Cycloplegia in African-American children

Purpose: The selection of a cycloplegic agent depends on the desired outcom e, the characteristics of the patient receiving the drug, and the associate d risks. The Orinda Longitudinal Study of Myopia (OLSM) has used 1% tropica mide to assess the ocular components and cycloplegic refractions in a large cohort of predominantly Caucasian children. Although tropicamide has provi ded adequate cycloplegia and mydriasis for the OLSM cohort, conventional cl inical wisdom and scientific investigations have suggested that tropicamide might not produce adequate cycloplegia and mydriasis for subjects with dar ker iris pigmentation. In this study one drop of 1% tropicamide followed by one drop of 1% cyclopentolate was used to determine their effectiveness in producing adequate cycloplegia and mydriasis for cycloplegic refraction an d ocular component measurements in a group of African-American children. Me thods: Nineteen children [age range 5.5 to 15.6 years, mean 8.4 years +/- ( SD) 2.5 years] were tested at Family HealthCare of Alabama, Eutaw, AL. Thei r accommodative responses were measured using a Canon R-1 autorefractor pri or to and at 30, 45, and 60 min after instillation of one drop of 0.5% prop aracaine, 1% tropicamide (Mydriacyl), and 1% cyclopentolate (Cyclogyl) in b oth eyes. A target of 20/155 letters in a 4 x 4 grid positioned behind a +6 .50 diopter (D) Badal lens provided accommodative stimuli of 1.00 D, 2.00 D , and 4.00 D. Results: All results are presented as mean +/- 1 SD. Pupils, measured from video frames, dilated rapidly and maximally at 30 min after i nstillation of eye drops (7.3 +/- 0.5 mm) Predilation, the mean accommodati ve responses were 0.17 +/- 0.29 D for the 1.00 D stimulus, 1.01 +/- 0.40 D for the 2.00 D stimulus, and 2.77 +/- 0.74 for the 4.00 D stimulus. At 30 m in after drop instillation, the responses were 0.07 +/- 0.14 D for the 1.00 D stimulus, 0.36 +/- 0.35 D for the 2.00 D stimulus, and 0.77 +/- 0.61 for the 4.00 D stimulus. Results were very similar at 45 and 60 min after drop instillation. Conclusions: Combining 1% tropicamide and 1% cyclopentolate was very effective in providing both cycloplegia and mydriasis adequate for ocular biometry and cycloplegic refractions 30 min after drop instillation in African-American children.