The Change in Ocular Refractive Components After Cycloplegia in Children

doi:10.1016/S0021-5155(02)00479-3

Japanese Journal of Ophthalmology

Volume 46, Issue 3, May–June 2002, Pages 293-298

https://doi.org/10.1016/S0021-5155(02)00479-3 Get rights and content

Abstract

Purpose: To study the change in ocular refractive components after cycloplegia in children.

Methods: Anterior chamber depth, lens thickness, vitreous chamber length, and ocular axial length were measured in 135 Chinese children (270 eyes) before and after cycloplegia. The corneal curvatures of 136 selected eyes were studied before and after cycloplegia with a computerized video keratoscope.

Results: Anterior chamber depth increased (P < .001) while both lens thickness and vitreous chamber length decreased (P < .001) significantly after cycloplegia regardless of the refractive state. However, axial length increased in hyperopic eyes (P = .027) but decreased in myopic eyes (P = .008) after cycloplegia. Mean corneal power of zones 3 mm (MD3, P = .009) and keratometer K1 readings increased (P = .025) in hyperopic eyes, while MD3 (P = .033), K1 (P = .039) and K2 (P = .003) readings decreased in myopic eyes significantly after cycloplegia. Similarly, mean corneal power of zones 5 mm and 7 mm in myopic eyes decreased dramatically (P ≤ .001). In both hyperopic and myopic eyes, there was significant difference (P < .001) in the mean value of the upper and lower half of the vertical meridian, as well as the medial and lateral half of the horizontal meridian, respectively.

Conclusions: Cycloplegia has a great influence on various refractive components in children. There is asymmetry of the corneal surface within the same horizontal or vertical meridian.

Introduction

It is now understood that several components contribute to refractive error, including corneal curvature, anterior chamber depth, lens power, and axial length.1, 2, 3 Thus, the refractive state of one eye is determined by the magnitude of each refractive component and its interaction with the other components. We conducted the current study to determine the influence of cycloplegia on refractive components in children by means of modern measurement techniques, and then proceeded to investigate the role of accommodation in the development of ametropia.

Section snippets

Subjects

A total of 135 Chinese children (270 eyes) were examined. Informed consent was obtained from their parents. Ages ranged from 7 to 13 years (mean = 9.6 ± 2.30 years). Sixty-eight (50.37%) subjects (136 eyes) with a wide enough palpebral fissure were selected from the 135 subjects and enrolled in corneal topography analysis. All subjects satisfied the following criteria: (1) No subject had worn contact lenses; (2) Cornea topography was taken at least 12 hours after the last administration of

Results

The results of a normality test showed that the distribution of all variables both before and after cycloplegia was normal (−1 < Skewness < 1).

One hundred and thirty-five children (270 eyes) were examined with A-scan of ultrasound. The patient demographics and refractive status are shown in Table 1. Data from A-scan ultrasonic measurements before and after cycloplegia are shown in Table 2, and pair sample t-test results of various ocular components are shown in Table 3. Anterior chamber depth

Discussion

Refractive error has been chosen by The World Health Organization as one of the five priority areas in the “Vision 2020” program.⁴ Within the ophthalmic community, there has been extensive discussion of the influence of hereditary and environmental factors in the development and progression of myopia. Epidemiological studies indicate that myopia represents a growing public health problem. It has been shown that the average prevalence of myopia among different age groups of school children in

