Long-Acting vs. Short-Acting Mydriatics for Children's Eye Care - Ophthalmology

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Should long-acting or short-acting mydriatics be used?


Hello, my child is currently 7 years old, and both eyes have a vision of 0.8 (measured after three applications of a short-acting dilating agent; the doctor said it is true myopia).
I have read many articles online stating that long-acting dilating agents are more effective, but the ophthalmologist still prescribed a short-acting dilating agent at a concentration of 0.5% (tropicamide), stating that it should be used until middle school.
I would like to ask if using a long-acting agent would be more effective in this situation.
Thank you.

inzu, 30~39 year old female. Ask Date: 2022/05/14

Dr. Gao Pilin reply Ophthalmology


Hello Inzu: According to research, only long-acting agents are effective.
Regarding the use of mydriatics, you can refer to the following link: https://bit.ly/3yz5nht

Reply Date: 2022/05/14

More Info


When considering the use of mydriatic agents (dilating eye drops) for children's eye care, particularly in the context of managing myopia (nearsightedness), it's essential to understand the differences between short-acting and long-acting mydriatics, their effectiveness, and their potential side effects.

Short-Acting vs. Long-Acting Mydriatics:
1. Short-Acting Mydriatics: These typically include agents like tropicamide, which are commonly used for routine eye examinations. They usually cause pupil dilation for a shorter duration (about 4 to 6 hours). While they are effective for diagnostic purposes, their effects may not be sufficient for therapeutic interventions in cases of significant refractive errors or myopia progression.

2. Long-Acting Mydriatics: Agents such as atropine are considered long-acting and can provide dilation for up to 24 hours or more. Research has shown that atropine, particularly in low doses, can be effective in slowing the progression of myopia in children. This is thought to be due to its ability to relax the ciliary muscle, reducing the eye's accommodative effort, which is a contributing factor to myopia development.

Effectiveness in Children:
In your case, your child has been diagnosed with true myopia, and the ophthalmologist has prescribed short-acting mydriatics. While there is evidence supporting the use of long-acting agents like atropine for myopia control, the decision to use one over the other often depends on the specific clinical situation, the degree of myopia, and the child's overall eye health.
The ophthalmologist may have chosen short-acting mydriatics for several reasons:
- Safety and Side Effects: Short-acting agents generally have fewer side effects and are less likely to cause prolonged visual disturbances, which can be particularly important for children who need to engage in daily activities like schoolwork.

- Monitoring and Follow-Up: Using short-acting agents allows for more frequent monitoring of the child's vision and refractive status without the extended effects of long-acting agents.

Potential Side Effects:
Both types of mydriatics can cause side effects, including light sensitivity, blurred vision, and in some cases, increased intraocular pressure. Long-term use of certain mydriatics, particularly in higher doses, has been associated with potential risks such as cataract formation or retinal changes, although this is still a topic of ongoing research.

Conclusion and Recommendations:
In conclusion, while long-acting mydriatics may offer benefits in controlling myopia progression, the choice of treatment should be individualized based on the child's specific needs and the ophthalmologist's clinical judgment. If you have concerns about the effectiveness of the prescribed treatment or the potential for myopia progression, it is advisable to discuss these with your child's eye care provider. They can provide insights into the rationale behind their treatment choice and whether a trial of long-acting mydriatics may be appropriate in your child's case.

Additionally, maintaining good eye care practices, such as ensuring proper lighting during reading, taking regular breaks during prolonged near work, and encouraging outdoor activities, can also play a significant role in managing myopia in children. Regular follow-ups with the eye care professional will help monitor your child's vision and adjust treatment as necessary.

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