Agreement evaluation between adaptive optics visual simulator and conventional refraction methods / 中华实验眼科杂志

Objective:To evaluate the difference and agreement of cycloplegic refraction between adaptive optics visual simulator (VAO) and conventional refraction methods.Methods:A diagnostic test study was conducted.Thirty-one eyes of 31 healthy subjects including 15 males and 16 females were enrolled in November, 2019 in Affiliated Hospital of North Sichuan Medical College.Mean age of the subjects was (20.1±1.0) years, and the right eye was taken for data analysis.Cycloplegic refraction was measured by VAO and conventional refraction methods, respectively.Spherical power, cylindrical power, Jackson cross-cylinder power at axis 90° and 180° (J 0) and Jackson cross-cylinder power at axis 45° and 135° (J 45) vector powers were recorded.Paired t-test was used to compare the refractive parameters between different refraction methods, and the intraclass correlation coefficient (ICC) and Bland-Altman plots were used to evaluate the agreement between VAO and conventional refraction methods.This study adhered to the Declaration of Helsinki, and the research protocal was approved by an Ethics Committee of Affiliated Hospital of North Sichuan Medical College (No.2020ER[A]018). Written informed consent was obtained from each subject prior to any medical examination. Results:For subjective refraction, the ICC for spherical power, cylindrical power, J 0 and J 45 between VAO and phoropter were 0.97, 0.75, 0.84 and 0.09, respectively.For objective refraction, the ICC for spherical power, cylindrical power, J 0 and J 45 between VAO and autorefractor were 0.98, 0.70, 0.74 and 0.61, respectively.The mean differences in spherical power, cylindrical power, J 0 and J 45 between VAO and phoropter were (0.05±0.32), (-0.23±0.28), (-0.10±0.14) and (-0.04±0.16)D, respectively, and the differences in cylindrical power and J 0 were statistically significant (both at P<0.01), whereas no significant differences in spherical power and J 45 were found ( P=0.41, 0.18). The mean differences in spherical power, cylindrical power, J 0 and J 45 measured by VAO and autorefractor were (-0.70±0.26), (-0.07±0.46), (-0.03±0.27) and (0.01±0.12)D, respectively, and the spherical power measurement by VAO was significantly more negative than the autorefractor ( t=15.09, P<0.01), while no significant differences in cylindrical power, J 0 and J 45 were found ( P=0.39, 0.59, 0.63). No significant difference values in spherical power, cylindrical power, J 0 and J 45 were found between the two objective refraction methods and phoropter subjective refraction (all at P>0.05). Conclusions:With cycloplegia, spherical power obtained by VAO objective refraction is more negative compared with autorefractor.There is a good agreement of spherical power and astigmatism vector values measured by VAO and phoropter subjective refraction, and the measurement differences are clinically acceptable.

Repeatability of ARK-30 in a pediatric population

Purpose: To determine repeatability and agreement of the ARK-30 handheld autorefractor with retinoscopy under cycloplegic and noncycloplegic conditions in children. Methods: Three consecutive autorefractor measurements (with and without cycloplegia) and retinoscopy were performed and compared in 30 randomized eyes of 30 children (mean age of 6.7 ± 2.7 years with spherical equivalent [SE] refraction from ?4.01 to +7.38 D) in a cross-section and masked study. Bland–Altman analysis of autorefractor measurements (with and without cycloplegia) and agreement with retinoscopy were calculated with conventional notation (sphere [Sph] and cylinder [Cyl]) and vector notation (SE, J0, and J45coefficients). Results: ARK-30 measurements without cycloplegia were lower than under cycloplegic conditions (Sph: ?0.52 ± 2.37 D vs + 0.86 ± 2.60 D, P < 0.01; Cyl: ?0.83 ± 0.80 D versus ?0.78 ± 0.77 D, P = 0.37; and SE: ?0.94 ± 2.19 D vs + 0.47 ± 2.44 D, P < 0.01, respectively) and statistically different (P < 0.03) from retinoscopy (Shp: +0.83 ± 2.66 D; Cyl: ?0.71 ± 0.87 D; SE: +0.51 ± 2.49 D). Without statistical differences were in J0and J45coefficients. Cyloplegic autorefraction measures were not found to be statistically significantly different to retinoscopy measures. ARK-30 under cycloplegia shows better repeatability with lower limits of agreement (LoA) in Sph (LoA: ?0.66 to +0.69 D), and SE (LoA: ?0.66 to +0.65 D) than without cycloplegia (LoA: ?1.45 to +1.77 D, and ?1.38 to +1.74 D, respectively). Conclusion: Under noncycloplegic conditions, ARK-30 autorefractor has low repeatability and a tendency toward minus over correction in children. However, repeatability and agreement with retinoscopy under cycloplegic conditions allow use of ARK-30 in children to estimate refraction but not to substitute gold standard retinoscopic refraction.

