A Tale of Four Strips
Why do eye doctors use dilating drops in child eye exams?
Dr. Boulet examines real world results from assessing the refractive state of two, six-and-a-half-year-old twins. The examples show how important cycloplegia refraction can be.
Cycloplegic or, ‘wet’ refraction is a procedure frequently used in eye clinics for reasons of both health and function. The refractive state is assessed in the ‘dry’ state, that is, as the patient exists normally day-to-day, and then drops are put into the eyes to relax the accommodative (focusing) system and to open the pupil. After a given period of time, the refractive state is reassessed in this ‘relaxed’ state. Before cycloplegia, the eyes and binocular vision can be stressed and unstable. Assessing refraction and binocular vision in this unstable state can be difficult and lead to variable measurements.
Cycloplegia is especially helpful in defining refractive status in the case of progressive myopia, moderate/high astigmatism and hyperopia (far-sighted). In cases of hyperopia especially, the mydriatic (pupil-dilating effect) will also be helpful to rule out other medical conditions such as Optic Nerve Hypoplasia, and the effects of Retinopathy of Prematurity (ROP).
Provided health is clear, appropriate optical correction should lead to good outcomes — this can include surgical intervention, contact lens, or iseikonic spectacles (www.shawlens.com). Add to this oculomotor and visuomotor skills training to ensure there are no deficits in this area.
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