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At least 19 recordsLinked to original sources
PubMed1981

[Retinoscopy under cycloplegic and non-cycloplegic conditions in children comparison of measurements of three examiners (author's transl)].

The refractive status of 100 eyes were measured by three ophthalmologists utilizing retinoscopy under non-cycloplegic and cycloplegic conditions. The statistical analysis of the results was done by multiple regression. The retinoscopic measurements of sphere and cylinder of the three examiners show smaller differences under cycloplegic than under non-cycloplegic conditions. The largest differences in the measurements of axis were found in cases of small cylinder power. Especially in children and in patients with strabismus, the authors feel that measurements of the refractive state have to be carried out under cycloplegia.

Accommodation, Ocular↗
PubMed2001

Non-cycloplegic screening for refractive errors in children with the hand-held autorefractor Retinomax: final results and comparison with non-cycloplegic photoscreening.

AIMS: To establish the results of refractive screening of preschool children with the hand-held autorefractor Retinomax under non-cycloplegic conditions, and to compare these results with those of photoscreening. METHODS: Among 1218 children undergoing non-cycloplegic refractive screening, 302 (25%) were also refracted under cycloplegia using the same refractor and were used as controls. Our criteria for a positive screening test were based on the spherical or cylinder values and were: myopia over 3D, astigmatism > or = 2D, spherical or cylindrical anisometropia > or = 1.5D, and hyperopia > or = 1.5D. Absolute myopia over 3D, absolute astigmatism > or = 2D, absolute anisometropia > or = 1.5D and absolute hyperopia > 3.5D were considered as true positives. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated within the group of controls for each refractive anomaly. On the basis of Bayes' theorem, these figures were then corrected to yield the true screening results that would be expected in a population without verification and selection bias. To determine the usefulness of this screening technique, the likelihood ratios for positive test results (+LR) were also calculated. The results of this screening in terms of sensitivity, specificity and predictive values were then compared with those of photoscreening. RESULTS: The basic results of screening with the hand-held autorefractor were as follows: -EHyperopia: sensitivity 46%, specificity 97%, PPV 55%, NPV 96%, +LR 15; -EAstigmatism: sensitivity 37%, specificity 99%, PPV 69%, NPV 96%, +LR 37; -EAnisometropia: sensitivity 66%, specificity 93%, PPV 19%, NPV 99%, +LR 9; -EMyopia: sensitivity 87%, specificity 99%, PPV 33%, NPV 100%, +LR 87. The comparison with photoscreening revealed a similar performance when screening for hyperopia, but the hand-held autorefractor yielded much better figures when screening for astigmatism. In the case of myopia and anisometropia, the lack of consistent information concerning photoscreening invalidates any comparison. CONCLUSION: The hand-held autorefractor Retinomax appears to have potential as a screening device. Our experience with the non-cycloplegic screening of preschool children for refractive anomalies indicates definite usefulness and reasonable accuracy of the Retinomax for detecting myopia, astigmatism and hyperopia. The weak point of this screening technique is the diagnosis of anisometropia, with only moderate utility and poor accuracy.

Bayes Theorem↗
PubMedDate not supplied

Higher order ocular aberrations after cycloplegic and non-cycloplegic pupil dilation.

PURPOSE: Clinical aberrometry is commonly undertaken with the use of mydriatic agents, however there is no literature available on whether aberrometry results obtained under cycloplegia differ from those obtained without cycloplegia. METHODS: Higher order aberrations were measured over a 6-mm pupil with a Bausch and Lomb Technolas Zywave Aberrometer on the right eyes of 31 young subjects (average age 19.7 +/- 1.7 years; 5 females, 16 males). Two measurement conditions were used for each subject: 1) topical installation of 3 drops 1% cyclopentolate hydrochloride; and 2) topical installation of 1 drop 2.5% phenylephrine hydrochloride, prior to aberrometry measurements. RESULTS: For higher order aberrations (3rd to 5th order), average root mean square (RMS) after phenylephrine measurement (0.3852 microm) was significantly lower than after cyclopentolate (0.4259 microm). A small but statistically significant difference was found between the two conditions for average vertical and horizontal coma and, to a lesser extent, horizontal 5th order aberrations. Repeatability RMS, a measure of test-retest measurement repeatability, was similar for the two conditions at 0.15 microm, and significantly lower than the average RMS for the difference between the two conditions (residual RMS) of 0.22 microm. CONCLUSIONS: The difference between cycloplegic and non-cycloplegic aberration measurements has implications for surgical correction of higher order aberrations.

