Comparative efficacy of tropicamide 1% and cyclopentolate 1% for cycloplegic refraction: A systematic review and meta-analysis of randomized controlled trials.

Abstract

Background: Cyclopentolate 1% is considered the drug of choice for effective cycloplegic refraction in clinical population, although tropicamide 1% is also reported to have similar effects with better tolerability.

Objectives: The objective of this meta-analysis was to evaluate the efficacies of tropicamide 1% and cyclopentolate 1% for cycloplegic refraction.

Data sources: MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched for articles published until March 20, 2024.

Study eligibility criteria, participants, and interventions: Randomized controlled trials that compared tropicamide 1% with cyclopentolate 1% in terms of differences in spherical equivalent refractive errors were included. The meta-analysis included only nonstrabismic participants with no restriction to age.

Study appraisal and synthesis method: The included studies were appraised using the Cochrane Risk of Bias Tool-2. The meta-analysis was conducted using the random-effects model with restricted maximum likelihood estimation method.

Results: Of 17 full-text reviews from 2555 identified studies, 4 randomized controlled trials were included in quantitative synthesis. The meta-analysis included 171 eyes of 171 participants (age range, 4 months to 50 years), in each group, with all types of refractive errors. The results showed no statistically significant differences in mean spherical equivalent refractive error values between the two groups (mean difference, -0.05; standard error, 0.16; p=0.774). There was no heterogeneity observed between the studies ( I2 = 0.00%, p=0.93). The outcome did not change when only children were included in the meta-analysis (age range, 4 months to 16 years; mean difference, -0.14; standard error, 0.21; p=0.51). In the risk-of-bias assessment, generally all studies were judged to have low risk of bias, but only one was judged to have low risk of bias across all seven domains.

Conclusions: Tropicamide 1% and cyclopentolate 1% showed similar efficacies for cycloplegic refraction in nonstrabismic children and adults. Considering patient tolerability and drug safety, it may be practical to use tropicamide 1% in routine cycloplegic refractions.