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Purpose: To compare pupil dynamics after using premixed intracameral anesthetic mydriatic combination (ICAM) of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) versus topical mydriatic (TM) drops consisting of tropicamide 0.8%, phenylephrine 5%, and cyclopentolate 0.5% in pediatric cataract surgery., Design: Randomized, masked, fellow eye-controlled trial., Setting: Tertiary eye care facility., Study Population: Children ≤12 years of age with bilateral cataracts planned for surgery. One eye was randomized to receive ICAM and the other eye (control) TM drops., Intervention: Commercially available ICAM that was injected at the beginning of surgery or TM 3 times at an interval of 30 minutes, 1 hour before the scheduled time of surgery. The other treatment was administered for the second eye cataract surgery., Main Outcome Measure: Pupil dynamics at various points of surgery were studied by a masked observer., Results: Sixty-three patients (126 eyes) were randomized to receive ICAM in 1 eye (group 1) or TM drops (group 2). The mean age of the children in the study was 15.7 ± 24.3 months (range 3 months to 5 years). Adequate mydriasis with a single injection was achieved in 93.5% of patients in group 1 and 88.8% of patients in group 2 without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.78 mm to 5.1 mm after injection of 1 unit of ICAM and from 1.75 mm to 6.06 mm with TM drops (P < .0001). The maximum pupillary dilation achieved was 6.06 ± 1.17 mm in group 1 and 6.75 ± 1.07 mm in group 2 (P = .004). The average change in pupillary size from injection of drug until the end of surgery was positive in group 1 (0.75 ± 0.98 mm) and negative in group 2 (-0.3348 ± 2.57 mm), ie, there was a relative miosis in group 2 toward the end of surgery (P = .001)., Conclusions: Topical drugs achieved a larger maximum pupil size compared with ICAM. However, ICAM provided adequate and stable mydriasis without the need for augmentation compared with topical drops in children undergoing cataract surgery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the impact of pharmacologic pupil dilation on axial length (AL) measurement in patients with dense cataracts and previous failed AL measurements carried out without pupil dilation., Design: Retrospective case series., Methods: All participants underwent swept-source optical coherence tomography (SS-OCT) biometry. Patients with unsuccessful AL measurements due to dense cataract underwent an additional SS-OCT biometric evaluation after pupil dilation, and the SS-OCT AL measurement was compared to the immersion ultrasound., Results: The study included 3668 eyes of 3668 patients who underwent SS-OCT between October 2021 and March 2023. Of them, 102 eyes (2.8%) had failed AL measurements because of dense cataract. Eighty-seven of those 102 eyes underwent a repeat SS-OCT biometric exam following pharmacologic pupil dilation, after which AL measurements were successfully achieved in 27 (31.0%) of the 87 eyes. These measurements were found to be consistent with immersion ultrasound, supporting the validity of SS-OCT biometer measurements post dilation., Conclusions: Pharmacologic pupil dilation improved the rate of successful SS-OCT biometrically measured AL in patients with failed AL measurement due to dense cataract., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: The study aims to compare morphology and location of crystalline lens between acute acquired concomitant esotropia (AACE) patients and control subjects, both before and after cycloplegia., Methods: This is a prospective and observational clinical study. Morphological and locational parameters of the crystalline lens in 53 AACE patients and 32 control subjects were assessed before and after cycloplegia using CASIA2 system, which represents the latest swept-source anterior segment optical coherence tomography. Cycloplegic refraction was recorded by administering 1% atropine in patients younger than 12 years and 1% cyclopentolate in those > 12 years old. Morphological parameters included anterior radius of curvature (ARC), posterior radius of curvature (PRC), lens thickness (LTH), and equivalent diameter of lens (LED). Locational parameters comprised lens decentration (LD) and lens tilt (LT). Comparison of these parameters before and after cycloplegia were conducted between AACE and controls. Additionally, the study analyzed and compared the changes in these parameter post-cycloplegia., Results: Our findings suggest no significant difference in morphological parameters including ARC, PRC, LTH and LED between AACE patients and controls before or after cycloplegia. However, 2D-modeling data in the 0° meridian revealed that variation post-cycloplegia of LD (lens shift) in right eyes was different in AACE patients, measuring - 0.03(0.08) [median(interquartile range)] which was significantly distinct from the control group, exhibiting a measurement of 0.01(0.06) (z =  - 2.373, p = 0.018). In left eyes, a similar trend was observed with lens shift in the 0° meridian being 0.02(0.06) in AACE, significantly differing from control group's measurement of - 0.02(0.08) (z =  - 2.809, p = 0.005). Further, correlation analysis revealed that larger temporal shift of lens was associated with greater changes in ARC (r = 0.294, p = 0.006) and LTH (r =  - 0.230, p = 0.031)., Conclusions: The morphological features of the crystalline lens were similar in AACE patients and controls; however, the change of lens location by cycloplegia was observed only in AACE patients, suggesting an association with excessive accommodation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery., Methods: Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied., Results: We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month-11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection., Conclusion: Fixed-dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To assess over 2 weeks, the effect of 3 different low concentrations of atropine on pupillary diameter and accommodative amplitude in children with myopia. Methods: Fifty-eight children with myopia [spherical equivalent (SE) of -0.50 diopters (D) or worse, astigmatism of less than or equal to 2.00 D] were randomly allocated to 3 groups receiving 0.01%, 0.02%, or 0.03% atropine eye drops, once nightly for 2 weeks. The primary outcome was the change from baseline in pupillary diameter and accommodative amplitude with each of the concentrations. Results: Fifty-seven participants (114 eyes), aged between 6 and 12 years, completed the 2-week trial (mean age 9.3 ± 1.7 years and mean SE -3.53 ± 1.79 D). After 2 weeks of use, all the 3 concentrations were found to have a statistically significant effect on both the pupillary diameter and accommodative amplitude. Accommodative amplitude reduced by an average of 5.23 D, 9.28 D, and 9.32 D, and photopic pupil size increased by an average of 0.95 ± 1.05 mm, 1.65 ± 0.93 mm, and 2.16 ± 0.88 mm with 0.01%, 0.02%, and 0.03%, respectively. Of the eyes, a total of 5.3% and 5.9% of the eyes on 0.02% and 0.03% atropine had a mean residual accommodative amplitude of <5 D. The percentage of eyes having a pupillary dilation >3 mm were 4.8%, 10.5%, and 23.5% for 0.01%, 0.02%, and 0.03% atropine, respectively. Conclusions: Low-dose atropine had an effect on pupillary diameter and accommodative amplitude. With the highest concentration assessed, that is, 0.03% nearly 1 of 4 eyes had pupillary dilation of >3 mm. Clinical Trial Registration number: NCT03699423.

Purpose: This study investigates the relationship between pupil size during biometry examinations and the chord mu value in candidates for cataract surgery., Methods: Retrospective analysis of ocular biometry measurements was performed on consecutive cataract surgery candidates above 50 years of age, examined between 2018 and 2020 at a single tertiary referral center. Statistical analysis assessed the association between pupil size and the chord mu value. The population was categorized into groups based on pupil size, and an analysis was conducted on the barycenter positions of the iris and pupil center for each group., Results: The analysis included 2877 patients. A weak positive correlation was observed between the chord mu value and pupil size using Pearson's test ( r  = 0.160, p  < 0.01). Group stratification by pupil size indicated temporal and inferior shifts in pupil center barycenter as pupil size increased, reflecting asymmetrical pupil dilation during mydriasis. A moderate positive correlation between the chord mu value and chord alpha value was identified (Pearson's test, r  = 0.641, p  < 0.01). As expected, no correlation was found between chord alpha value and pupil size., Conclusions: Chord mu values were higher in patients with mydriatic pupils, likely due to asymmetric pupil dilation and center displacement. Evaluating chord mu values requires considering pupil status and conducting biometry under standardized lighting to prevent misinterpretation caused by pharmacological dilation. This caution is crucial to avoid erroneously excluding eligible patients from multifocal IOL implants. Alternatively, the chord alpha value could serve as a more appropriate alternative in such scenarios., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The aim of this study was to evaluate the efficacy of intracameral administration of Mydrane® in children undergoing lens surgery., Methods: We set up a single center prospective cohort trial including 40 consecutive patients between 8 weeks and 17 years old who were planned for lens surgery, including cataract, persistent fetal vasculature or lens subluxation. We injected 0.1 mL of intracameral Mydrane at the beginning of surgery, no preoperative mydriatic eye drops were used. The aim of the study was to measure pupil size and to monitor the evolution of the pupil size during surgery and the need for additional pupil expanding techniques., Results: In 30 patients (75% [95% CI: 59-87%]), we did not need additional manipulations to obtain sufficient pupillary dilatation to perform the surgery and to implant an intraocular lens following the bag-in-the-lens (BIL) technique. In the remaining 10 patients (25%), we saw an initiation of dilatation but not to the required pupil diameter to continue the surgery without additional surgical maneuvers. The duration of surgery was significantly longer in the partial response group, reflecting the need for additional surgical steps. A significant relation between increase of pupillary diameter and age (p = 0.003), gender (p = 0.032), and horizontal corneal diameter (p < 0.001) could be shown. Even at baseline, there is a larger pupil diameter in eyes with larger horizontal corneal diameters (p = 0.039). No adverse events were observed during this study., Conclusion: Intracameral administration of Mydrane resulted in some degree of dilatation in all eyes in this series, 75% of eyes did not need additional techniques to proceed with the surgery. Smaller pupils at baseline, younger age, male sex and small horizontal corneal diameter were related to a poorer response to Mydrane. The mydriasis persisted for the entire duration of the surgery, no ocular adverse events were observed during this study. This leads us to conclude that intracameral Mydrane is an effective and safe way to dilate the pupil in pediatric lens surgery., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Purpose: To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil size compared to tropicamide and proparacaine during diagnostic eye examination. Methods: Sixty-three adult patients at Washington University School of Medicine Eye Clinic were enrolled in this prospective, randomized trial. Each patient received one of two dilating drop regimens: phenylephrine + tropicamide + proparacaine (PE+T+PP), which is considered the standard therapy, or tropicamide + proparacaine (T+PP). Main outcome measures were the proportion of pupils able to achieve successful clinical examination without need for additional dilating drops and change in predilation to postdilation pupil size. Comparisons were made using McNemar's test, repeated measures analysis of variance, and Fisher's test to determine whether PE is a necessary component of the standard eye examination. Results: There were no statistically significant differences between the PE+T+PP and T+PE treatment groups in predilation to postdilation changes in average resting pupil size (1.58 ± 0.66 and 2.61 ± 0.79; P  = 0.57) or constricted pupil size (2.52 ± 0.93 and 3.56 ± 0.96; P  = 0.15). There was no statistically significant difference between patients who obtained a successful dilated pupil examination between those receiving PE+T+PP and those receiving T+PP as determined by the examining physicians (Fisher's, P  = 0.67). Conclusion: The addition of phenylephrine to tropicamide and proparacaine did not improve pupillary dilation size or ability to conduct a clinical examination. A single dilating agent using tropicamide should be considered in clinical practice.

