with less associated discomfort than the instillation of cyclopentolate.

Comparison of retinoscopy results with and without 1% cyclopentolate in school‐aged children

“…Cycloplegic retinoscopy reveals significantly more hyperopia than is found under non-cycloplegic conditions, in line with previous studies using pre-and post-cycloplegic autorefraction, both in children and adults, 1,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] with the mean difference reported by the present study (0.59 AE 0.51DS) similar to autorefraction values. 18,25 As found using autorefraction, the largest differences were demonstrated in the present study's youngest participants (6)(7) year-olds), with differences reducing significantly as age increased up to 12-13 years.…”

“…Where published data are available, they tend to be limited by the use of inappropriate statistical analyses or methodologies. For example, Yoo et al . used retrospective analysis of retinoscopy results undertaken by different clinicians across an unspecified timeframe to evaluate differences between cycloplegic regimes recorded in hospital notes and failed to employ the Bland‐Altman approach to comparison analyses.…”

<p>Anterior Segment Biometry During Accommodation and Effects of Cycloplegics by Swept-Source Optical Coherence Tomography</p>

“…Several studies have been conducted to compare the cycloplegic effects of these agents, and different results have been reported. [7][8][9][10] In addition, cross-sectional imaging methods, including magnetic resonance imaging and Scheimpflug camera imaging, are used to determine the mechanisms underlying accommodation and cycloplegic action. [11][12][13][14] Anterior-segment optical coherence tomography (AS-OCT) has evolved rapidly for noninvasive imaging of the anterior segment of the eye.…”

Tropicamide has limited clinical effect on cycloplegia and mydriasis when combined with cyclopentolate and phenylephrine

“…[12][13][14] Still, there remains no consensus as to the optimal regimen for use in children. 10,15 According to a survey of 522 pediatric ophthalmologists, the most common mixture appears to be tropicamide-cyclopentolate-phenylephrine (TCP), followed by cyclopentolate-phenylephrine (CP). 16 While many continue to recommend TCP, 15,17 the added benefit of tropicamide remains dubious.…”

“…10,15 According to a survey of 522 pediatric ophthalmologists, the most common mixture appears to be tropicamide-cyclopentolate-phenylephrine (TCP), followed by cyclopentolate-phenylephrine (CP). 16 While many continue to recommend TCP, 15,17 the added benefit of tropicamide remains dubious. 18,19 One study found no significant difference in accommodative amplitude or pupil diameter between a TCP solution and CP control, suggesting that any effect induced by tropicamide was negligible in comparison to that of cyclopentolate and phenylephrine.…”