Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery

Abstract

Brimonidine tartrate ophthalmic solution 0.15% improved contrast sensitivity and acuity and decreased night-vision difficulty for up to 1 month in patients with significant complaints after refractive surgery.

Effect of brimonidine tartrate 0.10% ophthalmic solution on pupil diameter

“…As shown by Brown et al, 13 at once-daily dosing the influence on pupil diameter diminished after several days in 10 of 10 subjects and resulted in rebound mydriasis after discontinuation. Edwards et al 10 also report that the pupil diameter under dark conditions returned to its baseline values after 1 month of daily use of brimonidine in all patients. Therefore, brimonidine may not be suitable for chronic relief of night-vision disturbances, and further long-term research is necessary before it can be administered for this indication.…”

“…This is consistent with previous reports of brimonidine's effect on pupil diameter in concentrations of 0.15% and 0.20%. [7][8][9][10][11] Brimonidine has been suggested as an optional treatment to reduce night-vision disturbances after refractive surgery, which occur mainly in patients with large pupils, small optical treatment zones, and higher-order aberrations. 9,10 Brimonidine 0.10% seems to have the same antimydriatic effect as its higher concentrated solutions.…”

“…9 The same effect has been demonstrated with the use of brimonidine 0.15%. 10,11 A previous study by our group has shown that the effect on pupil diameter is more pronounced in light irides. 7 Some studies [5][6][7][8][9] refer to the decrease in pupil diameter as a miotic effect.…”

Effectiveness of daily use of brimonidine as antimydriatic agent

“…One patient showed no response and the remaining 9 showed tachyphylaxis within 18 days; the rebound mydriasis lasted several days in 5 of the 9 patients. Edwards et al 3 tested 6 patients with brimonidine 0.15%, although the dosing frequency was ambiguous (daily or ''not more than 3'' times per day). The mean baseline low-light pupil diameter was 6.44 mm; 1 hour after the first dose, it was 4.53 mm and after 30 days of use, it was 6.50 mm.…”

“…This point has not been adequately emphasized in the literature. 3 Patients should be advised to use brimonidine sparingly. They should also be warned that if tachyphylaxis develops, it might be followed by several days of visually debilitating rebound mydriasis (personal experience).…”