Background: Cataract surgery is one of the most common surgical procedures performed worldwide. Achieving appropriate intraoperative mydriasis is one of the critical factors associated with the safety and performance of the surgery. Inadequate pupillary dilation or constriction of the pupil during cataract surgery can impair the surgeon's field of view and make it difficult to maneuver instruments., Objectives: To evaluate the relative effectiveness of achieving pupillary dilation during phacoemulsification for cataract extraction using three methods of pupillary dilation: topical mydriatics, intracameral mydriatics, or depot delivery systems. We also planned to document and compare the risk of intraoperative and postoperative complications following phacoemulsification for cataract extraction, as well as the cost-effectiveness of these methods for pupillary dilation., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 1); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 22 January 2021., Selection Criteria: We included only randomized controlled trial (RCTs) in which participants underwent phacoemulsification for cataract extraction., Data Collection and Analysis: We followed standard Cochrane methodology., Main Results: We included a total of 14 RCTs (1670 eyes of 1652 participants) in this review. Of the 14 trials, 7 compared topical versus intracameral mydriatics, 6 compared topical mydriatics versus depot delivery systems, and 1 compared all three methods. We were unable to calculate overall estimates of comparative effectiveness for most outcomes due to statistical heterogeneity among the estimates from individual studies or because outcome data were available from only a single study. Furthermore, the certainty of evidence for most outcomes was low or very low, due primarily to imprecision and risk of bias. Comparison 1: topical mydriatics versus intracameral mydriatics Four RCTs (739 participants, 757 eyes) of the 8 RCTs that had compared these two methods reported mean pupillary diameters at the time surgeons had performed capsulorhexis; all favored topical mydriatics, but heterogeneity was high (I 2 = 95%). After omitting 1 RCT that used a paired-eyes design, evidence from three RCTs (721 participants and eyes) suggests that mean pupil diameter at the time of capsulorhexis may be greater with topical mydriatics than with intracameral mydriatics, but the evidence is of low certainty (mean difference 1.06 mm, 95% confidence interval (CI) 0.81 mm to 1.31 mm; I 2 = 49%). Four RCTs (224 participants, 242 eyes) reported mean pupillary diameter at the beginning of cataract surgery; the effect estimates from all trials favored topical mydriatics, with very low-certainty evidence. Five RCTs (799 participants, 817 eyes) reported mean pupillary diameter at the end of cataract surgery. Data for this outcome from the largest RCT (549 participants and eyes) provided evidence of a small difference in favor of intracameral mydriasis. On the other hand, 2 small RCTs (78 participants, 96 eyes) favored topical mydriatics, and the remaining 2 RCTs (172 participants) found no meaningful difference between the two methods, with very low-certainty evidence. Five RCTs (799 participants, 817 eyes) reported total intraoperative surgical time. The largest RCT (549 participants and eyes) reported decreased total intraoperative time with intracameral mydriatics, whereas 1 RCT (18 participants, 36 eyes) favored topical mydriatics, and the remaining 3 RCTs (232 participants) found no difference between the two methods, with very low-certainty evidence. Comparison 2: topical mydriatics versus depot delivery systems Of the 7 RCTs that compared these two methods, none reported mean pupillary diameter at the time surgeons performed capsulorhexis. Six RCTs (434 participants) reported mean pupillary diameter at the beginning of cataract surgery. After omitting 1 RCT suspected to be responsible for high heterogeneity (I 2 = 80%), meta-analysis of the other 5 RCTs (324 participants and eyes) found no evidence of a meaningful difference between the two methods, with very low-certainty evidence. Three RCTs (210 participants) reported mean pupillary diameter at the end of cataract surgery, with high heterogeneity among effect estimates for this outcome. Estimates of mean differences and confidence intervals from these three RCTs were consistent with no difference between the two methods. A fourth RCT reported only means for this outcome, with low-certainty evidence. Two small RCTs (118 participants) reported total intraoperative time. Surgical times were lower when depot delivery was used, but the confidence interval estimated from one trial was consistent with no difference, and only mean times were reported from the other trial, with very low-certainty evidence. Comparison 3: Intracameral mydriatics versus depot delivery systems Only one RCT (60 participants) compared intracameral mydriatics versus depot delivery system. Mean pupillary diameter at the time the surgeon performed capsulorhexis, phacoemulsification time, and cost outcomes were not reported. Mean pupil diameter at the beginning and end of cataract surgery favored the depot delivery system, with very low-certainty evidence. Adverse events Evidence from one RCT (555 participants and eyes) comparing topical mydriatics versus intracameral mydriatics suggests that ocular discomfort may be greater with topical mydriatics than with intracameral mydriatics at one week (risk ratio (RR) 10.57, 95% CI 1.37 to 81.34) and one month (RR 2.51, 95% CI 1.36 to 4.65) after cataract surgery, with moderate-certainty evidence at both time points. Another RCT (30 participants) reported iris-related complications in 11 participants in the intracameral mydriatics group versus no complications in the depot delivery system group, with very low-certainty evidence. Cardiovascular related adverse events were rarely mentioned., Authors' Conclusions: Data from 14 completed RCTs were inadequate to establish the superiority of any of three methods to achieve mydriasis for cataract surgery, based on pupillary dilation at different times during the surgery or on time required for surgery. Only one trial had a sample size adequate to yield a robust effect estimate. Larger, well-designed trials are needed to provide robust estimates for the comparison of mydriasis approaches for beneficial and adverse effects., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Purpose of the Study: Macular pigment (MP), comprising the dietary carotenoids lutein, zeaxanthin and meso-zeaxanthin, is believed to benefit eye health and vision. Numerous clinical and research devices and techniques are currently available to facilitate MP optical density (MPOD) measurement. One of those techniques, dual-wavelength fundus autofluorescence (AF) is being increasingly used for measurement of MP in the eye. There is substantial methodological variation across the published studies that have employed this technique, including in relation to the use of mydriasis, the possible influence of which does not appear to have been addressed in the literature. This prospective cross-sectional study was designed to investigate the effect of mydriasis on MP measurement quality and MPOD values obtained with dual-wavelength AF using the Heidelberg Spectralis HRA+OCT device., Materials and Methods: Twenty-one healthy participants were recruited to the study. The mean age of participants was 44.8 years (± 14.63). Pupil size and MPOD were measured in one eye for each participant, initially under natural pupil conditions and subsequently 30 minutes following instillation of one drop of 0.5% tropicamide., Results: Despite providing MPOD measurements for the majority of undilated eyes (85.7% of eyes herein), pupillary dilation resulted in statistically significant changes in MPOD ( p < .001 for central eccentricities). Our results indicate that the changes in MPOD were not uniform across the spatial profile. Marked improvements were also observed in image quality post-dilation ( p < .002 for central eccentricities)., Conclusions: This study clearly demonstrates that dual-wavelength AF measurements of MPOD in the same eye vary as a function of pupillary dilation status, with MPOD under-estimated across the entire spatial profile of MP for natural relative to dilated pupillary conditions. Mydriasis should, therefore, be used routinely for MPOD measurements using dual wavelength AF, pupil size should be reported and image quality optimized in order to ensure accurate MPOD quantification.

