Effect of pharmacologic pupil dilation with tropicamide and phenylephrine on wavefront measurements

Anterior Segment Biometry with Phenylephrine and Tropicamide during Accommodation Imaged with Ultralong Scan Depth Optical Coherence Tomography

PURPOSE

To investigate the influence of phenylephrine and tropicamide on anterior segment biometry with ultralong scan depth optical coherence tomography (UL-OCT) during accommodation.

METHODS

In this study, 20 left eyes of healthy volunteers with a mean ± standard deviation age of 31.05 ± 5.84 years and a mean refraction of -1.16 ± 1.11 diopters (range 0∼-3.0 D) were imaged using UL-OCT after instillation of artificial tears, phenylephrine, and tropicamide in three follow-up trials, respectively. At each follow-up trial, two repeated measurements were performed at states of relax and 5D accommodative stimulation. The dimensional parameters included central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter (PD), lens thickness (LT), and horizontal radii of the lens anterior and posterior surface curvatures (LAC and LPC).

RESULTS

Tropicamide led to larger pupil, deeper ACD, thinner LT, and flatter crystalline lens surface (P < 0.05). Phenylephrine induced an increase in PD (P < 0.05), while no significant changes were seen in ACD, LT, LAC, and LPC (P > 0.05). CCT did not change after both phenylephrine and tropicamide instillation in this study (P > 0.05). Tropicamide induced the loss of accommodation and phenylephrine achieved pupil dilation without affecting the accommodation. PD, ACD decreased, LT increased significantly and the anterior and posterior surface of the lens in a 6.294 mm of diameter optical zone became steeper during accommodation after administration of phenylephrine (P < 0.05).

CONCLUSION

The anterior segment physiology changed after tropicamide instillation. Besides, tropicamide induced the loss of accommodation and phenylephrine preserved the accommodation with a larger pupil. And, the anterior and posterior surface of lens in a 6.294 mm of diameter optical zone became steeper during the accommodation.

Ocular aberrations and wavefront aberrometry: A review

Wavefront aberrations can be described as deviations of the wavefront exiting the eye froma reference wavefront that is aberration free and diffraction limited. Ocular aberrations canbe sub-categorised as lower and higher order aberrations. Ocular aberrations have promptedinterest amongst the ocular healthcare community owing to their influences on the visualfunctioning of patients as well as differences observed in ocular aberrations through the useof refractive surgery both pre- and post-operatively. Uncompensated refractive error remainsone of the most common reasons for which patients consult optometrists. Compensationof refractive error, or lower order aberrations, has become a routine procedure during anoptometric examination. However, there are some patients who experience visual symptomseven after their refractive errors have been compensated via spectacles or contact lenses.Higher-order aberrations may be the source of these visual disturbances. Refractive surgeryhas been found to influence and even induce various changes in higher-order aberrationspost-operatively, which in turn has led to increased interest in wavefront aberrations and howthe measurement of these aberrations can improve diagnosis and treatment within optometryand ophthalmology.