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Agreement of wavefront-based refraction, dry and cycloplegic autorefraction with subjective refraction
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Citation Excerpt :
Some studies reported that spherical aberration increased significantly following cycloplegia.20,21 Gao et al. mentioned a significant reduction in the crystalline lens thickness following cycloplegia and backward lens shift which increased spherical aberration.22 Therefore, with a mydriatic pupil, the crystalline lens’ periphery is engaged in retinal image creation, which rises a positive spherical aberration and moves the image focus towards an anterior plane.23
To evaluate the agreement of dry, and cycloplegic autorefraction and wavefront-based refraction with subjective refraction.
83 subjects aged 19–57 years were included in this cross-sectional study. Refractive status was determined using four methods including subjective refraction, wavefront-based refraction, dry and cycloplegic autorefraction. Refractive data were recorded as sphere, cylinder and spherical equivalent (SE). Power vector components were used to compare the astigmatism obtained using the different methods of refraction.
The more negative spherical, cylindrical and SE components were obtained using dry autorefraction, wavefront-based refraction and dry autorefraction, respectively. The less negative spherical, cylindrical and SE components were obtained using cycloplegic autorefraction, subjective refraction and cycloplegic autorefraction, respectively. Considering the spherical component, there was a statistically significant hyperopic shift (0.12 ± 0.29 D, p = 0.001) with cycloplegic autorefraction and a significant myopic shift (−0.17 ± 0.32 D, p < 0.001) with dry autorefraction compared to subjective refraction, while the difference between wavefront-based and subjective refraction was not significant statistically (p = 0.145). The calculated cylindrical component using subjective refraction showed statistically significant difference with dry auto-refraction (p < 0.001), cycloplegic auto-refraction (p = 0.041) and wavefront refraction (p < 0.001). The highest correlation with subjective refraction in sphere, cylinder and SE was observed for cycloplegic auto-refraction (r_s = 0.967), dry auto-refraction (r_s = 0.983) and cycloplegic auto-refraction (r_s = 0.982), respectively.
As subjective refraction is gold standard in our study, sphere in cycloplegic auto-refraction and astigmatism in dry auto-refraction showed better agreement and correlation.
The effects of cycloplegic eyedrops on corneal tomography
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L’effet des cycloplégiques sur les mesures kératoréfractométriques et tomographiques cornéennes est peu connu. L’objectif de notre étude était de tester et de comparer les effets des cycloplégiques (cyclopentolate et atropine) sur la forme cornéenne et la puissance réfractive de l’œil.
Quarante-neuf participants ont été inclus (84 yeux) dans cette étude prospective. Les patients ont été randomisés en deux groupes, atropine 1 % (32 yeux) et cyclopentolate 1 % (52 yeux). L’orbscan IIz a été utilisé pour évaluer la tomographie cornéenne. Pour évaluer la forme cornéenne, les valeurs de SimK, BFS, antérieure et postérieure, W-W, la puissance cornéenne tangentielle et axiale ont été mesurées pour les faces cornéennes antérieures et postérieures, avant et pendant la cycloplégie. Le diamètre de la pupille, la profondeur de la chambre antérieure, l’épaisseur de la cornée dans les zones circulaires de 3,5 et 7 mm, et dans la partie la plus mince de la cornée et aussi l’épaisseur cornéenne au centre de fixation ont été également examinés. Le logiciel de statistique SPSS a été utilisé pour l’analyse statistique des données.
La BFS antérieure et postérieure, la puissance cornéenne tangentielle et axiale, le SimK, n’ont pas changé lors de la cycloplégie dans les deux groupes traités par atropine et cyclopentolate. L’ACD était plus profonde lors de l’utilisation de l’atropine que lors de l’utilisation du cyclopentolate. L’épaisseur cornéenne est restée inchangée pendant la cycloplégie dans les deux groupes. Le diamètre des pupilles était plus large chez les iris clairs traités avec le cyclopentolate que dans le groupe traité avec l’atropine. Dans les deux groupes, les mesures du diamètre cornéen – blanc à blanc n’ont pas montré une différence statistique avant (p = 0,473) et pendant la cycloplégie (p = 0,287).
Les examens effectués sur notre échantillon montrent que l’utilisation de l’atropine 1 % et du cyclopentolate 1 % ne change pas la forme cornéenne (mesurée par la tomographie cornéenne).
Whether cycloplegics affect standard keratorefractometric and tomographic measurements is unknown. The purpose of our study was to compare the effects of cycloplegics (cyclopentolate and atropine) on corneal shape and refractive power of the eye.
This study was performed on 84 eyes of 49 study participants. Patients were randomized into two groups: atropine 1% (32 eyes) and cyclopentolate 1% (52 eyes). Corneal tomography was performed with the Orbscan IIz. To evaluate the corneal shape, simulated keratometry values, anterior and posterior best-fit sphere, white-to-white and tangential and axial corneal power were performed for the anterior and posterior corneal surfaces before and during cycloplegia. Pupil diameter, anterior chamber depth, corneal thickness at the 3, 5 and 7 mm optical zones, thinnest area of the cornea and corneal thickness at the visual axis were examined. Data were analyzed using an SPSS statistical package.
The anterior and posterior BFS (in the atropine 1% group, anterior BFS was P = 0.188; anterior BFS in the cyclopentolate group was P = 0.227) and tangential and axial corneal power showed no change during cycloplegia in either group. SimK showed no statistical significance. The ACD was deeper when using atropine than cyclopentolate. Corneal thickness remained unchanged during cycloplegia in both groups. Pupil diameter was larger in light-colored irides in the cyclopentolate group than the atropine group. There was no change in W to W before (P = 0.473) and during cycloplegia (P = 0.287) in either group.
Our results suggest that usage of atropine or cyclopentolate does not alter corneal shape.
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The Change in Ocular Refractive Components After Cycloplegia in Children

Abstract

Introduction

Section snippets

Subjects

Results

Discussion

Am J Ophthmol

Am J Ophthalmol

Ophthalmology

Myopia

Measurement and analysis for juvenile myopia

Ophthalmol CHN

Role of the cornea in emmetropia and myopia

Optom Vis Sci

A comparative analysis of student myopia

Chin J Opt Ophthalmol

Myopia and educational attainment in 421,116 young Singaporean males

Ann Acad Med Singapore

Myopia and eye enlargement after neonatal lid fusion in monkeys

Nature