Association of age and spherical equivalent with differences in cycloplegic refractive effects between cyclopentolate and atropine

Purpose: Amblyopia and strabismus are common visual impairments linked to functional and social consequences in children. In this retrospective observational study, we aimed to compare the cycloplegic effects of two cycloplegic eye drops, cyclopentolate hydrochloride (cyclopentolate) and atropine sulfate (atropine), and examine whether age and initial spherical equivalent values influence these effects. Methods: We used the data from patients treated at the Kozawa Eye Hospital and Diabetes Center between 2001 and 2021, excluding cases not initially treated with cyclopentolate or those with an interval of over a month between administrations. The main outcome was the difference in refractive values between cyclopentolate and atropine. Refractive measurements were obtained using an autorefractometer and a handheld refractometer. Statistical analyses included Wilcoxon signed-rank tests and multivariate regression, adjusting for potential confounders such as age and initial spherical values. Results: This study included 188 eyes of 94 patients. Statistical analysis showed a significant difference in the refractive values between cyclopentolate and atropine, with atropine demonstrating a stronger cycloplegic effect. Age at the time of initial examination was markedly linked to the difference in the refractive values between the two agents. In particular, with each additional year of age, the difference in refractive values decreased by 0.04 D. Conclusion: Atropine revealed a consistently stronger refractive effect than cyclopentolate in the pediatric population, and age substantially influenced the cycloplegic effect. These results highlight the requirement for age-specific considerations when selecting cycloplegic agents for pediatric patients, thereby facilitating a more tailored approach to manage refractive errors in children. Clinical trial number : not applicable