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Kremer LJ, Medlicott N, Sime MJ, Broadbent R, Edmonds L, Berry MJ, Austin NC, Alsweiler JM, Reith DM. Low dose or very low dose phenylephrine and cyclopentolate microdrops for retinopathy of prematurity eye examinations (The Little Eye Drop Study): a randomised controlled non-inferiority trial. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324929. [PMID: 36593111 DOI: 10.1136/archdischild-2022-324929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if very low dose (VLD, 0.5% phenylephrine, 0.1% cyclopentolate) mydriatic microdrop (approximately 7 μL) administration (up to three doses) is non-inferior to low dose (LD, 1% phenylephrine, 0.2% cyclopentolate) mydriatic microdrop administration for ophthalmologist-determined successful retinopathy of prematurity eye examination (ROPEE). DESIGN Multicentre, prospective, randomised controlled, non-inferiority clinical trial. SETTING Four neonatal intensive care units in Aotearoa, New Zealand from October 2019 to September 2021. PATIENTS Infants with a birth weight less than 1250 g or gestational age less than 30+6 weeks and who required a ROPEE. INTERVENTIONS The intervention: microdrop (approximately 7 μL) of VLD (0.5% phenylephrine and 0.1% cyclopentolate) to both eyes, or the comparison: microdrop of LD (1% phenylephrine and 0.2% cyclopentolate) to both eyes. Up to three doses could be administered. MAIN OUTCOME MEASURES The primary outcome measure was an ophthalmologist-determined successful ROPEE. RESULTS One hundred and fifty preterm infants (LD mean GA=27.4±1.8 weeks, mean birth weight=1011±290 g, VLD mean GA=27.5±1.9 weeks, mean birth weight=1049±281 g,) were randomised. Non-inferiority for successful ROPEE was demonstrated for the VLD group compared with the LD group (VLD successful ROPEE=100%, LD successful ROPEE=100%, 95% CI no continuity correction -0.05 to 0.05) and for Māori (95% CI no continuity correction -0.02 to 0.19). CONCLUSION VLD microdrops enable safe and effective screening for ROPEE in both Māori and non-Māori preterm infants. TRIAL REGISTRATION NUMBER ACTRN12619000795190.
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Affiliation(s)
- Lisa Jean Kremer
- He Rau Kawakawa (School of Pharmacy), University of Otago Division of Health Sciences, Dunedin, New Zealand .,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Natalie Medlicott
- He Rau Kawakawa (School of Pharmacy), University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Mary Jane Sime
- Ophthalmology, Te Whatu Ora (Health New Zealand), Southern, Dunedin, New Zealand
| | - Roland Broadbent
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Liza Edmonds
- Division of Health Sciences, Kōhatu Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - Mary Judith Berry
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Nicola C Austin
- Neonatal Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics, The University of Auckland School of Medicine, Auckland, New Zealand.,Newborn Services, Auckland Hospital, Te Whatu Ora Health New Zealand, Auckland, New Zealand
| | - David M Reith
- Deans Department, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
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Maria van Minderhout H, Joosse MV, Schalij-Delfos NE. Neutral Density Filters as a Tool for Cycloplegic Plusoptix-Photorefractor Measurements: An Explorative Study. Open Ophthalmol J 2022. [DOI: 10.2174/18743641-v16-e2206061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
The purpose of this study is to investigate the usefulness of neutral-density (ND) filters in cycloplegic-Plusoptix-photorefractor measurements.
Methods:
No-filter and ND-filter 0.04, 0.1 and 0.2 cycloplegic-Plusoptix-photorefractor measurements were made in 42 hypermetropic eyes. Sphere, cylinder, spherical equivalent (SEQ), J0, and J45 values were compared.
