Study highlights differences between atropine and cyclopentolate for cycloplegia in preschoolers
- 29-09-2025
- Cycloplegia
- Editor's Choice
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medwireNews: Using atropine rather than cyclopentolate for cycloplegia is associated with less myopic refraction and potentially avoids overestimation of premyopia prevalence in preschool children, study findings indicate.
“Sufficient cycloplegia is essential for reliable refraction in preschool children,” write Xiangui He (Tongji University, Shanghai, China) and co-authors in JAMA Oncology.
“The choice of cycloplegic agent varies across countries and clinical settings,” they add, which “may affect refraction and diagnosis outcomes.”
The researchers explain that although atropine is considered the strongest cycloplegic agent, its routine use is limited due to its prolonged effects, potential systemic adverse events, and inconvenient administration schedule. Cyclopentolate, on the other hand, has a faster onset and shorter active duration than atropine and is therefore often used as an alternative in children.
However, current evidence does not clearly establish whether cyclopentolate provides equivalent cycloplegia to that of atropine in preschool-aged children.
To investigate, He and team carried out a post hoc analysis of 1761 propensity score matched children (3048 eyes) aged 3 to 7 years who had participated in two different studies involving cycloplegic agents.
There were 773 children (mean age 5 years, 53% boys, 1524 eyes) who had cycloplegia induced with 1% atropine given twice daily for 4 days with an additional dose on day 5 in the Preschool Children Refractive Development Pattern and Influencing Factors Study, and 988 children (mean age 5 years, 54% boys, 1524 eyes) who were given 1% cyclopentolate in two doses, 5 minutes apart during the Elaborative Shanghai Childhood Ocular Refractive Development Study.
Pretreatment, mean noncycloplegic spherical equivalents (SE), measured using an autorefractor, were similar between the children who received atropine and those given cyclopentolate, at 0.30 diopters (D) and 0.31 D, respectively.
The researchers report that, after cycloplegic refraction, the mean difference between the noncycloplegic and cycloplegic SE was significantly higher in the atropine group than in the cyclopentolate group, at 1.56 D versus 0.97 D.
In addition, significantly more children in the atropine than the cyclopentolate group had moderate-to-high hyperopia (SE of 3.00 to ≥5.00 D; 7.2 vs 2.7%) or low hyperopia (SE of 0.75–2.99 D; 82.8 vs 74.0%), while significantly fewer had premyopia (SE of –0.50 to +0.75 D; 8.7 vs 21.6%). The rate of myopia was similar between the two groups (SE ≤–0.50; 1.3 vs 1.8%).
“The observed intergroup differences in refractive state prevalence suggest that the choice of cycloplegic agent may lead to inconsistent classification—particularly in identifying premyopia,” He et al remark.
They add: “Such discrepancies may result in unnecessary or delayed interventions, potentially hindering efforts to prevent myopia.”
However, the investigators acknowledge that it is unclear “whether the observed differences in cycloplegic refraction outcomes would influence clinical decision-making.”
They say: “This uncertainty stems from the limited understanding of which agent yields a more accurate diagnosis of premyopia and better identifies children who may benefit from early myopia intervention.”
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