Significance: After a dilated eye examination, many patients experience symptoms of prolonged light sensitivity, blurred vision, and cycloplegia associated with pharmacological mydriasis. Phentolamine mesylate ophthalmic solution (PMOS) may expedite the reversal of mydriasis in patients, potentially facilitating return to functional vision and reducing barriers to obtaining dilated eye examinations., Purpose: The protracted reversal time after pharmacologically induced pupil dilation impairs vision. We tested the hypothesis that PMOS rapidly reduces pupil diameter in this acute indication., Methods: In this double-masked placebo-controlled, randomized, two-arm crossover phase 2b trial, we evaluated the effects of one drop of 1% PMOS applied bilaterally in subjects who had their pupils dilated by one of two common mydriatic agents: 2.5% phenylephrine or 1% tropicamide. End points included change in pupil diameter, percent of subjects returning to baseline pupil diameter, and accommodative function at multiple time points., Results: Thirty-one subjects completed the study (15 dilated with phenylephrine and 16 with tropicamide). Change in pupil diameter from baseline at 2 hours after maximal dilation with 1% PMOS was -1.69 mm and was significantly greater in magnitude compared with placebo for every time point beyond 30 minutes (P < .05). At 2 hours, a greater percentage of study eyes given 1% PMOS returned to baseline pupil diameter compared with placebo (29 vs. 13%, P = .03), which was this also seen at 4 hours (P < .001). More subjects treated with PMOS in the tropicamide subgroup had at least one eye returning to baseline accommodative amplitude at 2 hours (63 vs. 38%, P = .01). There were no severe adverse events, with only mild to moderate conjunctival hyperemia that resolved in most patients by 6 hours., Conclusions: Phentolamine mesylate ophthalmic solution at 1% reversed medically induced pupil dilation more rapidly than placebo treatment regardless of which mydriatic was used (adrenergic agonists and cholinergic blockers) with a tolerable safety profile., Competing Interests: Conflict of Interest Disclosure: The publication of this article was sponsored by Ocuphire Pharma, Inc. ARM, MPS, RMJ, KC, JEY, SAK, and ATA are or were employees, directors/officers, or paid consultants for Ocuphire Pharma. PMK, MBM, ESL, JSP, and GDH are on the medical advisory board for Ocuphire Pharma. PMK, SAF, SMM, and SRK were principal investigators for this clinical trial funded by Ocuphire Pharma. CBS serves as Chief Medical Officer of Oculos Development Services, LLC, which was the contract research organization for this clinical trial. The authors indicated that they have no other conflicts of interest with regard to the content of this article. The authors listed report a financial conflict of interest (PMK, SAF, SMM, SRK, CBS, ARM, MPS, RMJ, KC, JEY, SAK, ATA, MBM, GDH, ESL, and JSP). The sponsor (Ocuphire) provided financial and material support and participated in study design, analysis, and interpretation. The authors were responsible for the preparation of this article and the decision to submit this article for publication. Each of the authors had (full/limited) access to the study data and takes full responsibility for their presentation in this article., (Copyright © 2021 American Academy of Optometry.)

Purpose: To determine the frequency, symptoms and risk factors for adverse reactions to two-times instillation of 1% cyclopentolate in children., Study Design: Prospective, observational study., Methods: The subjects were 646 patients who underwent cycloplegic refraction with cyclopentolate (mean age; 7.0 ± 3.5 years, age range; 0-15 years). Five minutes after instillation of 0.4% oxybuprocaine hydrochloride, a 1% cyclopentolate eye drop was instilled twice, with an interval of 10 min. Fifty minutes later, two certified orthoptists evaluated adverse reactions using a questionnaire and interviewed the patients' guardians. The relationship between the adverse reaction rates and age, gender, additional instillation, complications of the central nervous system (CNS), time of day and season were analysed using binominal and polytomous logistic regression models., Results: The overall frequency of adverse reactions was 18.3% (118/646 patients). The main symptoms included conjunctival injection (10.5%, 68/646), drowsiness (6.8%, 44/646) and facial flush (2.2%, 14/646). The odds ratio (OR) of conjunctival injection increased with patient's age (p < 0.05), in boys (p < 0.01) and in winter (p < 0.001). In contrast, the OR of drowsiness decreased with age (p < 0.001). Facial flush was observed mostly in children younger than 4 years. CNS complications were not a significant risk factor for any of the symptoms., Conclusions: Adverse reactions to 1% cyclopentolate eye drops were more frequent than previously expected, but all were mild and transient. The probability of each symptom was associated with a clear age-specific trend., (© 2020 The Authors Ophthalmic and Physiological Optics © 2020 The College of Optometrists.)

Purpose: To evaluate the effect of Mydrane (contains tropicamide, phenylephrine hydrochloride, and lidocaine hydrochloride) on time needed to induce mydriasis and mydriasis stability during cataract surgery. Methods: This was an observational, non-interventional, multicenter study of patients undergoing cataract surgery who received Mydrane for mydriasis and intraocular anesthesia. The study was conducted at seven ophthalmology departments at university hospitals in Poland. Patients admitted for cataract surgery within a 2-week period were asked to participate in the study. Patients whose pupils dilated to a diameter ≥6 mm after topical mydriatic administration during preoperative examinations were scheduled to receive Mydrane and included in the registry. No additional inclusion criteria were used. Patients' medical histories, examination results, and operative details were recorded. Pupil diameter was measured during surgery. Surgeons were asked to complete a Likert-based survey in parallel. Results: A total of 307 patients were enrolled. The mean pupil diameter was 7.0 ± 1.0 mm before capsulorhexis and 6.9 ± 1.2 mm before lens implementation. A pupil diameter ≥6 mm was achieved in 91.9% and 87.6% of patients before capsulorhexis and lens implantation, respectively. We asked 58 surgeons whether they agreed with the statement "Mydriasis was obtained in a short time after the administration of Mydrane"; the surgeons agreed with this statement after 92.2% (283/307) of surgeries. In addition, after 88.2% of surgeries, the surgeons agreed with the statement "Mydriasis was stable after the administration of Mydrane." Conclusions: Mydriasis was rapidly and stably obtained after Mydrane injection, as demonstrated by pupil diameter measurements during surgery and surgeons' feedback.

PRéCIS:: Small but significant decreases in optical coherence tomography angiography (OCTA)-measured circumpapillary capillary density (cpCD) were observed in healthy eyes dilated with 2.5% phenylephrine/0.5% tropicamide. Although likely clinically insignificant, ophthalmologists should consider these changes when interpreting OCTA results from dilated eyes., Purpose: The purpose of this study was to investigate the effect of pupil dilation using 2.5% phenylephrine and 0.5% tropicamide on quantitative assessment of retinal microvasculature using OCTA., Methods: OptoVue AngioVue high density (HD) and non-HD OCTA macula and optic nerve head (ONH) images were obtained at 15-minute intervals predilation and postdilation in 26 healthy participants (mean age: 40.0; 95% confidence interval=33.9, 46.1 y). Superficial macular vessel density (VD) was measured in the whole image VD and the parafoveal region VD. ONH capillary density was measured in the whole image capillary density and the cpCD region. Differences between predilation and postdilation densities were assessed using linear mixed effects models to account for within-patient correlation., Results: Instillation of dilating drops resulted in a small but statistically significant reduction in non-HD ONH whole image capillary density of 0.6%, from a mean of 45.2% (95% confidence interval=41.9%, 48.4%) to 44.6% (41.4%, 47.8%) (P=0.046). A similar reduction in non-HD ONH cpCD of 0.8% also was observed, from a mean of 49.3% (45.3%, 53.3%) to 48.5% (44.5%, 52.4%) (P=0.025). No postdilation decreases in macular VD or HD ONH capillary density were observed., Conclusions: Pupil dilation using topical 2.5% phenylephrine and 0.5% tropicamide results in a small but statistically significant reduction in non-HD ONH whole image and cpCD in healthy eyes. The observed reduction likely is not clinically significant because the observed reduction was within the previously reported range of measurement variability. Further studies should consider investigating these effects in nonhealthy eyes with glaucoma and media opacities, as well as older individuals.

Purpose: To evaluate the efficacy and tolerability of cyclopentolate 1% administered as a spray in pediatric patients between 3 and 6 years old., Methods: In this prospective, randomized, parallel group study, healthy volunteers were randomly assigned to receive cyclopentolate 1% as a single drop or a single puff into closed eyes., Results: There were 61 patients included in the study; 31 received cyclopentolate 1% as drops and 30 received cyclopentolate 1% as spray. The mean age at presentation was 4.5 ± 1.07 years (range: 3 to 6 years) and 4.2 ± 1.06 years (range: 3 to 6 years) in the drops and spray groups, respectively. The distress level was significantly lower at the time of receiving cyclopentolate as a spray (P < .0001), with the exception of patients aged 6 years. There were no significant differences in pupil diameter between the two groups (P = .51), whereas 5 of 30 patients (16.6%) with dark irises who received cyclopentolate spray did not have adequate cycloplegia to allow for accurate refraction., Conclusions: Cycloplegia achieved with cyclopentolate 1% administered as a spray may be an option in uncooperative children because it is less distressing compared to cyclopentolate 1% drops. However, physicians should be aware that cycloplegia obtained is only partially effective in children with dark irises. [J Pediatr Ophthalmol Strabismus. 2020;57(5):301-304.]., (Copyright 2020, SLACK Incorporated.)

The purpose of this study was to investigate the effects of pupil diameter on canine visual evoked potentials with pattern stimulation (P-VEP). Atropine eye drop (1.0%) was applied to both eyes as a cycloplegic drug, and tafluprost eye drop (0.015%) was applied to one eye that was selected randomly for miosis (miosis group). The other eye did not receive tafluprost (mydriasis group). P-VEP was recorded at three pattern sizes. The P100 implicit time at a small pattern size in the mydriasis group was significantly prolonged compared to the miosis group. We hypothesized that the prolonged P100 implicit time under mydriatic conditions was due to increased spherical aberrations and concluded that mydriatic conditions affected P100 implicit time in canine P-VEP recordings.

