The effect of phenylephrine and cyclopentolate on objective wavefront measurements
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2006-05-01
Autores
Jankov, Mirko R.
Iseli, Hans Peter
Bueeler, Michael
Schor, Paulo
Seiler, Theo
Mrochen, Michael
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PURPOSE: To investigate the impact of phenylephrine and cyclopentolate on wavefront refraction and fourth order spherical aberration C(12).METHODS: This cohort study comprised 151 eyes with sphere up to -10.00 diopters (D) and cylinder -3.75 D. Aberrometry was performed using the ALLEGRO WAVE (WaveLight Laser Technologies AG, Erlangen, Germany) after instillation of phenylephrine 5% yielding objective phenylephrine refraction in accommodated steady-state, as well as after cyclopentolate 0.5% providing objective cyclopentolate refraction in non-accommodated state. Accommodation target fogging was turned off. Wavefront aberrations were expressed by Zemike expansion up to the sixth order, and paraxial curvature matching with Taylor series was used to calculate objective wavefront sphere.RESULTS: Objective wavefront sphere was not influenced by pupil size. Eyes showed substantial accommodation after phenylephrine with a myopic shift of -0.66 D comparing objective to subjective manifest sphere (r=0.942, P<.001). Cycloplegic eyes behaved like a model eye, with a difference of -0.08 D between objective and subjective cycloplegic sphere (r=0.976, P<.001). C(12) increased ten-fold from 4.0- to 7.0-mm pupil size, keeping the same sign. Comparing cyclopentolate with phenylephrine, the sign of C(12) changed in a positive direction by an average +0.124 +/- 0.109 mu m (range: -0.052 to +0.632 mu m) at 7.0 mm, whereas the total higher order aberrations changed very little. A good correlation was found between C(12) and the change in objective wavefront sphere between cyclopentolate and phenylephrine (r=0.75, P<.001).CONCLUSIONS: Fogging of the accommodation target should be used for wavefront measurements. Weaker cycloplegic agents, such as tropicamide, may be used to ensure relaxed but not completely paralyzed accommodation, which would yield manifest aberration values close to the natural resting state.
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Journal Of Refractive Surgery. Thorofare: Slack Inc, v. 22, n. 5, p. 472-481, 2006.