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R. N. Sanchez, F. Choudhury, K. Tarczy-Hornoch, M. Borchert, S. A. Cotter, S. Azen, R. Varma, The Multi-Ethnic Pediatric Eye Disease Study Group; Effect of Cyclopentolate versus Atropine on Cycloplegic Refraction: The Multi-Ethnic Pediatric Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1454.
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To compare the refractive error of hyperopic children aged 6 to 72 months as determined with cyclopentolate or atropine eye drops.
24 children aged 6-30 months (n=8) and 48-72 months (n=16) with spherical equivalent (SE) hyperopia >= 2.00 diopters (D) in either eye were examined. On Day 1, two drops of 1% cyclopentolate 5 minutes apart were instilled into both eyes (0.5% for children <= 12 months of age) and refractive error was measured 30 minutes later by Retinomax autorefraction. Subsequently, 1% atropine daily was instilled over 3 days in both eyes of the same subjects. Refractive error was re-measured on Day 3. Eyes with <2.00 D SE hyperopia on Day 3 were excluded.
Mean right eye SE refractive error with atropine was +3.39 D (s.d.± 0.85 D; range +2.25 D to +6.00 D). Similar results were found in left eyes. On average, an additional +0.43 D of hyperopia were detected on Day 3 with atropine (s.d. +0.29 D; range -0.13 D to +1.5 D) when compared to Day 1 with cyclopentolate for all eyes. Using a generalized estimating equation model to account for intereye correlation, the increase in SE hyperopia measured with atropine was statistically significant (p<0.0001). The increase in hyperopia with atropine was significant in both right and left eyes, in both younger children (6-30 months old: p=0.004, right eye; p=0.002, left eye) and older children (48-72 months old: p=0.0002, right eye; p=0.003, left eye). There was no significant difference between the amount of hyperopia measured with atropine in older children, and that in younger children (p=0.31, right eye; p=0.87, left eye; Wilcoxon rank sum test).
Atropine cycloplegia results in a higher estimate of hyperopic refractive error than cyclopentolate in young children with moderate hyperopia. However, the mean SE difference is <0.50D. Considering the practical advantages of cyclopentolate over atropine, this clinically minor effect supports the use of cyclopentolate as the standard cycloplegic agent for both routine clinical use and epidemiologic research.
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