Purpose: To determine the effect of atropine cycloplegia on the refractive status of children aged 4 to 10 years and to evaluate the necessity of cycloplegia for different refractive states and ages during refractive correction., Methods: This retrospective study included patients with low, moderate, and high myopia and hyperopia who were divided into two groups by age: 4 to 6 years (n = 5,320) and 7 to 10 years (n = 6,475). Every patient underwent cycloplegia with atropine sulphate. Refractive errors were measured by retinoscopy., Results: Within each group, the differences between cycloplegic and non-cycloplegic refractive errors (DIFF C-N ) were significant. DIFF C-N was negatively correlated with age (r = -0.356, P < .001). The differences in refractive error between prescribed glasses and non-cycloplegic refraction (DIFF G-N ) were largest in the groups with high myopia (0.83 ± 1.15 diopters [D] in the 4 to 6 years group and 0.60 ± 1.47 D in the 7 to 10 years group). After cycloplegia, 62.5% of the patients with mild myopia became emmetropic or hyperopic in the 4 to 6 years group, and 11.3% of the patients with mild myopia became emmetropic or hyperopic in the 7 to 10 years group., Conclusions: Without cycloplegia, autorefraction tends to overestimate refractive error in children with myopia. For accurate glasses prescriptions, cycloplegia should be used for children between 4 and 10 years, especially for children with high myopia. [J Pediatr Ophthalmol Strabismus. 2020;57(4):257-263.]., (Copyright 2020, SLACK Incorporated.)

Significance: It is apparent that a variety of biometric changes are caused by different types of cycloplegic eye drops. However, these effects are inconsistent and have not been reported in different refractive groups., Purpose: The purpose of this study was to determine the effect of cyclopentolate 1% on ocular biometric components in different types of refractive errors in children., Methods: This cross-sectional study was conducted on 226 eyes of 113 schoolchildren in Shahroud, northeast Iran, with a mean ± standard deviation age of 9.20 ± 1.65 years. All participants had noncycloplegic and cycloplegic objective refraction using an autorefractometer. Cycloplegia was induced using cyclopentolate 1% eye drops. Biometric measurements were made with Allegro Biograph (WaveLight AG, Erlangen, Germany) before and after administering cycloplegic drops. Mixed-effect model regression was used to analyze the data., Results: After cycloplegia, the vitreous chamber depth (VCD) (-0.043; 95% confidence interval [CI], -0.067 to -0.019 mm), lens thickness (-0.146; 95% CI, -0.175 to -0.117 mm), axial length (-0.009; 95% CI, -0.012 to -0.006 mm), and lens power (-0.335; 95% CI, -0.463 to -0.208 D) decreased significantly, whereas the anterior chamber depth (ACD) (0.183; 95% CI, 0.164 to 0.202 mm), anterior segment length (0.036; 95% CI, 0.014 to 0.058) mm), lens central point (0.109; 95% CI, 0.094 to 0.124 mm), and pupil diameter (1.599; 95% CI, 1.482 to 1.716 mm) increased (P value for all tests, <.001). For changes in VCD and ACD, a significant interaction was observed between different types of refractive errors and cycloplegia, such that the adjusted mean change for ACD was significantly lower and for VCD was significantly higher in hyperopes compared with emmetropes. Lens center moves backward in myopes (0.17 mm) and stays the same in hyperopes under cycloplegia., Conclusions: According to the findings of this study, cycloplegia reduces the thickness of the crystalline lens and subsequently causes an increase in the ACD. Cycloplegia-related ocular biometric changes were different by type of refractive error.

Purpose: To compare the use of topical dilation drops vs topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times., Setting: Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA., Design: Retrospective chart review., Methods: Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical time, and costs in all patients and in patients with a history of tamsulosin use., Results: In the topical group, PEDs were used in 31.1% of cases compared with 13.5% of cases in the intracameral group (P < .0001). History of tamsulosin use was noted in about one third of cases in both groups. For patients with a history of tamsulosin use, PED use decreased from 52.7% in the topical cases to 17.9% in the intracameral group (P < .0001). Surgical times were on average 7.1 minutes slower with PED use than without PED use. There was a medication savings of $50.44 USD per case in the intracameral group compared with the topical group. Factoring in the $100 to $130 USD per PED used, total surgical costs were $19 267 USD less in the intracameral group over 6 months., Conclusions: Intracameral epinephrine with lidocaine decreases the need for PED use during cataract surgery, lowers intraoperative costs, and improves efficiency compared with topical dilation drops alone.

Purpose: To study the pupillary system by combining mydriasis and multifocal pupillographic objective perimetry (mfPOP). In particular, we explored how the dynamics of recovery differ for concurrently measured direct and consensual sensitivity, response delay, and signal-to-noise ratios (SNRs) for binocular mydriasis., Methods: We recruited 26 normal participants, all with brown irides. The dichoptic mfPOP stimuli concurrently assessed 44-region/eye and both pupils. Two pre-dilation tests were followed by pairs of repeated tests at 1, 2, 4, 6, 8, 12, 24, and 48 h following dilation of both pupils with 1% tropicamide. Three subjects were retested with only the right pupil dilated. Linear models determined the independent effects of mydriasis upon the per-region and pupil measures over time., Results: Post-dilation, the per-region delays initially decreased by 16.3 ± 6.02 ms (mean ± SE) (p < 0.0001, cf. baseline of 471.1 ± 4.36 ms), then increased to slower than baseline by 17.42 ± 5.57 ms after 4 h (p < 0.002), recovering to baseline at 8 h. By comparison, per-region sensitivities (constriction amplitudes) were still reduced by - 6.20 ± 0.70 μm at 8 h (p < 0.0001, cf. baseline of 21.1 ± 0.55 μm), recovered at 24 h, but rebounded at 48 h (p = 0.005). The SNRs for sensitivities and delays both recovered by 8-12 h. Across all the data, sensitivities reduced by 2.67 ± 0.25 μm/decade of age, and delay increased by 15.4 ± 1.98 ms/decade (both p < 0.00001). Data from 3 of the 26 subjects who repeated the testing for monocular dilation found that consensual response sensitivities were larger than direct for 8 h (p < 0.018)., Conclusions: The per-region sensitivities were affected for longer than SNRs or delays. Strong early SNRs indicated proportionately lower pupil noise for larger pupil diameters. Following mydriasis with tropicamide 1%, the constriction amplitude measurements with mfPOP should be considered only after 48 h, but time-to-peak can be measured after 8-12 h.

Introduction: Cataract surgery is the most commonly performed surgery in the world, and its success depends in part on the quality of mydriasis., Purpose: To compare, for the same eye, the pupillary dilation obtained with Mydrane® (standardized intracameral solution of 0.02% tropicamide, combined with 0.31% phenylephrine and 1% lidocaine) intraoperatively versus Mydriasert® (0.28mg tropicamide insert and 5.4mg phenylephrine) with a contact time between 45 and 60 minutes in the preoperative period., Methods: Single center prospective study from November 2016 to January 2018 at the Laveran Army Instructional Hospital in Marseille. Patients referred for surgery were dilated at the preoperative consultation with Mydriasert®. The pupillary diameter after 45-60 minutes of contact with the insert was manually measured, by two different examiners, through the "iris image" tab of the Pentacam® elevation topography. Patients were dilated on the day of their cataract surgery with 0.2cc of Mydrane® injected in the anterior chamber through a paracentesis. Thirty seconds later, prior to injection of viscoelastic, an eye photograph was taken by screen capture. The pupillary diameter was evaluated by two different examiners with to the Piximeter 5.9 metrology software. The difference in pupil dilation between Mydriasert® and Mydrane® was tested with the paired series Student t-test., Results: In total, 111 eyes of 82 patients were included. Mydriasert® achieved a mean pupillary dilation of 7.21±0.79mm. The mydriasis obtained with Mydrane® averaged 6.35±0.8mm. This difference of 0.86mm was statistically significant (P<0.001) with a confidence interval of 95% [-0.97; -0.74]., Conclusion: On average, Mydrane® dilates the pupil less than Mydriasert®. However, the mydriasis obtained with Mydrane® remains comfortable for the performance of the capsulorhexis. It helps save preoperative time and affords additional anesthetic to the cataract surgery. Nevertheless, the use of Mydriasert® is beneficial when extra mydriasis is required., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Purpose: To identify the characteristics that are associated with adherence to annual diabetic eye exams and patient awareness of retinopathy using a nationally representative sample from the United States., Design: Cross-sectional, secondary analysis., Participants: National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2016 aged 20 years and older with diabetes mellitus., Methods: The NHANES collected surveys every 2 years from 2005 to 2016, which contained demographic information, clinical information, and time to last dilated eye exam. From 2005 to 2008, retinal photographs were taken of all participants older than 40 years of age. We used univariate and multivariable logistic regression to determine the demographic and clinical factors associated with adherence to annual diabetic eye examinations and those associated with correctly reporting their retinopathy status., Main Outcome Measure: Factors associated with adherence defined as having an eye exam within the preceding 12 or 24 months., Results: From 2005 to 2016, NHANES surveyed 4072 individuals who represent 20 million Americans aged 20 years and older with self-report of diabetes. By using the adherence definitions of 12 and 24 months, 63.4% and 78.7%, respectively, were adherent to diabetic eye examinations. The nonadherence rates of 36.6% and 21.3% for this national estimate did not change from 2005 to 2016 (P = 0.7, logistic regression). Insurance status, age, education, income, cholesterol levels, duration of diabetes, and self-reported retinopathy were all significantly associated with adherence with both definitions (all P < 0.05, logistic regression). Insurance status had the highest predictive value, with 76% of Americans on combination private-public insurance adherent compared with 36% of uninsured. Most Americans with retinopathy incorrectly denied having the diagnosis (2 727 144/3 896 093 or 70%)., Conclusions: Multiple variables were associated with nonadherence to eye exams, with insurance status having the strongest association. Adherence with annual eye exams has not improved over the past decade. The majority of patients with retinopathy are unaware of this diagnosis, including the majority of those with a dilated funduscopic examination in the past year. Further improvements in education and adherence may reduce the visual morbidity caused by diabetes., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Significance: Increasing prevalence of refractive error requires assessment of ametropia as a screening tool in children. If cycloplegia is not an option, knowledge about the increase in uncertainty for wavefront-based autorefraction is needed. The cycloplegic agent as the principal variant presents cross-reference and allows for extraction of the influence of accommodation., Purpose: The purpose of this study was to determine the repeatability, agreement, and propensity to accommodate of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront-based autorefraction (ZEISS i.Profiler plus; Carl Zeiss Vision, Aalen, Germany) in children aged 2 to 15 years., Methods: In a clinical setting, three consecutive measurements were feasible for 145 eyes (OD) under both conditions. Data are described by spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45). In the case of M, the most positive value of the three measurements was chosen, whereas the mean was applied for astigmatic components., Results: Regarding agreement, differences for ARc minus ARnc were statistically significant: for M, 0.55 (0.55 D; mean [SD]; P < .001), that is, more hyperopic in cycloplegia; for J0, -0.03 (0.11 D; P = .002); and for J45, -0.03 D (SD, 0.09 D; P < .001). Regarding repeatability, astigmatic components showed excellent repeatability: SD < 0.11 D (ARnc) and SD < 0.09 D (ARc). The repeatability of M was SD = 0.57 D with a 95% interval of 1.49 D (ARnc). Under cycloplegia, this decreased to SD = 0.17 D (ARc) with a 95% interval of 0.50 D. The mean propensity to accommodate was 0.44 D from repeated measurements; in cycloplegia, this was reduced to 0.19 D., Conclusions: Wavefront-based refraction measurement results are highly repeatable and precise for astigmatic components. Noncycloplegic measurements of M show a systematic bias of 0.55 D. Cycloplegia reduces the propensity to accommodate by a factor of 2.4; for noncycloplegic repeated measurements, accommodation is controlled to a total interval of 1.49 D (95%). Without cycloplegia, results improve drastically when measurements are repeated.