Results:
Mean Plusoptix-photorefractor pupil sizes were 7.7±0.68 and 7.7±0.72 mm The no-filter failure rate was 16%, with 87% in pupils >7.8 mm. Mean no-filter sphere, cylinder, SEQ, J0 and J45 values were +0.34±0.35D, -0.29±0.22D, +0.20±0.36, -0.00±0.15, and +0.02±0.11, respectively. Only ND-filter-0.04 provided 5% more successful measurements and a clinically significant alteration in the percentage of values exceeding 0.5D for sphere and SEQ (-10% and -20%), but not for cylinder (+5%). Despite the increased accuracy, 21% of the spherical outcome exceeded 0.50D. Furthermore, the single-measure-intraclass-correlation-coefficient between no-filter and ND-filter-0.04 outcome was moderate (sphere 0.78 (0.62-0.87), cylinder 0.59 (0.35-0.75), SEQ 0.68 (0.48-0.82), J0 0.73 (0.54-0.84) and J45 0.57 (0.50-0.86)) and indicated significant individual variation. Bland-Altman-analyses indicated significant bias for sphere and SEQ; p=0.038 and p=0.030.
Conclusion:
ND-filter-0.04 resulted in a larger proportion of successful measurements and an increased accuracy. However, an unacceptable percentage of inaccuracy was still present compared to retinoscopy. There could be validity issues with the ND-filter 0.04 or the baseline no-filter readings at the start. We conclude that cycloplegic Plusoptix-photorefraction, even with the use of a 0.04 ND filter, is not a suitable method for exact objective refraction purposes in children.
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Szpernal J, Bachman Groth JA, Wynne N, Williams V, Spellecy R, Thuruthumaly C, Carroll J. Pupillary Dilation in Research: More than Meets the Eye. Curr Eye Res 2022; 47:965-977. [PMID: 35499263 DOI: 10.1080/02713683.2022.2053723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: Pupil dilation is a commonly used procedure in vision research. While often considered a minimal risk procedure, there is the potential for significant adverse effects. Methods: Currently, there is variance in practices and protocols among researchers and institutions, perhaps due to a lack of guidelines for safe pupil dilation practices in research settings. In this perspective, we explore variables that can increase the potential for adverse effects and provide suggestions to limit their impact. Prior to dilation, an investigator can assess an individual's medical status and drug regimen when deciding upon a mydriatic agent to be used. Results: Assessing the angle through a variety of methods (i.e. penlight test, van Herick slit lamp, optical coherence tomography, gonioscopy) can also prevent inappropriate dilation of pupils with concerning anatomical features. During dilation, an investigator should look to limit the potential of infection and use caution in repeat dosing of dilation-resistant pupils. Conclusions: Post-dilation, an investigator should closely monitor eyes with elevated risk factors and improve an individual's health literacy on angle closure complications. When combined with proper informed consent processes regarding adverse effects, the aforementioned can allow for risk mitigation in studies using pupil dilation.
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Affiliation(s)
- Jacob Szpernal
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jane A Bachman Groth
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Niamh Wynne
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vesper Williams
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Catherine Thuruthumaly
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
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Mehraban Far P, Tai F, Ogunbameru A, Pechlivanoglou P, Sander B, Wong DT, Brent MH, Felfeli T. Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis. BMJ Open Ophthalmol 2022; 7:e000915. [PMID: 35237724 PMCID: PMC8845326 DOI: 10.1136/bmjophth-2021-000915] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the diagnostic accuracy of teleretinal screening compared with face-to-face examination for detection of diabetic retinopathy (DR) and age-related macular degeneration (AMD). Methods and analysis This study adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). A comprehensive search of OVID MEDLINE, EMBASE and Cochrane CENTRAL was performed from January 2010 to July 2021. QUADAS-2 tool was used to assess methodological quality and applicability of the studies. A bivariate random effects model was used to perform the meta-analysis. Referrable DR was defined as any disease severity equal to or worse than moderate non-proliferative DR or diabetic macular oedema (DMO). Results 28 articles were included. Teleretinal screening achieved a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (0.74 to 0.95) for any DR (13 studies, n=7207, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) low). Accuracy for referrable DR (10 studies, n=6373, GRADE moderate) was lower with a sensitivity of 0.88 (0.81 to 0.93) and specificity of 0.86 (0.79 to 0.90). After exclusion of ungradable images, the specificity for referrable DR increased to 0.95 (0.90 to 0.98), while the sensitivity remained nearly unchanged at 0.85 (0.76 to 0.91). Teleretinal screening achieved a sensitivity of 0.71 (0.49 to 0.86) and specificity of 0.88 (0.85 to 0.90) for detection of AMD (three studies, n=697, GRADE low). Conclusion Teleretinal screening is highly accurate for detecting any DR and DR warranting referral. Data for AMD screening is promising but warrants further investigation. PROSPERO registration number CRD42020191994.