Administration, Topical↗
PubMed1999

A longitudinal study of cycloplegic refraction in a cohort of 350 Japanese schoolchildren. Cycloplegic refraction.

We performed a 5 year longitudinal study of cycloplegic refraction in a cohort of 350 Japanese schoolchildren from 6 to 11 years of age in a rural area of southwestern Japan. The spherical refraction was measured under cycloplegia with an infrared autorefractometer. The grouped data from 350 right eyes showed leptokurtic frequency distributions, and the median was +0.91 D at age 6 yrs, shifted towards emmetropia with increasing age and reached +0.34 D at age 11 years. The prevalence of myopia of -1.0 D or more was 0.3%, 0.6%, 2.0%, 2.6%, 2.9%, and 4.9% from age 6 to 11 years, and the prevalence of myopia of more than -2.0 D was less than 1% at age 6-9 years and thereafter increased up to 6.0% at age 11 years. Linear regression analysis for the longitudinal refractive data revealed that 247 (70.6%) of the 350 eyes exhibited first-order linear decrease in hyperopia or increase in myopia with an average annual change of -0.15 D/year, 14 (4%) showed second-order curvilinear change, and 89 (25.4%) remained unchanged. In the eyes with linear change, there was a significant relationship between the refraction at age 6 years and the rate of subsequent change such that the less hyperopic or emmetropic at age 6 years, the larger the change. The refraction at birth was estimated by extrapolation of the linear regression analysis results, implying that 88% of newborns have hyperopia of +1.0 D or greater and myopia is rare. These results indicate the current state of refraction in Japanese schoolchildren of a rural area.

Child↗
PubMed2001

Repeat cycloplegic examinations at the Naval Operational Medicine Institute.

BACKGROUND: Cycloplegic examination is required for applicants who desire entry into Naval Aviation training. Before this study, all cycloplegic examinations performed at any site were repeated at the Naval Operational Medicine Institute (NOMI), Pensacola, FL, on all student naval aviator (SNA) candidates to assess for latent hyperopia which exceeded established limits for entry into training. HYPOTHESIS: Repeat cycloplegic examination does not vary sufficiently to change student status regarding physical qualification for training. METHODS: Data analysis of cycloplegic examinations repeated at the NOMI, for which the first and second examination were recorded in the Aviation Medical Data Retrieval System (AMDRS), over 10 yr. RESULTS: There were 3919 SNA applicants who had cycloplegic examinations repeated at NOMI. Of them, 3903 (99.59%) were within standards on the repeat examination. There were 16 candidates who were sent to NOMI with a previously disqualifying cycloplegic examination. On second cycloplegic examination, 15 were within standards for SNA. Only 15 of the SNAs with a first cycloplegic examination within standards were outside SNA standards on repeat examination. Of these 15, 12 were also outside SNA standards in distant visual acuity and/or in manifest refraction. The remaining 3 were found to have excessive myopia, not latent hyperopia, on the second cycloplegic examination. The standard deviation between the first and the second cycloplegic examination was computed to be less than 0.50 diopters in any meridian. CONCLUSION: The cycloplegic examination of SNA candidates need only be repeated if the first cycloplegic examination is outside the SNA limit or within two standard deviations of the SNA limit.

Adult↗
PubMed1993

Efficacy of a pediatric cycloplegic administered as a spray.