A multifunction glasses in the recovery term of cycloplegia and its primary application / 中国医学装备

Objective:To design functionality glasses in order to solve or alleviate various visual disorder during cycloplegia.Methods:Based on the principle of the polarizing lens and pinhole lens, the glasses frame was combine with them so as to be suitable for the recovery of cycloplegia and for the usage in near and distant vision situation.Results: This glasses has a series of advantages including small size, light weight, convenience and beauty. Through the combination of different lenses, the symptom of visual unclear during cycloplegia wasimproved, and the symptom of glare and squint in distant vision also was improved. Besides, the symptom that adjustment of near vision couldn't be activated was improved, and near vision blurry leaded by peripheral aberration coming from mydriasis also was improved. On the other hand, this device was easy and simple on combination and was convenient on usage.Conclusion: This design contributes to correct refractive error, and enhance the definition of near or distant vision. And it is suitable for various situation of usage including near, distant, indoor and outdoor.

Feasibility of microcoria optometry in screening for ametropia in school -age children / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To discuss the feasibility of microcoria optometry in screening for children ametropia. METHODS: Totally 217 school - age children were selected, included 94 first-grade students ( 6 ~ 8 years old) and 123 fourth-grade students ( 9 ~12 years old ) . Refractive diopter was measured with automatic refractor RM-8000 to evaluate the accuracy of micocoria optometry in screening ametropia.RESULTS: After cycloplegia, both the mean sphere diopter and cylinder diopter in grade one students changed significantly (P0. 05 ) in grade four students. Different refractive type: before and after mydriasis spherical myopia, spherical equivalent difference was 0. 263 ± 0. 618 and 0.216±0.653D, with statistical significance (P 0. 05 ). Choosing small pupil computer optometry for ≤- 1. 00D, ≥- 0. 50D child myopia or hyperopia could get more accurate value of diagnostic cutoffs, Youden index was 0. 672 and 0. 580. CONCLUSlON: Microcoria optometry can be as a effective method of screening of children with ametropia, but if for optometry, school-age children must accept mydriasis.

Cycloplegic effects of 0 . 5 g/L tropicamide in various low myopia age groups / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigated the refraction and cycloplegic effects of 0. 5g/L tropicamide eye drops in various low myopia age groups, and provide clinical guidelines for proper usage of cyclopegic agent in different population.METHODS:Three low myopia age groups (n=45) were selected, non-cycloplegic and cycloplegic auto-refraction using “Shin-Nippon” auto-refractor were performed at various time point for refractive error. The subjective accommodation amplitudes were also collected at each time point. RESULTS: The accommodation amplitude showed a similar but significant decline between 20~60min after the first cyclopegic drops in all three age groups. However, the decline of accommodation amplitudes were not statistically correlated with the results of “Shin-Nippon”auto-refraction results at different time points. CONCLUSlON: The refraction time should be arranged according to the cycloplegic effects of tropicamide. Open-field auto-refractor could reduce the usage of cycloglegice drugs in low myopia groups, even for the youngest.

