Comparison of tropicamide and cyclopentolate for cycloplegic refractions in myopic adult refractive surgery patients.
OBJECTIVE
To compare tropicamide 1%, a shorter-acting cycloplegic agent, with cyclopentolate 1% for cycloplegic refractions in adult refractive surgery patients.


METHODS
Navy Refractive Surgery Center, Ophthalmology, Naval Medical Center, San Diego, California.


METHODS
The study was prospective, single center, with randomized sequencing of cycloplegic agent; each patient received both agents. Thirty consecutive myopic adult refractive surgery patients (mean age 35.4 years) participated. A complete preoperative examination, including cycloplegic refraction, was obtained twice, 1 week apart. The patient and the examiner were masked to the medication. Main outcome measures included cycloplegic and manifest refractions, best corrected distance acuity, near-point accommodation, pupil diameters, and subjective appraisal of experience with cycloplegic agents.


RESULTS
Twenty-eight of 30 patients completed both examinations. Both eyes were measured, but comparisons were limited to right and left eyes, independently. No statistically significant difference was found between the tropicamide and cyclopentolate cycloplegic refractions (mean difference in MSE +/- SD, OD=0.054 +/- 0.214 diopters (D), t=1.33, P=.10; OS=0.054 +/- 0.253 D, t=1.12, P=.14). Five eyes of 3 patients had a difference of 0.50 D or greater between the 2 agents; less myopia with cyclopentolate. Near-point testing revealed less residual accommodation with cyclopentolate (difference in MSE, OD=-0.27 +/- 0.51 D, t=2.68, P=.006; OS=-0.32 +/- 0.49 D, t=3.46, P=.001). Subjectively, 24 of 28 (86%) patients preferred tropicamide, 1 (4%) preferred cyclopentolate, and 3 (10%) had no preference.


CONCLUSIONS
There was no statistically significant difference in mean cycloplegic refractions. Cyclopentolate was more effective than tropicamide in reducing accommodative amplitude in adult myopes (near-point testing). Patients strongly preferred tropicamide.
Hofmeister
Elizabeth M
EM
Navy Refractive Surgery Center, Department of Ophthalmology, Naval Medical Center, San Diego, California 92134-1005, USA.
Kaupp
Sandor E
SE
Schallhorn
Steven C
SC
D000065:Accommodation, Ocular / Q000187:drug effects; D000328:Adult; D002924:Ciliary Body / Q000187:drug effects; D003519:Cyclopentolate / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage*; D009216:Myopia / Q000150:complications* / Q000601:surgery; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects; D012029:Refraction, Ocular / Q000187:drug effects*; D014331:Tropicamide / Q000008:administration & dosage*
D009184:Mydriatics; D009883:Ophthalmic Solutions; D003519:Cyclopentolate; D014331:Tropicamide