BACKGROUND: The topical administration of eyedrops is often an unpleasant procedure in the pediatric population. We sought to learn whether a combination mydriatic-cycloplegic solution would be an effective cycloplegic if delivered as a spray. METHODS: We conducted a prospective, examiner-masked, parallel-group study and randomized 38 subjects (age range 6 months to 12 years, mean = 7.3 years) into four groups such that the same combination mydriatic-cycloplegic solution was administered under the following conditions: 1) eyedrops to eyes that were open; 2) eyedrops to eyes that were closed; 3) spray to eyes that were open; 4) spray to eyes that were closed. Both eyes of each subject received the solutions administered under one of the four conditions. Residual accommodation was measured using dynamic retinoscopy and the subjective push-up method, where applicable, at times 0, 10, 20, 30, 45, and 60 mins following administration of the medications. RESULTS: Repeated measures analysis of covariance revealed no statistically significant difference (p > 0.05) in cycloplegic efficacy among the four methods of drug delivery. CONCLUSIONS: The results of this study suggest that administering cycloplegics by spray to the closed eye is as efficacious as instilling eyedrops to the open eye. Use of a cycloplegic spray can have important clinical advantages compared to conventional cycloplegic eyedrops administered to children.

Accommodation, Ocular↗
PubMedDate not supplied

Relationship between cycloplegic and wavefront-derived refraction.

PURPOSE: To compare cycloplegic refractions to preoperative wavefront-derived refractions from three Hartmann-Shack-based wavefront devices. METHODS: Ninety-nine eyes of 55 subjects were evaluated preoperatively using the LADARWave, WaveScan, and Zywave aberrometers. With cycloplegic refraction as the standard, the spherical equivalent refraction, sphere, and cylinder were compared to the wavefront-derived refractions using the three wavefront devices. RESULTS: The LADARWave unit showed the highest correlation between wavefront-derived sphere and mean spherical equivalent refraction values relative to cycloplegic refraction, followed by Zywave and WaveScan. The WaveScan unit exhibited higher variability than the LADARWave or Zywave. Although Alcon Laboratories (LADARWave) and Bausch & Lomb Surgical (Zywave) recommend dilation, VISX specifically recommends against dilation in their WaveScan unit. All devices showed high cylinder error vectors when the cycloplegic cylinder was greater than 1.00 D. CONCLUSION: Although wavefront-derived refractions appeared to correlate well to cycloplegic refractions, further research is required to reduce variability and improve the calculation of cylinder terms.

Adult↗
PubMedDate not supplied

[Cycloplegic effectiveness of cyclopentolate and tropicamide preparations compared with atropinization].

To gain a comparative estimate of cycloplegic agents with mild effect vs conventional atropinization, a study was performed on refraction in 57 children after instillations of cyclopentolate and atropine and in 57 children after instillations of tropicamide and atropine. A difference was determined in refraction after instillation of cycloplegic agents with mild effect and atropine. It turned out that by depth of cycloplegic effect cyclopentolate is reaching that of atropine. Cyclopentolate can be used in initial study of refraction in children with hypermetropic and myopic refraction and in repeated studies of any refraction. Tropicamide is less effective cycloplegic agent than cyclopentolate and thus it can be used in initial studies of refraction in children with myopia and in repeat studies of refraction in children with myopia and hypermetropia and also in cases of intolerance of other cycloplegic agents.

Adolescent↗
PubMed2003

Cycloplegic autorefraction results in pre-school children using the Nikon Retinomax Plus and the Welch Allyn SureSight.

PURPOSE: Early detection and treatment of amblyogenic conditions such as high refractive errors and anisometropia can help prevent the development of amblyopia. The traditional gold standard for the determination of refractive error in pre-school children is retinoscopy. Difficulties with retinoscopy in pre-school children have led to the development of autorefractors that can be free of operator bias and can be used by lay individuals. The Nikon Retinomax Plus handheld autorefractor has proven to be reliable for quick and accurate assessments of refractive errors in children. The Welch Allyn SureSight Vision Screener is a relatively new handheld autorefractor. The present study compares the results of measurements with the Retinomax Plus and the SureSight to the results of cycloplegic retinoscopy in pre-school children. METHODS: Thirty-five children ranging in age from 3 to 5 years old were subjects. Any subjects with strabismus, amblyopia, nystagmus, or ocular disease were excluded. Refractive error was assessed 30 min after the application of a cycloplegic spray. RESULTS: Both autorefractors showed moderate agreement with cycloplegic retinoscopy results for measurement of spherical equivalent and cylinder power. In addition, the SureSight and the Retinomax Plus sphere and cylinder results showed moderate agreement with each other. Although the mean differences of the spherical equivalents determined were minimal, the 95% confidence intervals were large, which limits the value of the data obtained from each instrument. CONCLUSIONS: Even though the Retinomax Plus and the SureSight appear to agree with each other and with the results of cycloplegic retinoscopy for determining sphere and cylinder power, interpretation of the data should be considered as screening only because the actual magnitude of sphere and cylinder may vary from the actual magnitude. These results suggest that either device may be useful only as screening tools for assessing refractive error in pre-school children.