Introduction: Cataract surgery is the most commonly performed surgery in the world, and its success depends in part on the quality of mydriasis., Purpose: To compare, for the same eye, the pupillary dilation obtained with Mydrane® (standardized intracameral solution of 0.02% tropicamide, combined with 0.31% phenylephrine and 1% lidocaine) intraoperatively versus Mydriasert® (0.28mg tropicamide insert and 5.4mg phenylephrine) with a contact time between 45 and 60 minutes in the preoperative period., Methods: Single center prospective study from November 2016 to January 2018 at the Laveran Army Instructional Hospital in Marseille. Patients referred for surgery were dilated at the preoperative consultation with Mydriasert®. The pupillary diameter after 45-60 minutes of contact with the insert was manually measured, by two different examiners, through the "iris image" tab of the Pentacam® elevation topography. Patients were dilated on the day of their cataract surgery with 0.2cc of Mydrane® injected in the anterior chamber through a paracentesis. Thirty seconds later, prior to injection of viscoelastic, an eye photograph was taken by screen capture. The pupillary diameter was evaluated by two different examiners with to the Piximeter 5.9 metrology software. The difference in pupil dilation between Mydriasert® and Mydrane® was tested with the paired series Student t-test., Results: A hundred and eleven eyes of 82 patients were included. Mydriasert® achieved a mean pupillary dilation of 7.21±0.79mm. The mydriasis obtained with Mydrane® averaged 6.35±0.8mm. This difference of 0.86mm was statistically significant (P<0.001) with a confidence interval of 95% [-0.97; -0.74]., Conclusion: On average, Mydrane® dilates the pupil less than Mydriasert®. However, the mydriasis obtained with Mydrane® remains comfortable for the performance of the capsulorhexis. It helps save preoperative time and affords additional anesthetic to the cataract surgery. Nevertheless, the use of Mydriasert® is beneficial when extra mydriasis is required., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: To evaluate the effect of pupil dilation obtained with cyclopentolate on biometric measurements using swept-source optical coherence tomography biometry., Methods: This study involved 63 eyes of 63 healthy volunteers. After ophthalmic examination, biometry measurements of the participants were obtained with IOL Master 700 (Carl Zeiss Meditec AG, Jena, Germany). After pre-dilation measurements were taken, subjects were given one drop of cyclopentolate hydrochloride ophthalmic solution three times at 10-minute intervals. When cycloplegia had been achieved, a dilated fundus examination was conducted and post-dilation measurements were taken with IOL Master 700. The biometric parameters were recorded and SPSS Software 22.0 was used for statistical analysis., Results: There was a significant increase in anterior chamber depth, anterior aqueous depth and central corneal thickness values after pupil dilation (p < 0.05). A significant decrease was observed in lens thickness values after cycloplegia (p < 0.05). There were no statistically significant differences between pre-dilation and post-dilation axial length, keratometry (K1, K2) and white-to-white values (p > 0.05)., Conclusion: This study demonstrated there is no significant difference in axial length and keratometry measurements using swept-source optical coherence tomography biometry before and after cycloplegia., (© 2019 Optometry Australia.)

Importance: In improving clinical outcomes, developing a sustainable, transformative care delivery model is important for accessible, efficient, low-cost, high-quality community-based imaging and diagnosis of retinal diseases., Objective: To test the feasibility and accuracy of the remote diagnosis imaging model as a clinical screening tool to facilitate the identification of referable macular degeneration., Design, Setting, and Participants: A nonrandomized study of 159 patients was conducted in sites with a relatively high disease prevalence (Duke University Health System endocrinology clinic and 2 Duke University Health System assisted living centers in North Carolina). All patients underwent remote diagnosis imaging, defined as color fundus photography (CFP) and optical coherence tomography (OCT) of nondilated pupils, acquired by nonexpert imagers using a retinal imaging device located at the point of service. The criterion standard examination was defined as a traditional dilated eye examination performed by retinal specialists. Deidentified remote diagnosis images were graded for interpretability and presence of referable macular degeneration, defined as any condition requiring a retinal specialist attention. Data analysis was performed from November 20, 2015, to February 10, 2019., Main Outcomes and Measures: Primary outcome was feasibility of the remote retinal imaging. Secondary outcomes were operational characteristics and diagnostic and referral accuracy., Results: Of the 159 patients included in the study, the mean (SD) age of enrolled participants was 65 (17) years, with a female to male ratio of 1.3 to 1. Most patients were white (111 [69.8%]), 44 were black patients (27.7%), approximately 1% were Asian patients and Hispanic patients, and 2 patients declined to disclose their race/ethnicity. Thirty-five eyes (22.0%) were determined to require referral to the retinal specialist by criterion standard examination. Remote diagnosis image interpretability was better when OCT was used compared with CFP (241 [96.4%] vs 164 [65.6%]). Remote diagnosis had high diagnostic accuracy in identifying referable macular degeneration: OCT and CFP both had 94% sensitivity (95% CI, 84%-98%), and OCT had specificity higher than for CFP (93% [95% CI, 87%-96% ] vs 63% [95% CI, 53%-71%]). Substantial agreement was found between the criterion standard and OCT (κ = 0.83; 95% CI, 0.76-0.91; P < .001) and between the criterion standard and CFP (κ = 0.76; 95% CI, 0.64-0.87; P < .001). The nonvalidated patient satisfaction survey revealed that 122 participants (76.7%; mean score, 4.16; 95% CI, 3.98-4.35) preferred remote imaging over the standard care examination., Conclusions and Relevance: Remote diagnosis imaging and a standard examination by a retinal specialist appeared equivalent in identifying referable macular degeneration in patients with high disease prevalence; these results may assist in delivering timely treatment and seem to warrant future research into additional metrics.

Purpose: The aim of this study was to evaluate the factors affecting cycloplegia, as determined by pupil reactivity, in Asian children., Design: Prospective observational study., Methods: Two-hundred sixty-eight children, aged 2 to 12 years, requiring cycloplegic refraction, were recruited. Nurses instilled 2 to 3 cycles of eye drops consisting of cyclopentolate 1%, tropicamide 0.5%, and phenylephrine 2.5%, and recorded the child's level of cooperation. Optometrists recorded pupil reactivity after the last cycle. Multivariate analysis determined factors affecting pupil reactivity including age, sex, race, number of eye drop cycles, pupil sizes before and after cycloplegia, and child's cooperation during eye drops instillation., Results: The pupils in 36 children (13.4%) were found to be still reactive. On univariate analysis, children with reactive pupils also had smaller pupils after cycloplegia (6.27 ± 1.16 mm vs 7.42 ± 0.81 mm, P < 0.001). On multiple logistic regression analysis, for every 1-mm increase in the pupil size after cycloplegic eye drop administration, the odds of having reactive pupils decreases by 65% (odds ratio = 0.35, 95% confidence interval 0.25-0.51, P ≤ 0.001). Those who were uncooperative during administration of eye drops were 3.13 times more likely to have reactive pupils (95% confidence interval 1.21-8.13, P = 0.019), whereas age (P = 0.904), sex (P = 0.355), the number of cycles of eye drops (P = 0.462), and other psychological factors were not relevant in affecting pupil reactivity., Conclusions: Pupil reactivity, which was used as a measure of cycloplegia, was more likely to be affected by children's level of cooperation during instillation of eye drops, rather than age and sex. Two cycles of eye drops were as effective as 3 cycles in producing cycloplegia.

