Comparison of ocular accommodation throughout the day in children using 0.05% low‐dose atropine versus controls: A pilot study

PURPOSE: The purpose of this pilot study was to assess the effect of 0.05% low-dose atropine on ocular accommodation (amplitude and accuracy) and how its effect changed throughout the day. METHODS: Sixteen children aged 6-16 years using 0.05% atropine and 16 controls not using atropine were enrolled. Monocular accommodative amplitude was measured objectively using a Grand Seiko WAM-5500 open field autorefractor (formerly manufactured by RyuSyo Industrial Co.) and subjectively using the push-up method. Accuracy of accommodation was measured using monocular estimation (MEM) retinoscopy. All measures were taken at three study visits over a single day to assess change over time. Measures of accommodative amplitude and accuracy were compared using a 2-way analysis of variance (ANOVA). Nonparametric analyses were performed to compare MEM retinoscopy using the Mann-Whitney U-test and Friedman's test. RESULTS: Objectively measured accommodative amplitude was significantly lower in the 0.05% atropine group (morning: 5.99 ± 2.28D, midday: 6.17 ± 2.06D, afternoon: 7.08 ± 1.82D) compared to the control group (morning: 7.68 ± 1.59D, midday: 7.62 ± 1.93D, afternoon: 7.63 ± 1.48D) at the morning and midday visits (p = 0.01, 0.03). There was no difference between groups at the afternoon visit (p = 0.40). In the 0.05% atropine group, objectively measured amplitudes were greater at the afternoon visit compared to those of the morning and midday visits (p < 0.01). There were no significant differences throughout the day in the push-up amplitude of accommodation or MEM retinoscopy. CONCLUSIONS: When measured objectively, accommodative amplitude in children using 0.05% low-dose atropine was reduced compared to controls during the morning and midday visits and increased over the day reaching a level comparable to that of the control group by the afternoon visit. Common clinical measures of accommodative ability, including subjective amplitude of accommodation using the push-up test and accommodative accuracy using MEM retinoscopy, did not demonstrate these same differences.