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Mydriatic Visual Acuity in Diabetic Patients: A Randomized Controlled Trial

Heus, Pauline*; van Trijffel, Emiel*; Busch, Eelco M.; Lucas, Cees

doi: 10.1097/OPX.0b013e31828b38f5

Purpose The aim of this randomized controlled equivalence trial was to demonstrate that, in diabetic patients, dilating the pupils before as compared with after refraction and visual acuity assessment would not lead to different advice given to patients.

Methods Three hundred sixteen adult patients with diabetes mellitus were randomized. The experimental group was administered tropicamide 0.5% before refraction and visual acuity assessment and the control group after refraction and visual acuity assessment. Study outcomes were the advised time till next visit, the advice on adjustment of refractive correction, further diagnostics, treatment, duration of the eye examination, and patient satisfaction.

Results No difference was seen in advised time till next visit between the experimental group (12.39 ± 5.01 months) and the control group (12.84 ± 4.96 months) (p = 0.425). In addition, the advice concerning adjustment of refractive correction (p = 0.069), further diagnostics (p = 1.000), and therapy (p = 0.178) did not significantly differ. Waiting time was significantly shorter for the experimental group (22.25 vs. 36.18 minutes; p < 0.001). People in the experimental group were relatively more often “very satisfied” than “satisfied” in comparison with participants in the control group for “attention being paid by the optometrist” (p = 0.025) and “advice on refractive correction” (p = 0.047).

Conclusions In diabetic patients, dilating pupils before refraction and visual acuity assessment does not lead to different advice given to patients compared with dilating pupils after refraction and visual acuity assessment, whereas waiting time significantly decreases and patient satisfaction is similar or even better. Increased efficiency is beneficial to both patients and clinicians.



Ophthalmology Department, Medical Center Alkmaar, Alkmaar, The Netherlands (PH, EMB); and Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands (PH, EvT, CL).

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Pauline Heus Medisch Centrum Alkmaar polikliniek oogheelkunde (011) Wilhelminalaan 12 1815 JD Alkmaar The Netherlands e-mail:

© 2013 American Academy of Optometry