Choice of cycloplegia regime
Reviewed by Fiona Rowe

The purpose of this randomised control trial (RCT) was primarily to compare the refractive outcome of atropine 0.5% (A) instilled twice daily at home 2.5 days before measurement versus two drops of 1% cyclopentolate (CC) in one eye versus one drop of 1% cyclopentolate with one drop of 1% tropicamide (CT) in the fellow eye. Sixty-nine children were recruited and all completed the study; 33 males and 34 females aged 4.5 years (SD 1.0). Ten had non-compliance with the atropine protocol. Difference in spherical equivalent refraction was +2.15 ±1.43D (A-CC groups) and +2.10 ±1.38D (A-CT groups). Hypermetropia was significantly higher following atropine than after 50 minutes for CC and CT. No difference was found between CC and CT groups. Skin colour was a significant factor in the differences between A, CC and CT groups. Sex was not significant and ethnicity reached borderline significance. The authors conclude that skin colour should be considered when choosing cycloplegia regimes. They recommend atropine should be avoided where possible. Double doses of CC or CT provided almost comparable outcomes in hypermetropic children with dark irides. Their first choice was combined cyclopentolate with tropicamide. 

A randomised clinical trial using atropine, cyclopentolate and tropicamide to compare refractive outcome in hypermetropic children with a dark iris; skin pigmentation and crying as significant factors for hypermetropic outcome.
Van Minderhout HM, Joosse MV, Grootendorst DC, et al.
STRABISMUS
2019;27(3):127-38.