Visual acuity after cycloplegia in children: Implications for atropine penalization

Background: Atropinization of the sound eye is an alternative to patching i n the treatment of amblyopia. Whether atropine treatment can induce a switc h in fixation depends on the refractive error of the sound eye, visual acui ty of the amblyopic eye, distance from the fixation target, and presence of any optical correction or penalization. General guidelines are needed an t he basis of refractive error and visual acuity in the amblyopic eye to pred ict which patients may potentially benefit from atropine penalization. Meth ods: Refractive error and visual acuity at distance (6 m) and/or at near (3 3 cm) were recorded in a normal eye of 126 consecutive children (mean age, 8.2 years), 30 to 60 minutes after receiving cyclopentolate 1%. Visual acui ty was plotted versus refractive error at distance and at near, and best-fi t curves were calculated. Results: There was a consistent, reproducible rel ationship between refractive error and visual acuity after cycloplegia at b oth distance and near in healthy children. Conclusions: The results of this study can be used to quickly determine whether atropine penalization has t he potential for success on the basis of a patient's visual acuity in the a mblyopic eye and refractive error in the sound eye. When adequate hyperopia is present in the sound eye, one should consider testing for fixation pref erence or initiating a therapeutic trial of atropine. Those children with i nsufficient hyperopia in the sound eye relative to visual acuity in the amb lyopic eye can be spared the time, expense, and potential side effects of a tropine penalization.