Purpose: 1. To evaluate the repeatability of macular pigment optical density (MPOD) measurements in non-mydriatic and mydriatic conditions with a single wavelength reflection photometry. 2. To compare the non-mydriatic measurement with the mydriatic measurement of MPOD values., Methods: Fifty-one healthy young subjects were recruited in this prospective study. MPOD parameters including maximum optical intensity (OD), mean OD, volume and area, were measured using a single 460-nm wavelength reflection method (Visucam 200, Carl Zeiss Meditec) twice both before and after pupil dilation. Paired t test, Pearson's correlation, intraclass correlation coefficient (ICC) and Bland-Altman plots were used to evaluate the agreement and correlation of MPOD parameters before and after mydriasis., Results: The differences of maximum OD, mean OD and volume between the two measurements without mydriasis was statistically significant for all parameters, but not significant between the two measurements with mydriasis or between non-mydriatic and mydriatic measures. The ICCs were higher for the two measurements with mydriasis (range: 0.687-0.840) than those without mydriasis (range: 0.448-0.695) or non-mydriatic and mydriatic measures (range: 0.473-0.769). The 95% limit of agreement (LOA) of measurements between the two measurements after mydriasis was the smallest among all the other comparisons. The coefficient of repeatability was lower for the measurements with mydriasis than those without mydriasis., Conclusions: MPOD measurement by Visucam 200 with mydriasis has higher repeatability than the measurement without mydriasis. The non-mydriatic and mydriatic measures had less agreement compared to the two measure after mydriasis. Therefore, mydriasis is recommended.

Background: Eye drop treatment routinely used to obtain mydriasis prior to fundoscopy in neonates requires repeated instillations of mydriatic agents that can lead to systemic side effects., Objectives: The aim of this study was to compare the mydriatic efficacy and tolerance of administration of phenylephrine and tropicamide via the ophthalmic insert Mydriasert® versus standard eye drop treatment in neonates., Methods: In this prospective, single-blinded, noninferiority study, 80 hospitalized neonates (age < 18 months) requiring bilateral fundus examination were randomized to receive eye drops (repeated instillations of 2.5% phenylephrine and 0.5% tropicamide) or the insert. The primary outcome was mydriasis suitable for fundoscopy 75 min after mydriatic agent introduction (T75)., Results: Mydriasis was successfully achieved in both eyes at T75 in 97.5% (n = 39/40) of the insert group patients versus 90% (n = 36/40) receiving eye drops (between-group difference 7.5%, demonstrating noninferiority). Mydriasis remained stable in 60.0% of patients (n = 24/40) in the insert group versus 15% (n = 6/40) in the eye drop group (p < 0.0001). The insert group required fewer nursing interventions than the eye drop group (p = 0.0001). Mean blood pressure were significantly higher in the insert versus the eye drop group (p < 0.0001 and p = 0.0003, respectively); mean heart rate was not significantly different between the groups (p = 0.37). In the insert group, 2 patients reported an adverse event (bradycardia, n = 1, and gastroesophageal reflux, n = 1; both appeared to be related to neonate pathology)., Conclusions: The degree of mydriasis achieved with Mydriasert® was noninferior to that obtained with eye drops. The insert appears to be safe to use in neonates without a history of increased vagal tone or gastrointestinal reflux., (© 2018 S. Karger AG, Basel.)

Objective: To assess changes in pupil size and intraocular pressure (IOP) following topical application of a 0.5% tropicamide solution in the eyes of healthy butorphanol-sedated dogs., Animals: 12 healthy adult Beagles., Procedures: In a randomized crossover study consisting of 2 treatment periods with a 1-week washout between periods, dogs received an IM injection of butorphanol (0.2 mg/kg) or an equal volume of sterile saline (0.9% NaCl) solution. For each dog, 1 drop of 0.5% tropicamide ophthalmic solution was topically instilled in one eye and 1 drop of artificial tear solution was topically instilled in the other eye 10 minutes after the IM injection and again 5 minutes later. Extent of sedation, pupil size, and IOP were evaluated from 20 minutes before to 80 minutes after the IM injection and compared among treatment combinations., Results: Butorphanol induced mild (n = 9) or moderate (3) sedation in all dogs and slightly delayed the onset of, but did not prevent, tropicamide-induced mydriasis. Butorphanol caused a significant increase in IOP, which was not exacerbated by tropicamide-induced mydriasis; however, that increase was generally not sufficient to exceed the upper limit of the IOP reference range., Conclusions and Clinical Relevance: Results indicated that butorphanol did not prevent tropicamide-induced mydriasis but did increase the IOP in ophthalmologically normal Beagles. Although the butorphanol-induced increase in IOP did not appear clinically relevant for the dogs of this study, that may not be true for dogs with glaucoma, and care should be taken when butorphanol is administered to such dogs.

Purpose: To determine if the RETeval system can be used for the screening of diabetic retinopathy (DR) to provide early diagnosis., Methods: The subjects were 42 diabetic patients selectively recruited by examination of their medical records to have varying severities of DR. The severity of DR was classified into four groups according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Full-field electroretinograms (ERG) without mydriasis were obtained by the DR assessment protocol of the RETeval system. Macular retinal nerve fiber layer (RNFL) thickness was measured by optical coherence tomography. We compared the DR assessment protocol results and the macular RNFL thickness among four groups. Moreover, an analysis was conducted on whether there was any correlation among the DR assessment protocol results, duration of diabetes mellitus, and RNFL thickness individually for each group of patients., Results: The mean ages and mean duration of diabetes mellitus of the four groups were similar. The DR assessment protocol results in the moderate-severe nonproliferative DR, and proliferative DR groups were significantly higher than those in the other groups (p < 0.001). The mean macular RNFL thickness was similar in all groups. No significant correlation was found between the DR assessment protocol results and duration of DM and the RNFL thickness., Conclusions: Our results suggest that the RETeval full-field ERG system can be used as an adjunctive tool for the mass screening of DR, while macular RNFL thickness would not be useful.

Aim: To compare sphere and cylinder refraction values using retinoscopy and autorefraction under cycloplegic conditions in children., Methods: This cross-sectional study was carried out using multistage cluster sampling. The target population was children aged 6-12 years in Shahroud, a northern city in Iran. Examinations included measurements of visual acuity, subjective refraction and objective refraction. Objective refraction was measured with and without cycloplegia with a retinoscope and an autorefractometer., Results: After applying the exclusion criteria, data from 5053 children were analysed. Spherical refraction results with autorefraction were significantly higher than results with retinoscopy (P<0.001). Refraction overestimation was significant in all age groups (P<0.0001). Comparison of differences in different spherical ametropia subgroups also showed a significant intermethod difference in all refractive states (P<0. 01). Overall, autorefraction tended to over plus hyperopics and under minus myopic cases compared with retinoscopy. The 95% limits of agreement for spherical values measured with the two techniques were -0.35 Diopter (D) to 0.50 D. The values of J 0 and J 45 vectors with autorefraction were significantly higher than those with retinoscopy (P<0.001). The 95% limits of agreement between the two methods for vectors J 0 and J 45 were -0.12 D to 0.15 D and -0.10 D to 0.11 D, respectively., Conclusion: Since the observed differences in spherical refraction and the cylindrical components obtained through retinoscopy and autorefraction are statistically significant, but clinically insignificant, and the two methods have a strong correlation and agreement, it can be concluded that autorefraction can be a suitable substitute for retinoscopy in children under cycloplegic conditions., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: A single eye drop containing 0.01% atropine every evening has previously been found to inhibit myopia progression in young adults. We have tested the short-term effects of very low-dose atropine eye drops on pupil sizes and accommodation in young adult subjects., Methods: Fourteen eyes of young adult subjects participated in the clinical observation. A single eye drop was applied with concentrations of either 0.01%, 0.005%, or 0.001% in the evening. Baseline parameters were measured before atropine application. Changes of pupil sizes, under photopic and mesopic conditions, as well as accommodation amplitudes were observed over the next day and analyzed by paired the Wilcoxon signed-rank test., Results: The pupil was significantly dilated 12 h after instillation of 0.01% atropine eye drops, both under photopic (3.3 ± 0.5 mm vs. 4.9 ± 0.9 mm) and mesopic (4.8 ± 0.7 mm vs. 6.1 ± 0.7 mm) conditions. Pupil sizes recovered over the day but were still significantly larger in the evening, compared to the baseline parameters measured on the day before (3.9 ± 0.5 mm vs. 5.3 ± 0.6 mm). The subjective near point of accommodation was reduced from 8.0 ± 2.4 to 6.6 ± 2.8 dpt in the morning and to 7.0 ± 2.9 dpt in the evening. At 0.005%, the pattern of results remained still similar, although the magnitude of the effects was generally smaller. At 0.001%, pupil sizes were still weakly significantly larger in the morning., Conclusions: At a dose of 0.01%, clinically significant short-term effects were detected on pupil size and accommodation for at least 24 h. At the lowest dose of 0.001%, only tiny effects on pupil size were detectable.

