ABSTRACT
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.
Subject(s)
Accommodation, Ocular/drug effects , Cyclopentolate/administration & dosage , Phenylephrine/administration & dosage , Pupil/drug effects , Tropicamide/administration & dosage , Administration, Topical , Aerosols , Child , Child, Preschool , Female , Humans , Infant , Male , Ophthalmic SolutionsABSTRACT
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.
Subject(s)
Cyclopentolate/administration & dosage , Phenylephrine/administration & dosage , Pupil/drug effects , Tropicamide/administration & dosage , Aerosols , Child , Child, Preschool , Double-Blind Method , Drug Combinations , Eye Color/drug effects , Female , Humans , Infant , Male , Ophthalmic Solutions , Sensory DeprivationABSTRACT
The purpose of this study was to determine if differences exist between subjective and objective methods of measuring the amplitude of accommodation. In a double-masked study on 57 patients, ages 6 to 35 years, 2 examiners measured the amplitude, 1 using the subjective push-up method and the other using a modified form of dynamic retinoscopy. Significant differences among the findings occurred (p < 0.001), the amplitude of accommodation being on the average 2.7 D higher with dynamic retinoscopy. The amplitudes as determined subjectively for each eye were highly correlated (gamma = 0.92), as were the objective findings (gamma = 0.85). Four other examiners also used this method of dynamic retinoscopy to determine the amplitude of accommodation on 43 patients, ages 11 to 39 years. For three examiners, the average amplitude of accommodation measured objectively was statistically similar to that measured subjectively. For the other examiner, the objective findings were on the average 1.19 D higher than the subjective findings. This study suggests that this modified form of dynamic retinoscopy can give consistent results, although different for some examiners than the traditional push-up method when determining the amplitude of accommodation.
