Elsevier

Ophthalmology

Volume 120, Issue 1, January 2013, Pages 8-13
Ophthalmology

Original article
Influences of Cycloplegia with Topical Atropine on Ocular Higher-Order Aberrations

https://doi.org/10.1016/j.ophtha.2012.07.057Get rights and content

Purpose

To investigate the influence of cycloplegia with topical atropine on higher-order aberrations (HOAs) of the eye in children.

Design

Prospective, noncomparative study.

Participants

Twenty-three eyes of 23 subjects (11 boys and 12 girls) with hyperopia, ranging in age from 3 to 12 years (average, 5.74 years), were enrolled in this study.

Methods

Refraction and wavefront aberration were evaluated before and after cycloplegia with topical instillation of 1% atropine solution administered twice daily for 1 week. Ocular and corneal HOAs were measured simultaneously, and individual Zernike components were analyzed for a 6-mm pupil up to the 6th order. All these parameters were compared before and after cycloplegia.

Main Outcome Measures

Ocular and corneal HOAs before and after cycloplegia.

Results

Cycloplegia with topical atropine significantly increased spherical equivalent refraction from +1.92±1.53 diopters (D) to +3.10±1.61 D (P<0.01, paired t test). Ocular HOAs significantly increased from 0.282±0.086 μm to 0.316±0.087 μm for coma-like aberrations (P = 0.02), from 0.169±0.058 μm to 0.192±0.076 μm for spherical-like aberrations (P = 0.02), and from 0.333±0.093 μm to 0.377±0.095 μm for total HOAs (P = 0.01). Corneal HOAs did not change after cycloplegia. As for individual Zernike components, significant changes were found in C31 and C40 after cycloplegia (P<0.05). The induced changes in C40 were correlated significantly with those in spherical equivalent refraction (Pearson's correlation coefficient, R = 0.45; P = 0.03).

Conclusions

Cycloplegia with atropine induced significant hyperopic shift and increases in ocular HOAs in children, leading to reduction in optical quality of the eye. It may be that physiologic tonic accommodation plays a role in improving retinal image quality by decreasing HOAs and refractive errors.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

Subjects were recruited between September 2006 and March 2008 at the Miyata Eye Hospital. They were selected from consecutive cases among the clinic population who matched the inclusion criteria. Inclusion criteria were as follows: between 3 and 12 years of age, eyes with hyperopic refractive errors, best spectacle-corrected visual acuity (BSCVA) of 20/25 or better, and no ocular and systemic pathologic features except refractive error and ocular deviation (ocular misalignment or strabismus).

Results

Cycloplegia with topical instillation of 1% atropine solution for 1 week significantly increased spherical equivalent refraction from +1.92±1.53 D to +3.10±1.61 D (P<0.01, paired t test). Ocular HOAs significantly increased from 0.282±0.086 μm to 0.316±0.087 μm for coma-like aberrations (P = 0.02), from 0.169±0.058 μm to 0.192±0.076 μm for spherical-like aberrations (P = 0.02), and from 0.333±0.093 μm to 0.377±0.095 μm for total HOAs (P = 0.01; Fig 1). However, corneal HOAs did not change after

Discussion

As shown in the “Results,” spherical equivalent refraction significantly increased from +1.92±1.53 D to +3.10±1.61 D after cycloplegia, showing a mean positive shift of 1.18 D. It is known that cycloplegia inhibits accommodation during refraction and thereby prevents the overestimation of myopia and the underestimation of hyperopia.25 Even for an object at infinity, a certain amount of accommodation is present because of the balance between the sympathetic and parasympathetic innervation.26 The

References (44)

  • L. Gao et al.

    The change in ocular refractive components after cycloplegia in children

    Jpn J Ophthalmol

    (2002)
  • G. Prakash et al.

    Association between amblyopia and higher-order aberrations

    J Cataract Refract Surg

    (2007)
  • R.V. North et al.

    A review of the uses and adverse effects of topical administration of atropine

    Ophthalmic Physiol Opt

    (1987)
  • R.V. North et al.

    Atropine occlusion in the treatment of strabismic amblyopia and its effect upon the non-amblyopic eye

    Ophthalmic Physiol Opt

    (1991)
  • A. Foley-Nolan et al.

    Atropine penalisation versus occlusion as the primary treatment for amblyopia

    Br J Ophthalmol

    (1997)
  • A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children

    Arch Ophthalmol

    (2002)
  • M.X. Repka et al.

    A randomized trial of atropine regimens for treatment of moderate amblyopia in children

    Ophthalmology

    (2004)
  • M.M. Scheiman et al.

    Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial

    Arch Ophthalmol

    (2008)
  • Pharmacological plus optical penalization treatment for amblyopia: results of a randomized trial

    Arch Ophthalmol

    (2009)
  • M.X. Repka et al.

    A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years

    Arch Ophthalmol

    (2008)
  • H.V. Gimbel

    The control of myopia with atropine

    Can J Ophthalmol

    (1973)
  • R.H. Bedrossian

    The effect of atropine on myopia

    Ophthalmology

    (1979)
  • Cited by (25)

    • Peripheral refraction and higher-order aberrations with cycloplegia and fogging lenses using the BHVI-EyeMapper

      2016, Journal of Optometry
      Citation Excerpt :

      Carkeet et al.,34 investigated the effect of cycloplegia on ocular aberrations in young adults using Technolas Zywave aberrometer (Bausch and Lomb, USA) and found small yet statistically significant differences between higher order measures (3rd and 5th order) between cycloplegic and non-cycloplegic states. Hiraoka et al.,35 confirmed similar results after assessing the effect of cycloplegia on ocular aberrations in children using the Topcon Hartmann-Shack aberrometer (KR-9000PW, Topcon, Tokyo, Japan) and 1% Atropine. Our results, reported from a custom-built instrument, are in agreement with these previous reports.

    View all citing articles on Scopus

    Manuscript no. 2012-11.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    View full text