A recent study suggests substituting tropicamide for cyclopentolate as the cycloplegic agent during refraction may be beneficial due to its rapid onset of action when controlling accommodation.

Researchers arrived at this conclusion after carrying out a comprehensive literature search, followed by an evaluation of the methodological quality of the literature and a statistical analysis. The study notes that the present meta-analysis included six studies—half were randomized and controlled and the other three were case-control.

The team found that the pooled standardized difference in the refractive error mean change was 0.175D. While there was more plus in the cyclopentolate group, they add, the difference was not statistically significant. The study notes that the stronger cycloplegic effect of cyclopentolate was only statistically significant in children with a mean refractive difference of 0.22D.

The researchers recommend clinicians exercise caution when using tropicamide as the sole cycloplegic agent in infants and patients with high hyperopia or strabismus, especially in situations where findings are variable or examination results and clinical manifestations of visual problems are not consistent.

Yazdani N, Sadeghi R, Momeni-Moghaddam H, et al. Comparison of cyclopentolate and tropicamide as a cycloplegic agent. J Optom. July 24, 2018. [Epub ahead of print].