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Affiliation(s)
- Parsa Mehraban Far
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Felicia Tai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Adeteju Ogunbameru
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital, Toronto Unity Health, Toronto, Toronto, Ontario, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Retina Service, Donald K Johnson Eye Institute, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Kremer LJ, Broadbent R, Medlicott N, Sime MJ, McCaffrey F, Reith DM. Randomised controlled pilot trial comparing low dose and very low- dose microdrop administration of phenylephrine and cyclopentolate for retinopathy of prematurity eye examinations in neonates. Arch Dis Child 2021; 106:603-608. [PMID: 33051215 DOI: 10.1136/archdischild-2019-318733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/23/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022]
Abstract
AIMS To determine ifVery low dose mydriatic eye microdrop regimen sufficiently dilates the pupil (above 4.1 mm) compared with the currently used low dose mydriatic eye microdrop regimen.Cardiovascular, gastrointestinal and respiratory adverse effects occur following eye drop instillation. METHODS Seventeen premature infants were recruited into this prospective, randomised controlled pilot trial in January 2017 to November 2018. Data were collected from the single-centre Neonatal Intensive Care Unit, Dunedin Hospital, New Zealand. The inclusion criteria were birth weight less than 1500 g or gestational age less than 31 weeks, or any premature infant requiring red reflex testing. Infants were randomised to receive either phenylephrine 1% or 0.5% and cyclopentolate 0.2% or 0.1%, 1 microdrop in both eyes. Efficacy outcome measures were pupil size at retinopathy of prematurity eye examination (ROPEE) and ophthalmologist rating of ease of screen. RESULTS All participants had sufficient pupillary dilation for a successful ROPEE. Ophthalmologists rated the ROPEE as easy for 90% of all examinations. Pupil dilation measurements at the time of examination, mean±SD, 4.8±0.2 (95% CI 4.5 to 5.2) mm for treatment A and 5±0.2 (95%CI 4.6 to 5.4) mm for treatment B (p=0.61). There were no statistically significant differences between the groups for safety data. CONCLUSIONS Very low dose microdrop administration of phenylephrine and cyclopentolate appears to be effective at sufficiently dilating the neonatal pupil for ROPEEs. Low dose and very low dose microdrop mydriatic regimens may also reduce the risk of unwanted adverse effects associated with these medicines. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (reference ACTRN12616001266459p).
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Affiliation(s)
- Lisa Jean Kremer
- School of Pharmacy, University of Otago, Dunedin, New Zealand .,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Roland Broadbent
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Mary Jane Sime
- Ophthalmology, Southern District Health Board, Dunedin, New Zealand
| | - Frances McCaffrey
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - David M Reith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Kelbsch C, Strasser T, Chen Y, Feigl B, Gamlin PD, Kardon R, Peters T, Roecklein KA, Steinhauer SR, Szabadi E, Zele AJ, Wilhelm H, Wilhelm BJ. Standards in Pupillography. Front Neurol 2019; 10:129. [PMID: 30853933 PMCID: PMC6395400 DOI: 10.3389/fneur.2019.00129] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/31/2019] [Indexed: 12/31/2022] Open
Abstract
The number of research groups studying the pupil is increasing, as is the number of publications. Consequently, new standards in pupillography are needed to formalize the methodology including recording conditions, stimulus characteristics, as well as suitable parameters of evaluation. Since the description of intrinsically photosensitive retinal ganglion cells (ipRGCs) there has been an increased interest and broader application of pupillography in ophthalmology as well as other fields including psychology and chronobiology. Color pupillography plays an important role not only in research but also in clinical observational and therapy studies like gene therapy of hereditary retinal degenerations and psychopathology. Stimuli can vary in size, brightness, duration, and wavelength. Stimulus paradigms determine whether rhodopsin-driven rod responses, opsin-driven cone responses, or melanopsin-driven ipRGC responses are primarily elicited. Background illumination, adaptation state, and instruction for the participants will furthermore influence the results. This standard recommends a minimum set of variables to be used for pupillography and specified in the publication methodologies. Initiated at the 32nd International Pupil Colloquium 2017 in Morges, Switzerland, the aim of this manuscript is to outline standards in pupillography based on current knowledge and experience of pupil experts in order to achieve greater comparability of pupillographic studies. Such standards will particularly facilitate the proper application of pupillography by researchers new to the field. First we describe general standards, followed by specific suggestions concerning the demands of different targets of pupil research: the afferent and efferent reflex arc, pharmacology, psychology, sleepiness-related research and animal studies.
