The effect of pupil dilation with tropicamide on vision and driving simulator performance

Potamitis, Theo; Slade, Sarah V.; Fitt, Alan W D; Mallen, Edward A. H.; Auld, Rosemary; Dunne, Mark; Murray, Philip I.

doi:10.1038/eye.2000.77

Cited by 25 publications

(18 citation statements)

References 13 publications

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“…10 In a study of 28 patients, all of whom had fulfilled the UK visual requirements for driving before dilating drops, 22% failed to read a standard number plate at 20 m indoors post dilation and 14% of patients felt unsafe to drive.…”

Section: Discussionmentioning

confidence: 99%

“…Mydriasis, however, increases screening time and can cause inconvenience to the patient especially those needing to drive and/or return to work. [10][11][12] We have assessed the detailed reasons, and predictors for an ungradeable nonmydriatic image. Predicting patients who fail nonmydriatic photography could help make screening more efficient by anticipating the need for mydriasis.…”

Section: Introductionmentioning

confidence: 99%

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Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy?

Murgatroyd

Cox

Ellingford

et al. 2006

Eye

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Purpose We aimed to determine the reasons for, and variables which predicted, ungradeable retinal photographs during screening patients for diabetic retinopathy. Materials and methods Age, duration of diabetes, visual acuity, and HbA1c were recorded. Following dark adaptation, a single 451 nonmydriatic photograph was taken of each fundus. The pupils were then dilated and the photograph repeated. Using slit lamp biomicroscopy, lenticular changes (LOCS III), and fundus appearance were recorded. Results In ungradeable photographs the fovea could not be visualised in 98% of cases of images from nonmydriatic photography, and in 88% if mydriasis was used. Poor definition in the nonmydriatic image was associated with a subsequent ungradeable mydriatic photograph (P ¼ 0.001), however, the positive predictive value was poor (34%). Age, posterior subcapsular cataract, and near vision predicted ungradeable status of nonmydriatic photographs (Po0.001, P ¼ 0.004, P ¼ 0.006, respectively; regression analysis). Nuclear colour and poor definition of the nonmydriatic photograph predicted ungradeable status of mydriatic photographs (P ¼ 0.006 & P ¼ 0.001, respectively). Conclusion Inability to visualise the fovea is the commonest cause of an ungradeable image from digital retinal photography. Age and posterior subcapsular cataract were best predictors of ungradeable status of nonmydriatic fundus photographs. Nuclear colour was the strongest predictor for ungradeable mydriatic photography.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy?

Murgatroyd

Cox

Ellingford

et al. 2006

Eye

View full text Add to dashboard Cite

show abstract

“…14 Pupillary dilation can also impair aspects of driving performance, and reduced contrast sensitivity is likely to be a contributing factor to this. 1,4 We believe patients should be warned that even if they satisfy the current legal requirements for driving after tropicamide administration, their vision can still be significantly impaired. The extent to which this affects their safety, and the safety of others, is still to be definitely answered and may vary between individuals.…”

Section: Resultsmentioning

confidence: 99%

“…1 However, others studies have shown only limited effects on high-contrast acuity and PelliRobson contrast threshold and no significant effects on low-contrast visual acuity and field of vision. [2][3][4] The aims of this study were to determine the effects of pupil dilatation on colour discrimination, and on contrast sensitivity over a wide range of spatial frequencies.…”

Section: Introductionmentioning

confidence: 99%

Changes in chromatic and achromatic contrast sensitivities following tropicamide administration

Lee

Ong

Rajak

et al. 2005

Eye

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Purpose To investigate the effects of tropicamide on chromatic and achromatic contrast sensitivities over the physiological range of spatial frequencies. Methods A total of 26 healthy volunteers, with a mean age of 32 years, were examined with and without one drop of 1% tropicamide being administered 30 min previously. On each occasion, acuity and pupil diameter were recorded, and chromatic and achromatic contrast sensitivities were examined using the Sussex Grating Machine. Results Following tropicamide administration mean pupil diameter increased from 4.1 mm to 7.2 mm (Po0.001), and mean BCVA was reduced by 0.07 LogMar units (Po0.001). Achromatic contrast sensitivity was significantly reduced following tropicamide administration at 2.20 cycles per degree (cpd) (P ¼ 0.01), 3.40 cpd (P ¼ 0.01), 10 cpd (P ¼ 0.04), 17 cpd (P ¼ 0.04), and 25 cpd (Po0.01). There was no difference in contrast sensitivity at lower spatial frequencies (0.33 and 0.66 cpd). Chromatic contrast sensitivity was not significantly altered when tested along the red-green and tritan confusion axes. Conclusions Achromatic contrast sensitivity is significantly reduced following tropicamide administration at intermediate and high spatial frequencies. No significant changes were seen at low spatial frequencies and in chromatic contrast sensitivities.

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“…Mydriasis using tropicamide 1% can interfere with the patient's lifestyle by reducing visual acuity and decreasing their amplitude of accommodation, restricting driving and the return to employment. [9][10][11][12] This may discourage attendance for the screening visit particularly in the younger age group who are more at risk for non-attendance. 13 A recent study found that many return to work and drive immediately after the appointment and the introduction of the routine use of drops may discourage attendance.…”

Section: Introductionmentioning

confidence: 99%

Targeted mydriasis strategies for diabetic retinopathy screening clinics

Dervan

O’Brien

Hobbs

et al. 2010

Eye

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Purpose To examine factors necessitating pupil dilation to achieve gradable diabetic screening photographs using a digital non-mydriatic camera and to establish techniques to predict the need for dilation and to validate them. Methods Prospective clinic-based crosssectional study with follow-up validation study. The participants' involved consecutive patients attending the diabetic retinopathy screening clinic at a University Hospital. Best corrected visual acuity, age, sex, pupil size, mean spherical equivalent, cataract grade and the requirement for dilation to achieve gradable photographs in 90 patients were recorded. Data analysis using principal component analysis and multivariate analysis of variance derived a set of equations to predict the requirement for dilation. The predictive powers of these equations were validated in an independent group of 51 patients. Results Smaller pupil size, denser nuclear colour, older age, poorer best-corrected visual acuity, cortical lens opacity and posterior subcapsular lens opacity were associated with the need for dilation (Po0.001 in all). Single variables used in isolation had a poorer predictive value than combining variables. Dilating patients with either a pupil size 43.75 mm or age 459 years correctly allocates 83 and 78% of patients, respectively to dilation or not. Combining pupil size with age produces a decision table that improves the predictive value to 84%. In the validation study this table had a predictive value of 80%. Conclusion We have produced and validated criteria based on a range of clinical variables for application in a clinical setting that allows for the development of targeted mydriasis.

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The effect of pupil dilation with tropicamide on vision and driving simulator performance

Abstract: The effect of pupil tested for statistical significance at the 95% level using one-tail paired t-tests.

Cited by 25 publications

References 13 publications

Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy?

Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy?

Changes in chromatic and achromatic contrast sensitivities following tropicamide administration

Targeted mydriasis strategies for diabetic retinopathy screening clinics

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