Meta analysis of comparison between atropine and cyciopentolate in cycloplegia / 中华实验眼科杂志

Background Medical refraction after cycloplegia is the preferable choice for precise measurement of degree of refractive error.Drugs used in China for cycloplegia include atropine and tropicamide,and the use of cyclopentolate is an alternative for ophthalmologist.However,the data for the evaluation and comparison of efficacy of the available drugs in cycloplegia is still lacking.Objective This system analysis was to evaluate the difference between atropine and cyclopentolate in cycloplegia in children.Methods A systematic literature retrieval was conducted in MEDLINE,EMbase,Google residual accommodation after cycloplegia by atropine and cyclopentolate were compared.Statistical analysis was performed using the RevMan 5.1.0 software.Results A total of 7 studies were included in this meta analysis,including 6 cohort study design and 1 randomized,doubleblinded clinical trial and 1232 eyes.For retinoscopic evaluation after cycloplegia,no significant differences were found between cyclopentolate and atropine in children with hyperopia and myopia (WMD =-0.21,95％ CI:-0.47-0.06,P=0.13 ; WMD =-0.10,95％ CI:-0.36-0.15,P =0.43).For residual accommodation after cycloplegia,no significant difference was seen between cyclopentolate and atropine in ammetropic children (WMD =0.30,95％ CI:-0.10-0.71,P =0.15).Conclusions Cyclopentolate shows the same effect on the cycloplegia as atropine in children,and it can take the place of atropine in cycloplegia in childhood.

Use of atropine to predict the accommodative component in esotropia with hypermetropia.

This cohort study included children with esotropia and hypermetropia of ≥ +2.0 diopters (D). The deviation was measured at presentation, under atropine cycloplegia and 3 months after full refractive correction. Of 44 children with a mean age of 5.2 ± 2.4 years, 25 were males. Eighteen (41%) had fully refractive accommodative esotropia (RAE), 10 (23%) had partial accommodative esotropia (PAE), and 5 (11%) had nonaccommodative esotropia (NAE). Eleven (25%) had convergence excess (CE). Under cycloplegia, all with RAE and RAE with CE had orthotropia. There was no significant change in the deviation in the patients with NAE. The deviation under cycloplegia and that with full refractive correction in PAE and PAE with CE (with +3.0 D addition) were not different. The intraclass correlation coefficient for deviation under cycloplegia and after full refractive correction (+3.0 D addition for CE) was 0.89. It was concluded that ocular deviation under cycloplegia can help to predict the accommodative component in esotropia with hypermetropia.

Efficacy of Conjunctival Application Using Cotton-tipped Applicator for Mydriasis and Cycloplegia

PURPOSE: We compared the efficacy of applying mydriatics to the conjunctiva of the lower eyelid by using a cotton-tipped applicator with an eye-dropping method. METHODS: Thirty children under 16 years of age (60 eyes) and 30 adults more than 20 years old (60 eyes) were randomly chosen. Mydriatics were applied to each eye using an eye-dropping method for one eye and a conjunctival application method using a cotton-tipped applicator for the other eye. Pupil size was measured before applying mydriatics, immediately and at 30 and 60 minutes after application. Also, we investigated the degree of discomfort. RESULTS: In the children, the pupil size in the eye dropping group and the conjunctival application group were each 8.01+/-0.57 mm and 7.97+/-0.57 mm at 60 minutes after applying mydriatics (P=0.07). In the adults, the pupil size was 7.94+/-0.59 mm in the eye-dropping group and 7.89+/-0.55 mm in the conjunctival application group at 60 minutes after applying mydriatics (P=0.074). In terms of degree of discomfort, the adults found the conjunctival application method to be significantly more unpleasant than the eye-dropping method at each three applications (P=0.001, 0.001, 0.001). CONCLUSIONS: The conjunctival application method using a cotton-tipped applicator has an equal effect in terms of mydriasis compared to the eye-dropping method. It is convenient to use in children and in the elderly who show less compliance. Also, this new method reduces systemic absorption of the medication. Therefore, the conjunctival application method is a good substitute for the conventional methods for mydriasis.

The Effect of Cycloplegia on Vision and Stereopsis: Comparison between before and after Cycloplegia

PURPOSES: To evaluate the effect of cycloplegia on the visual acuity and stereopsis according to the refraction and age. METHODS: This study included 112 eyes of 56 patients, which were divided into three groups according to the refraction. The best corrected visual acuity and stereopsis were compared between without and with cycloplegia in all groups according to age. RESULTS: After cycloplegia, at near, naked visual acuity decreased in 0.53 logMAR, average and stereopsis also deceased from 93 seconds to 343 seconds. At far, the naked and best corrected visual acuity had less decreased than near visual acuity. At near, there was no significant difference on the degree of decreased visual acuity and stereopsis according to refraction, but in emmetropic patients, the visual acuity at near significantly decreased. Patients younger than ten years old had more decreased visual acuity at near compared with older than forty-five years old. CONCLUSIONS: After pupil dilatation, there significant decreased near visual acuity and stereopsis, there was little change at far. The degree of decreased vision was different according to the refraction and age, therefore it would be helpful to explain the anticipating result.