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Affiliation(s)
- Carina Kelbsch
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Torsten Strasser
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, AL, United States
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Paul D. Gamlin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Randy Kardon
- Neuro-Ophthalmology Division, University of Iowa and Iowa City VA Healthcare System, Iowa City, LA, United States
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Kathryn A. Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stuart R. Steinhauer
- VA Pittsburgh Healthcare System, VISN 4 MIRECC, University Drive C, Pittsburgh, PA, United States
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Elemer Szabadi
- Developmental Psychiatry, University of Nottingham, Nottingham, United Kingdom
| | - Andrew J. Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Helmut Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Barbara J. Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
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Sherman AE, Shaw MM, Ralay-Ranaivo H, Rahmani B. Tropicamide has limited clinical effect on cycloplegia and mydriasis when combined with cyclopentolate and phenylephrine. J AAPOS 2019; 23:30.e1-30.e5. [PMID: 30641136 DOI: 10.1016/j.jaapos.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine the cycloplegic and mydriatic effect of tropicamide omission from a common pediatric eye drop combination. METHODS Consecutive children examined at the Ann & Robert H. Lurie Children's Hospital of Chicago from June 8, 2017 to September 6, 2017 were enrolled prospectively. Tropicamide, cyclopentolate, and phenylephrine (TCP) was instilled in one eye; cyclopentolate and phenylephrine (CP), in the other. Spherical equivalent, maximum pupil size, and pupillary constriction in response to photostimulation were measured before and 30 minutes after instillation using an autorefractor and pupillometer. Iris pigmentation was examined as a between-subjects variable. RESULTS A total of 75 children 4-11 years of age were included. Mean differences in spherical equivalent between TCP and CP were not statistically significant (P = 0.95). Significant interactions between eye drop regimen and iris pigmentation were observed for pupil size (P = 0.001) and constriction percentage (P = 0.02). Among only patients with dark irides, TCP yielded slightly larger pupils (7.70 vs 7.31 mm [P < 0.001]) that were less responsive to light (5.75% vs 8.07% [P = 0.002]). All pupils dilated to ≥6.0 mm, with equivalent proportions achieving ≥7.0 mm for TCP and CP (P = 0.18). CONCLUSIONS TCP and CP elicited equivalent cycloplegic effects. Mydriatic differences between the regimens, although statistically significant in dark irides, were of limited clinical magnitude, and all pupils achieved sufficient dilation for funduscopy.
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Affiliation(s)
- Alain E Sherman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa M Shaw
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Bahram Rahmani
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Kremer LJ, Reith DM, Medlicott N, Broadbent R. Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ Paediatr Open 2019; 3:e000448. [PMID: 31206081 PMCID: PMC6542421 DOI: 10.1136/bmjpo-2019-000448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Routine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines. OBJECTIVE This review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination. METHOD Systematic literature review. RESULTS There is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports. CONCLUSIONS Current international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.