Child, Preschool↗
PubMed1998

The cycloplegic effects of cyclopentolate and tropicamide on myopic children.

Thirty-seven myopic children were given either 1-2 drops of 1% cyclopentolate or 1% tropicamide twice with 5 min intervals to evaluate the time course and maximal cycloplegic effect of both agents. The other fifteen subjects were given 1% tropicamide initially, then 1% cyclopentolate given after 30 min of maximal effect of tropicamide appeared to evaluate whether the effect of cyclopentolate was superior to tropicamide. Cycloplegic refraction was measured with an auto-refractometer (Topcon RK-3000) before drug delivery and every 15 min thereafter, for 90 min. The maximal cycloplegic effect of cyclopentolate was around 45 min, then it remained stable until 90 min after the last instillation. The effect of tropicamide was faster than that of cyclopentolate. It was around 30 min, then it stabilized until 75 min. The extra effect of cyclopentolate over tropicamide was minimal (only -0.1D). The power of cornea and astigmatism were not affected by either agent. However, a big variation in astigmatism was noted during the course, especially with cyclopentolate. This study suggests that 1% tropicamide should be a good agent for routine refractive status checking on myopic children.

Accommodation, Ocular↗
PubMed1978

The pharmacology of cycloplegics.

A brief review of the pharmacological action of cycloplegic drugs is followed by a specification of the doses and actions of five commonly used cycloplegics. Some criterion for selecting a cycloplegic are presented.

Adult↗
PubMed1987

A comparison of cycloplegic and manifest refractions on the NR-1000F (an objective Auto Refractometer).

The manifest (dry) and cycloplegic refractions of 50 eyes of 25 patients aged 8 to 28 years were studied on the Nikon Auto Refractometer NR-1000F (AR) and compared with the results of clinical refraction (CR) under homatropine and the final clinical acceptance on postmydriatic testing. Only patients in the younger age groups with low to moderate refractive errors were included in this study; high myopes and hypermetropes and patients with aphakia and mixed astigmatism were excluded. The degree of agreement for spherical equivalents, sphere components, and cylinder components was analysed separately for both cycloplegic and manifest refractions on the AR and CR. The results showed that the fixation target in the NR-1000F induces significant instrument myopia during manifest refraction in the younger patients with lower refractive errors. We recommend that caution should be exercised in interpreting manifest refractions on the AR, especially in younger patients. A cycloplegic automatic refraction would be acceptably accurate.

Adolescent↗
PubMed2000

Comparison of computer-photoscreening with non-cycloplegic retinoscopy for amblyopiogenic risk factors in children.

OBJECTIVE: To determine the sensitivity and specificity of using a computer-photoscreener and non-cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants and children. METHODS: Three hundred children, nine to fifty months old, were screened with the computer-photoscreener and non-cycloplegic retinoscopy. With a blinded standardized clinical assessment as the standard, an overall comparison of the sensitivity of and specificity results obtained with the two techniques was made. Photoscreen images on the computer monitor screen were reviewed and analyzed immediately by two independent observers for indicators of amblyopiogenic risk factors. Simultaneously, the results were compared to the findings of a full ophthalmologic examination. RESULTS: The computer-photoscreener revealed a sensitivity of 94.6% and specificity of 90.1%, and the non-cycloplegic retinocopy revealed a sensitivity of 85.7% and specificity of 81.0% for the detection of amblyopiogenic risk factors, including hyperopia (+2.75 D or more), myopia (-1.50 D or more), astigmatism (1.75 D or more), anisometropia (2.00 D or more), ocular misalignment (5 degrees or more), and media opacity (1.5 mm or more). CONCLUSIONS: The computer-photoscreener offers an opportunity to identify problems that limit vision, and could provide a feasible and sufficiently reliable screening technique in infants and preschool children to be screened successfully for amblyopiogenic risk factors.