Purpose: To compare the pupil dynamics of an intracameral combination of 2 mydriatics and 1 anesthetic (Mydrane) to a standard topical regimen for cataract surgery., Setting: Sixty-two centers in Europe and 6 centers in Algeria., Design: Prospective case series., Methods: Pupil size measurements were performed in 2 randomized studies (phase 2 and phase 3) under masked conditions (recorded videography, masked reading center). The outcomes in the phase 2 study supported evaluation of the timeframe to obtain pupil dilation and the phase 3 study provided results on mydriasis stability., Results: Phase 2 and phase 3 comprised 139 patients and 591 patients, respectively. After intracameral combination administration, 95% of the pupil dilation was achieved within a mean of 28.6 seconds ± 4.6 (SD). At the beginning of capsulorhexis creation, the mean pupil diameter was larger than 7.0 mm in both groups. The intraoperative pupil diameter remained stable in the intracameral combination group and decreased in the topical group. The mean change in pupil size just before capsulorhexis to the end of surgery (just before cefuroxime injection) was -0.22 ± 0.72 mm and -1.67 ± 0.98 mm, respectively. No clinically significant change in pupil diameter (change <1.0 mm) occurred in the majority of the intracameral combination group (89.3%) compared with the topical group (26.8%)., Conclusions: Intracameral combination of 2 mydriatics and 1 anesthetic is an alternative to topical mydriatics for cataract surgery. The prompt onset of pupil dilation and the stable mydriasis induced by this drug combination improved the intraoperative conditions during crucial steps, such as intraocular lens implantation., (Copyright © 2018. Published by Elsevier Inc.)

The aim of the present paper was the development of semi-solid (hydrogels) and solid (film) ophthalmic formulations for the controlled release of two mydriatics: phenylephrine and tropicamide. The formulations - based on polyvinylalcohol and hyaluronic acid - were characterized, and release studies were performed with three different in vitro set-ups, i.e. Franz-type diffusion cell, vial method and inclined plane; for comparison, a solution and a commercial insert, both clinically used to induce mydriasis, were evaluated. Both gels and film allowed for a controlled release of drugs, appearing a useful alternative for mydriatics administration. However, the release kinetic was significantly influenced by the method used, highlighting the need for optimization and standardization of in vitro models for the evaluation of drug release from ophthalmic dosage forms.

Purpose: To study the time course (onset, time and duration of maximal cycloplegia, and the full duration) of cycloplegic action of 1% Cyclopentolate - 1% Tropicamide., Methods: Seventy-seven students, aged 15-24 years were purposively sampled from the University of Cape Coast and Cape Coast Technical Institute. Subjective near addition (ADD) determination and pupil diameter measurement before and after a drop of the test agent (1% Cyclopentolate - 1% Tropicamide combination in the right eye) and the control (1% Cyclopentolate in the left eye) were performed. Measurements of subjective near ADD and pupil diameter were made after the initial reading at 5 minutes interval for the first hour and every 30 minutes for the next 7 hours for each participant. Time of onset, time of peak cycloplegia, duration of peak cycloplegia and duration of total cycloplegic effect was indirectly determined., Results: 1% Cyclopentolate - 1% Tropicamide combination had rapid onset of cycloplegia (5-10 minutes), shorter time of maximal cycloplegia (55 versus 90 minutes), and recovery (7 versus ≥ 8hours) in the majority (79.2%) of subjects., Conclusion: Cyclopentolate -Tropicamide combination was comparable to Cyclopentolate in depth of cycloplegia produced, and clinically superior to 1% Cyclopentolate in rapidity of cycloplegic onset, time of maximal cycloplegia and recovery from cycloplegia.

Objective: To evaluate whether the addition of phenylephrine to tropicamide produces any clinically significant change in pupil size during diagnostic eye examination., Methods: Twenty healthy adults at the Washington University School of Medicine Eye Clinic were enrolled in this prospective, nonrandomized, crossover trial. Each had 3 dilating eye drop regimens administered to the left eye on separate days. Tropicamide (T) + proparacaine (PP) + phenylephrine (PE) (T+PP+PE) was considered the standard therapy, to which tropicamide alone (T alone) and tropicamide + proparacaine (T+PP) were compared against. Main outcome measures were postdilation pupil size and proportion of pupils able to achieve adequate clinical pupil dilation of >7 mm. Comparisons were made using Wilcoxon signed-ranked tests and McNemar's test., Results: Mean postdilation pupil size was 7.94 ± 0.78 mm, 7.64 ± 0.78 mm, and 7.48 ± 0.77 mm for T+PP+PE, T+PP, and T alone, respectively. T+PP+PE was statistically superior to T+PP (p = 0.004) and T alone (p < 0.001) with respect to postdilation pupil size. The proportion of pupils able to achieve adequate pupil dilation of >7 mm was 90%, 80%, and 70% for T+PP+PE, T+PP, and T alone, respectively. No statistical difference was observed in each regimen's ability to achieve adequate pupil dilation of >7 mm (T+PP+PE and T+PP: p = 0.47; T+PP+PE and T alone: p = 0.13)., Conclusion: The addition of phenylephrine eye drops to tropicamide produced larger pupil dilation, but the magnitude of benefit was marginal and clinically insignificant in this young, healthy cohort. A single-dilating-agent regimen using tropicamide could be considered in routine clinical practice., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Patients are usually advised to wait 5 minutes between eye drops. This delay supposedly allows the first drop not to be washed out by the second one, thereby increasing the combined effect. However, in the only experimental study conducted in humans on the concurrent administration of two different eye drops, the authors concluded that a 10-minute time interval between eye drops did not increase their combined effect. Our study was designed to address this puzzling observation., Methods: Using digital photographs shot in photopic conditions in 40 eyes of 20 healthy volunteers, we compared relative pupil surface (i.e., pupil to iris surface area ratios) before and after the administration of one drop of 10% phenylephrine and one drop of 0.5% tropicamide either immediately or after a 5-minute time interval., Results: Waiting 5 minutes yielded a 5.6% relative pupil surface gain (observer 1: P = .003, observer 2: P = .005) indicating an additional combined effect with a 5-minute time interval., Conclusions: These results show a detectable additive effect that is probably the result of methodological refinements including the challenging of the mydriasis by photopic conditions and the use of pupil and iris surface areas, which may show differences that would be undetectable in terms of diameter.