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Affiliation(s)
- Lisa Jean Kremer
- School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand.,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - David M Reith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Natalie Medlicott
- School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand
| | - Roland Broadbent
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Ostrin LA. The ipRGC-driven pupil response with light exposure and refractive error in children. Ophthalmic Physiol Opt 2018; 38:503-515. [PMID: 30259538 DOI: 10.1111/opo.12583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The intrinsically photosensitive retinal ganglion cells (ipRGCs) signal environmental light, control pupil size and entrain circadian rhythm. There is speculation that ipRGCs may be involved in the protective effects of light exposure in myopia. Here, the ipRGC-driven pupil response was evaluated in children and examined with light exposure and refractive error. METHODS Children ages 5-15 years participated. Subjects wore an actigraph device prior to the lab visit for objective measures of light exposure and sleep. For pupillometry, the left eye was dilated and presented with stimuli, and the consensual pupil response was measured in the right eye. Pupil measurements were preceded by 5 min dark adaptation. In Experiment 1 (n = 14), 1 s long wavelength light ('red,' 651 nm, 167 cd m-2 ) and 10 increasing intensities of 1 s short wavelength light ('blue,' 456 nm, 0.167-167 cd m-2 ) were presented with a 60 s interstimulus interval. A piecewise two-segment regression was fit to the stimulus response function to determine the functional melanopsin threshold. Pupil responses were analysed with light exposure over the previous 24 h. For Experiment 2 (n = 42), three 1 s red and three 1 s blue alternating stimuli were presented with a 60 s interstimulus interval. Following an additional 5-min dark adaption, the experiment was repeated. Pupil metrics included peak constriction, the 6 s and 30 s post-illumination response (PIPR), early and late area under the curve (AUC). Following pupil measurements, cycloplegic refractive error and axial length were measured. RESULTS For Experiment 1, PIPR metrics demonstrated a graded response to increasing intensity blue stimuli, with a mean functional melanopsin threshold of 6.2 ± 4.5 cd m-2 (range: 0.84-16.7 cd m-2 ). The 6 s PIPR and early AUC were associated with 24-h light exposure for high intensity stimuli (33.3 and 83.3 cd m-2 , p < 0.005 for both). For Experiment 2, there were no associations between pupil metrics and refractive error. The 6 s PIPR and early AUC to blue stimuli were significantly increased for Trial 2 compared to Trial 1. CONCLUSIONS The ipRGC-driven pupil responses in children were robust and similar to responses previously measured in an adult population. The 6 s PIPR and early AUC to high intensity blue stimuli were associated with previous light exposure. There were no associations between the ipRGC-driven pupil response and refractive status in this cohort.
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Affiliation(s)
- Lisa A Ostrin
- College of Optometry, University of Houston, Houston, USA
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10
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Kothari M, Rathod V. Efficacy of 1% atropine eye drops in retarding progressive axial myopia in Indian eyes. Indian J Ophthalmol 2017; 65:1178-1181. [PMID: 29133646 PMCID: PMC5700588 DOI: 10.4103/ijo.ijo_418_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: The aim of this study is to assess the efficacy of 1% atropine eye drops for the retardation of progressive axial myopia in Indian eyes. Methods: This prospective interventional cohort study included children aged 5–16 years. Both the eyes of myopic children with progressive increase of ≥−0.5D sphere/year with the best-corrected vision of ≥6/6 were treated with once a day application of 1% atropine eye drops and progressive addition photogray lenses. The progression of myopia after 1-year follow-up was analyzed. Results: Sixty eyes of thirty myopes were included in the study. The mean age was 10 years and 15 were girls. The mean baseline sphere was −5.2D (−2.5D–−13D). Mean duration of follow-up was 23 months (12–36 months). The baseline rate of progression was reduced from −0.6D/year (range −0.5D/year to −3D/year) to −0.2D/year (range 0D/year to −1.5D/year) after atropine therapy. Seventeen patients (57%) had to use the atropine in the daytime to reach the target progression of <−0.5D/year. There was no difference between the efficacy of atropine drops in the boys and girls (P = 0.6). The efficacy of atropine drops did not have a correlation with the age of the patients or the magnitude of baseline myopia (Pearson's r = 0). Conclusion: 1% atropine eye drops was well tolerated and efficacious for the retardation of progressive myopia in Indian eyes. Effectiveness was better with daytime application. Further studies are necessary to assess the role of 1% atropine in the rapid progressors and patients poorly responding to low-dose atropine.
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Affiliation(s)
- Mihir Kothari
- Department of Pediatric Refractive Services, Jyotirmay Eye Clinic for Children and Adult Squint and Ocular Motility Laboratory, Thane; Department of Pediatric Ophthalmology, Mahatme Eye Hospital, Nagpur, Maharashtra, India
| | - Vivek Rathod
- Department of Pediatric Refractive Services, Jyotirmay Eye Clinic for Children and Adult Squint and Ocular Motility Laboratory, Thane, Maharashtra, India
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Current World Literature. Curr Opin Neurol 2011; 24:89-93. [DOI: 10.1097/wco.0b013e3283433a91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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