Pharmacologic Mydriasis and Cycloplegia: A Review of Novel Delivery Devices

Abstract

Pharmacologic mydriasis, or pupillary dilation, is achieved using various agents, and is an important component of a comprehensive eye examination. Of the medications available to achieve mydriasis, the most favourable are those with a rapid onset and a low risk of causing side effects. The current standard of care is to administer multiple drops of different medications to achieve mydriasis. However, a number of innovations in the field are addressing this shortcoming. Fixed-combination eyedrop therapy has been suggested as a more efficient method, with the potential to cause fewer side effects. Additionally, novel drug delivery devices have been devised to further improve efficiency and decrease waste by delivering smaller volume drops with greater precision. Two devices of current interest are the Nanodropper (Nanodropper, Inc., Rochester, MN, USA) and Optejet® (MydCombi™; Eyenovia, Inc., New York, NY, USA). Recent studies of these devices have shown their ability to achieve similar levels of mydriasis as conventional medications without additional side effects. Furthermore, the Optejet has shown in two phase III trials that fixed-combination therapy is able to achieve greater pupil dilation compared with the current standard. This review provides an overview of pharmacologic dilation and reviews these emerging technologies.