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This study aimed to assess the time needed for effective cycloplegia after instillation of 1% cyclopentolate drops in children with brown irides. The study recruited 161 consecutive patients aged three to 16 years. All had refraction on arrival, then instillation of one cycloplegic drop in each eye. A second drop was instilled after 10 minutes. Refraction was done four times, 15 minutes apart at 15, 30, 45 and 60 minutes using a Nidek AR1000 autorefractor. Spherical equivalent was calculated for results of refraction. Mean age was nine years (SD 3.1) and 46.6% were male. Myopia was recorded in 16.5%, hypermetropia in 75.8% and emmetropia in 7.8%. For myopia, the spherical equivalent range was -10.75 to -0.50DS (mean -2.94, SD 2.70). For hypermetropia, the spherical equivalent range was 0.50 to 15.50DS (mean 1.87, SD 2.60) and for emmetropia, the range was -0.375 to 0.375 (mean -0.28, SD 0.38). The mean spherical equivalent overall was 0.22D at baseline, rising to 0.89D at 15 minutes, 1.07D at 30 minutes, 1.13D at 45 minutes and 1.17D at 60 minutes. A plateau was calculated at 30 minutes: 68.9% reached maximum cyclo at 15 minutes, 87.3% at 30 minutes and 94.7% at 45 minutes. Time to reach maximum cyclo was not affected by type of refractive error or age but the authors acknowledge the small numbers with high refractive errors and recommend further research with children who have high refractive errors. This is a useful practical study indicating that many children with brown irides can be refracted 30 minutes after instillation of the first cycloplegic drop but with a wait to 45 minutes for those with high refractive errors.

Time for effective cycloplegia in patients with brown iris.
Al-Omari R, Atoum D, Khader Y, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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