Comparison of Autorefraction and Clinical Refraction with or without in Children

PURPOSE: The difference in the values between autorefraction and clinical refraction with or without cycloplegia in children were analyzed as a function of age. METHODS: One hundred and twenty five children (230 eyes) with myopia or hyperopia were classified into three age groups. Their ages ranged from 2 to 14. They were examined with a Cannon RK-5 autorefractor, and experienced personnel the clinical refraction before and after cycloplegia. Discrepancies beyond 0.5 diopter in spherical equivalent, spherical and cylinder power were regarded as being significant and the discrepancy rates (%) were calculated. The mean absolute differences in the values of each refractive component in myopia and hyperopia were also compared separately according to. RESULTS: All the differences by cycloplegia were significantly smaller in the myopia patients over 5 years old. However, only the discrepancy rates of the spherical equivalent and the sphere component between the clinical manifest refraction and the cycloplegic refraction were significantly smaller in the higher age groups. The comparisons between the clinical and autorefraction revealed significant difference between the age groups only in those with myopia with cycloplegia. CONCLUSIONS: There were differences between the cycloplegic refraction and non-cycloplegic refraction values particularly in myopia patients under five years old and in all hyperopic patients. Autorefraction showed differences from the clinical refraction in both myopia and hyperopia regardless of their ages particularly in those without cycloplegia. Therefore, autorefraction and clinical refraction should be used with caution in children.

Additive effect of Dapiprazole and Pilocarpine for the Reversal of Mydriasis and Cycloplegia

We assessed the combined effects of dapiprazole, an alpha-adrenergic receptor blocker, with pilocarpine. direct-acting parasympathomimetics, on reversing mydriasis and cycloplegia in 40 eyes (20 subjects) who received 1% tropicamide or 2.5% phenylephrine for pupillary dilation and cycloplegic refraction. These results were compared to 40 eyes (20 subjects) that received dapiprazole alone. The study was divided into four groups, each of which consisted of 20 eyes that received either 1% tropicamide or 0.5% phenylephrine followed by instillation of 0.5% dapiprazole alone or in combination with 2% pilocarpine. A significant difference in the reduction of pupil size and the increase in accommodative amplitude has been observed between the groups that received dapiprazole alone and those received both dapiprazole and pilocarpine(p<0.001). These results suggest that dapiprazole and pilocarpine eyedrops have additive effects on reversing both mydriasis and cycloplegia after instillation of 1% tropicamide or 2.5% phenylephrine for pupillary dilation and cycloplegic refraction.

A Case Report of Mydriasis and Cycloplegia Developing after General Anesthesia / 대한마취과학회지

Belladonna drugs dilate the pupil and paralyze accomodation after either local or systemic administration. Conventional systemic doses of atropine (0.5-0.6 mg) have little ocular effect, but with larger doses ocular effects develop. We experienced one case where a 30 year old healthy male patient developed mydriasis and cycloplegia of unknown origin on both eyes after general anesthesia for removal of intracerebral hematoma of left superficial parietal area. The symptoms disappeared spontaneously 11 days after the operation without any treatment. During the operation, the vital signs were stable, there was no sign of increased intracerebral pressure or rebleeding, and there was no abnormal ophthalmic findings. We could not find any definite causes of mydriasis and cycloplegia in this case, except that the patient received large doses of belladonna drugs during the anesthesia, such as Robinul 0.2 mg IM as premedicant, atropine 0.5 mg IV for treatment of bradycardia, and Robinul 0.2 mg IV for reversal of muscle relaxation with neostigmine 1.0 mg. Careful examination of all the circumstances would not let us exclude the possibility that the cause was atropine and robinul.