Amblyopia↗
PubMed1990

A comparison of cycloplegic refraction to the near retinoscopy technique for refractive error determination.

The near retinoscopy technique of refractive error determination was compared to the standard method of cycloplegic refraction using 10 "infants" (3-12 months of age) and 10 "children" (32-109 months of age). There was a significant difference between the techniques for both sphere and cylinder power. Although there was no interaction of refractive technique and age group, the difference between near retinoscopy and cycloplegic refractive error tended to be larger for infants than for children. No significant difference was found when the average refractive values were compared for monocular or binocular conditions and no significant effect was found for either gender or laterality (right versus left eye). Based on these findings, it is suggested that caution be used in substituting the near retinoscopy technique for cycloplegic refraction even utilizing a "correction" factor for the dioptric difference between techniques.

Analysis of Variance↗
PubMed1993

Mydriatic efficacy of a cycloplegic spray in the pediatric population.

BACKGROUND: The topical administration of eyedrops is often an unpleasant procedure in the pediatric population. We sought to learn whether a combination mydriatic-cycloplegic solution would be an effective mydriatic if applied as a spray. METHODS: We used a prospective, examiner-masked, parallel-group study design and randomized 38 subjects (age range 6 months-12 years, mean = 7.3 years) into four groups such that the same combination mydriatic-cycloplegic solution was administered under the following conditions: 1) eyedrops to eyes that were closed; 2) eyedrops to eyes that were open; 3) spray to eyes that were closed; 4) spray to eyes that were open. Both eyes of each subject received the solutions administered under one of the four conditions. Photographs were taken of each subject's pupils at times 0, 5, 15, 25, 40, and 55 mins following administration of the medications. RESULTS: Repeated measures analysis of variance revealed no statistically significant difference (p > 0.05) in mydriatic efficacy among the four methods of drug administration. CONCLUSIONS: The results of this study suggest that the mydriatic efficacy of a mydriatic-cycloplegic spray is comparable to that associated with eyedrop instillation. Mydriatic sprays may have important clinical advantages over conventional ophthalmic solutions in the pediatric population.

Aerosols↗
PubMed2003

Comparison of measurements of refractive errors between the hand-held Retinomax and on-table autorefractors in cyclopleged and noncyclopleged children.

PURPOSE: To compare the measurement of refractive errors (sphere, cylinder, and axis) between the hand-held Retinomax and on-table Topcon autorefractors in cyclopleged and noncyclopleged young children. The average bias and measurement agreement were assessed. DESIGN: Observational cross-sectional study. METHODS: The study included 114 cyclopleged and 156 noncyclopleged young children. The mean difference between the two methods and the 95% limits of agreement were calculated to evaluate the average bias. Two types of analyses were conducted to assess the degree of agreement. First, the proportion of the absolute mean differences was presented in different ranges ( 1.0 diopters for sphere and cylinder; 0-10, 11-20 and >20 degrees for axis). Second, the paired t test was conducted to evaluate the consistency of two types of measurements. RESULTS: The data by the Retinomax had mild bias (0.59 diopters) toward a lower sphere data under noncycloplegia but no bias under cycloplegia. For cylinder and axis, there was either no bias or clinically acceptable bias (0.02-0.13 diopters for cylinder and 2-7 degrees for axis) regardless of cycloplegia. Besides the sphere data under noncycloplegia, in general 90% of the mean differences of sphere and cylinder were within 0.5 diopters. More than 97% of the difference in axis under cycloplegia and 68% under noncycloplegia were within 20 degrees. After adjusting for mild bias, the paired t test showed very consistent results. CONCLUSIONS: The data by the Retinomax were consistent with those by the Topcon. The Retinomax is a useful instrument to screen refractive errors in young children.

Child↗