Background: Macular Integrity Assessment microperimetry assesses macular sensitivity to projected point light sources and maps eye movements to assess fixation stability. Although microperimetry is gaining prominence as an assessment tool in clinical and research settings, there is no consensus on whether it should be performed before or after pupil dilation. No studies to date have examined the effect of pupil dilation on results. The aim of this project was to elucidate the effect of pupil dilation on microperimetry outcomes., Design: Prospective audit., Participants: Twenty healthy patients from postoperative cataract clinic and 10 patients with choroideremia to simulate a disease with peripheral visual field loss., Methods: Subjects underwent 10-2 68-point field testing using the Macular Integrity Assessment microperimeter on each eye. Subjects then underwent randomized dilation of one eye, and the test was repeated in both eyes., Main Outcome Measures: We compared changes in threshold sensitivity and fixation stability pre-pupil and post-pupil dilation. The undilated eye was analysed for any learning or fatigue effect caused by test repetition., Results: Dilation produced no significant effect on threshold sensitivity (dilation effect: -0.29 decibels, P = 0.23) or fixation stability in healthy controls or in choroideremia patients (dilation effect: +0.08log bivariate contour ellipse area, P = 0.14). There was also no significant learning effect seen in the undilated eye, with no improvement in threshold sensitivity (order of eye testing: +0.03log bivariate contour ellipse area, P = 0.71)., Conclusions: In the clinical setting, patients may be tested for 10 degree microperimetry with or without pupil dilation, as both scenarios yield consistent and interchangeable results., (© 2016 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To determine the effect of dilating drops on strabismus measurements in adults., Design: Prospective cohort study., Methods: Patients aged 18 and older with strabismus underwent a standard evaluation of ocular motility, stereopsis, and ocular alignment with alternate prism cover test by a certified orthoptist. After pupil dilation with 2.5% phenylephrine and 1% tropicamide, ocular alignment was remeasured in primary gaze at 6 meters, at 1/3 meter, and at 1/3 meter with a +3.00 by a second certified orthoptist, masked to the previous measurements. The primary outcome was the mean difference in the angle of horizontal and vertical deviations after dilation in prism diopters., Results: A total of 55 patients were enrolled with a variety of diagnoses. For horizontal measurements the mean change was 0.54 prism diopters at 6 meters (95% confidence interval [CI] -0.36 to 1.43, P = .24), 1.67 prism diopters at 1/3 meter (95% CI -0.19 to 3.54, P = .08), and -0.05 prism diopters at 1/3 meter with a +3.00 add (95% CI -1.65 to 1.56, P = .95). The mean change in vertical deviation was 0.18 prism diopters at 6 meters (95% CI -0.19 to 0.56, P = .34), 0.57 prism diopters at 1/3 meter (95% CI 0-1.15, P = .05), and 0.47 prism diopters at 1/3 meter with a +3.00 add (95% CI -0.23 to 1.17, P = .18)., Conclusions: Pupil dilation does not meaningfully affect vertical or horizontal strabismus measurements in adults. Mild variability at near in younger patients is eliminated with the use of a +3.00 add., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the agreement of cycloplegic refractive error measures between the Grand Seiko and Retinomax autorefractors in 4- and 5-year-old children., Methods: Cycloplegic refractive error of children was measured using the Grand Seiko and Retinomax during a comprehensive eye examination. Accommodative error was measured using the Grand Seiko. The differences in sphere, cylinder, spherical equivalent (SE) and intereye vector dioptric distance (VDD) between autorefractors were assessed using the Bland-Altman plot and 95% limits of agreement (95% LoA)., Results: A total of 702 examinations were included. Compared to the Retinomax, the Grand Seiko provided statistically significantly larger values of sphere (mean difference, 0.34 D; 95% LoA, -0.46 to 1.14 D), SE (mean, 0.25 D; 95% LoA, -0.55 to 1.05 D), VDD (mean, 0.19 D; 95% LoA, -0.67 to 1.05 D), and more cylinder (mean, -0.18 D; 95% LoA, -0.91 to 0.55 D). The Grand Seiko measured ≥0.5 D than Retinomax in 43.1% of eyes for sphere and 29.8% of eyes for SE. In multivariate analysis, eyes with SE of >4 D (based on the average of two autorefractors) had larger differences in sphere (mean, 0.66 D vs 0.35 D; P < 0.0001) and SE (0.57 D vs 0.26 D; P < 0.0001) than eyes with SE of ≤4 D., Conclusions: Under cycloplegia, the Grand Seiko provided higher measures of sphere, more cylinder, and higher SE than the Retinomax. Higher refractive error was associated with larger differences in sphere and SE between the Grand Seiko and Retinomax., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: Pupillary dilatation with three types of eye drops is used regularly in the clinic; however, a mixture of these drops in a single bottle may be more beneficial in reducing workloads and resources. This study compared the efficacy in pupillary dilatation between two protocols of dilating drop instillation., Methods: This prospective, randomized, comparative study included 30 eligible Thai patients. The patients randomly received preoperative pupillary dilatations by either the conventional protocol (1% tropicamide (T), 10% phenylephrine (P) and 0.1% diclofenac (D) in three separate bottles) or the fixed combination (TPD) protocol which had the three types of eye drops mixed in a single bottle in a ratio of 4:3:3. The chi-square test and independent t-test were used to analyze the data., Results: The conventional protocol group and TPD protocol group each had 15 patients. Sixty minutes after the initial instillation, all patients in the TPD protocol and 13 patients (86.7%) in conventional protocol achieved at least 6mm in the shortest diameter. The mydriatic rate between protocols showed no difference. In patients who received the TPD protocol, the systemic effects on the mean arterial blood pressure and pulse rate decreased over time., Conclusion: The mixture of tropicamide, phenylephrine and diclofenac had a comparable efficacy for a pupillary dilatation to the conventional dilating drops in separate bottles. The systemic complications on blood pressure and arterial pulse of the TPD mixture were less than the conventional protocol., Trial Registration: TCTR20130325001., (Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Comparison of the efficacy of tropicamide eyedrops to the combination of 0.5% tropicamide and 5% phenylephrine eyedrops in order to achieve a proper dilation in premature infants undergoing screening for retinopathy of prematurity., Methods: A prospective, randomized, double-blind study was conducted to compare the efficacy of two mydriatic regimens: one regimen consisting of three drops of 0.5% tropicamide (TTT regimen), the other regimen consisting of one drop of 5% phenylephrine and two drops of 0.5% tropicamide (PTT regimen). Thirty premature infants were enrolled and received both mydriatic regimens: one regimen in each eye. Outcomes were pupil dilation evaluated by the percentage of pupil diameter over cornea diameter, the percentage of pupil surface over cornea surface and the quality of the eye fundus examination., Results: The percentage of pupil diameter over cornea diameter was 47.3% (±8.7) with the TTT regimen and 65.9% (±8.8) with the PTT regimen (p < 0.0001). The percentage of pupil surface over cornea surface was 23.1% (±8.3) with the TTT regimen and 43.8% (±7.3) with the PTT regimen (p < 0.0001). Thus, the pupil surface area was 1.9 times greater with the PTT than with the TTT regimen. Visualization of the retinal periphery was possible for 30 of 30 eyes dilated with the PTT regimen and for 16 of 30 eyes dilated with the TTT regimen (p < 0.0001)., Conclusion: The dilated pupil surface area for the combination of 5% phenylephrine and 0.5% tropicamide was almost twice that for 0.5% tropicamide eyedrops alone and provided significantly superior quality of the eye fundus examination., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Objective: The objective of the study was to evaluate the effect of topical 1% cyclopentolate hydrochloride (CH) on tear production (TP), pupil size (PS), and intraocular pressure (IOP) in dogs., Animal Studied: Fifteen healthy beagle dogs from the UAB research-teaching colony., Procedure: Dogs without ocular diseases were included. Each animal received one drop of 1% CH ophthalmic solution in a randomly selected eye. TP, PS, and IOP were evaluated by means of STT-1, static pupillometry, and rebound tonometry, respectively. Evaluations were performed before drug instillation and at 0.5, 1, 2, 4, 8, 12, 24, 30, 36, 48, 54, 60, 72, 84, and 96 h postinstillation. Examinations took place in a room with fixed light intensity (40-55 lux). Statistical analysis was performed by means of generalized estimating equations for the effect on STT-1, pupil size, and IOP over time., Results: After unilateral application of 1% CH, significant pupillary dilation started at 30 min, reached its maximum at 12 h, and returned to pre-instillation size after 72 h. No significant effects were found on TP or IOP, at any time. No effects were observed in the untreated eye on any of the parameters evaluated., Conclusion: Cyclopentolate hydrochloride could be considered a therapeutic alternative when use of a cycloplegic drug is needed and effects on tear production and IOP are unwanted., (© 2015 American College of Veterinary Ophthalmologists.)

Purpose: Prostaglandin analogs contribute to blood-aqueous barrier breakdown and may exacerbate uveitis. As these analogs induce de novo synthesis of endogenous prostaglandins, their therapeutic, hypotensive effect could potentially be inhibited by anti-inflammatory treatment. We therefore evaluated whether topical 1% prednisolone acetate alters the effects of 0.005% latanoprost on pupil diameter (PD) and intraocular pressure (IOP)., Animals Studied: Ten healthy Labrador retriever dogs from the Israel Guide Dog Center for the Blind., Methods: Pupil diameter and IOP were measured hourly, 8 AM-4 PM, with the right and left eyes serving as control (CE) and treated (TE) eyes, respectively. Measurements were conducted during four sessions: (1) without treatment (n = 10), (2) following latanoprost treatment (n = 10) at 8 AM, (3) following prednisolone treatment (n = 7) at 8 AM, and (4) bilateral latanoprost treatment at 8 AM, prednisolone treatment in TE at 11 AM (n = 8). The different number of dogs in sessions 3 and 4 is because some dogs were matched with their new owners earlier than expected., Results: Pupil diameters were not affected by the addition of prednisolone and, at 4 PM, were 3.82 ± 0.47 and 3.97 ± 0.36 mm in TE and CE, respectively (P = 0.175, Wilcoxon). IOPs were not affected by the addition of prednisolone and, at 4 PM, were 9.0 ± 0.8 and 9.3 ± 0.8 mm Hg in TE and CE, respectively (P = 0.339, Wilcoxon)., Conclusion: Prednisolone did not alter latanoprost's miotic and hypotensive effects in normal dogs during this study period., (© 2015 American College of Veterinary Ophthalmologists.)

Purpose: To evaluate the effect of corneal crosslinking (CXL) with ultraviolet A (UVA) irradiation on pupil response to tropicamide 0.5% instillation., Methods: This prospective interventional study enrolled 17 patients (19 eyes) with progressive keratoconus who underwent CXL with UVA irradiation. Central corneal thickness (CCT) was evaluated with the use of anterior segment optical coherence tomography (Visante OCT 3.0). Pupil diameter was measured with the use of Colvard infrared pupillometer before the instillation of tropicamide 0.5% and after the instillation of tropicamide every 5 minutes for total duration of 30 minutes. Corneal epithelial integrity was examined with the use of fluorescein dye staining. Measurements were performed 1 day preoperatively and 1 month postoperatively, with emphasis on simulating the same light conditions regarding the pupil measurements., Results: No intraoperative or postoperative complications were observed in any of the patients. Mean CCT decreased significantly (p&lt;0.001) 1 month postoperatively. Mean postoperative pupil size did not change significantly at any time point compared to the mean preoperative measurements., Conclusions: The CXL procedure seems not to impair effectiveness of topical drugs, using pupil size measurements after tropicamide 0.5% instillation.

PurposeTo ascertain the risk of angle closure glaucoma associated with mydriasis in the Northern Ireland Diabetic Retinopathy Screening Programme.MethodsA retrospective case note review was carried out, cross referencing hospital records with those of the screening programme, to identify episodes of angle closure glaucoma, which occurred within 14 days of a retinopathy screening episode involving pharmacological mydriasis.ResultsThree cases of angle closure following mydriasis for screening were identified. The incidence of angle closure within the screening programme was calculated to be 1 in 31 755 patients dilated or 0.75 patients per year.ConclusionAngle closure is a rare complication of mydriasis used in photographic screening for diabetic retinopathy. We advocate the provision of clear instructions to patients in screening programmes on when and how to access emergency ophthalmic care following dilation to prevent loss of vision in this rare event.