{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T20:50:51Z","timestamp":1770843051160,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009248","name":"Innovatiefonds Zorgverzekeraars","doi-asserted-by":"publisher","award":["n.a."],"award-info":[{"award-number":["n.a."]}],"id":[{"id":"10.13039\/501100009248","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare the refractive outcome and residual accommodation with respect to various degrees of iris and skin pigmentation in hypermetropic children using 2 drops of cyclopentolate 1% (C\u2009+\u2009C) or 1 drop of cyclopentolate 1% and 1 drop of tropicamide 1% (C\u2009+\u2009T).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred fifty\u2010one hypermetropic children were classified according to iris and skin pigmentation (light, medium, dark) and received randomized and double\u2010blind C\u2009+\u2009C or C\u2009+\u2009T. Refractive error (spherical equivalent, SEQ) was determined using the Retinomax\u2010K\u2009+\u20093. In 204 subjects, residual accommodation (RA) was determined using the PlusoptiX PowerRefractor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A linear mixed model with a light\u2010irided and light skin\u2010pigmented reference group receiving C\u2009+\u2009T (mean SEQ +3.10\u2009\u00b1\u20091.87D) indicated significant less hypermetropia in subjects with a dark iris having a medium\u2010 and dark\u2010pigmented skin in C\u2009+\u2009T, \u22121.02\u2009\u00b1\u20090.29 (\u22121.59\/\u22120.45) and \u22121.53\u2009\u00b1\u20090.30 (\u22122.10\/\u22120.95); and in subjects having a light\u2010, medium\u2010 and dark\u2010pigmented skin in C\u2009+\u2009C, \u22120.74\u2009\u00b1\u20090.34 (\u22121.41\/\u22120.06), \u22121.26\u2009\u00b1\u20090.30 (\u22121.85\/\u22120.66) and \u22121.84\u2009\u00b1\u20090.30 (\u22122.42\/\u22121.26). Similar findings were present for RA. Our model with a light\u2010irided and light skin\u2010pigmented reference group receiving C\u2009+\u2009T (mean RA +0.84\u2009\u00b1\u20090.61D) indicated significantly higher RA in dark\u2010irided subjects with medium\u2010 and dark\u2010pigmented skin in C\u2009+\u2009T, +1.05\u2009\u00b1\u20090.19 (+0.67\/+1.43) and +1.35\u2009\u00b1\u20090.20 (+0.9\/+1.74), and in C\u2009+\u2009C, +1.13\u2009\u00b1\u20090.21 (+0.71\/+1.55) and +1.90\u2009\u00b1\u20090.19 (+1.51\/+2.28).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found solid evidence that skin pigmentation rather than iris pigmentation is the decisive factor for effectiveness of cycloplegics. Awareness of the limitations of cycloplegic regimens in dark\u2010irided\/pigmented children is needed. Our study showed that cyclopentolate 1% combined with tropicamide 1% provides more accurate refractive outcomes both statistically and clinically integrating the factor skin pigmentation for dark\u2010irided subjects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.15016","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T05:33:13Z","timestamp":1634794393000},"page":"454-461","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Eye colour and skin pigmentation as significant factors for refractive outcome and residual accommodation in hypermetropic children: a randomized clinical trial using cyclopentolate 1% and tropicamide 1%"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-8815","authenticated-orcid":false,"given":"Helena M.","family":"van Minderhout","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Haaglanden Medical Centre  The Hague The Netherlands"},{"name":"Department of Ophthalmology Pediatric Ophthalmology Leiden University Medical Centre  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurits V.","family":"Joosse","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Haaglanden Medical Centre  The Hague The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana C.","family":"Grootendorst","sequence":"additional","affiliation":[{"name":"Landsteiner Institute, Research and Development Haaglanden Medical Centre  The Hague The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoline E.","family":"Schalij\u2010Delfos","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Pediatric Ophthalmology Leiden University Medical Centre  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"217","article-title":"Iris melanocyte numbers in Asian, African American, and Caucasian irides","volume":"101","author":"Albert DM","year":"2003","journal-title":"Trans Am Ophthalmol Soc"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-1313.2009.00679.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.1964.5.1.62"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.06-0604"},{"key":"e_1_2_5_6_1","first-page":"1029","article-title":"Comparison of cyclopentolate versus tropicamide cycloplegia in children","volume":"1993","author":"Egashira SM","year":"1993","journal-title":"Optom Vis Sci"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.3921\/joptom.2008.36"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1961.00960010338007"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.1988.tb04069.x"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-199902000-00017"},{"key":"e_1_2_5_11_1","first-page":"897","article-title":"Time of maximum cycloplegia after instillation of cyclopentolate 1% in children with brown irises","volume":"10","author":"Laojaroenwanit S","year":"2016","journal-title":"Clin Ophthalmol"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/APO.0000000000000254"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e31816bf58b"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-199308000-00013"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1972.01000020517004"},{"key":"e_1_2_5_16_1","first-page":"518","article-title":"A non\u2010cycloplegic refraction technique for infants and young children","volume":"48","author":"Mohindra I","year":"1977","journal-title":"J Am Optom Assoc"},{"key":"e_1_2_5_17_1","first-page":"299","article-title":"Comparison of 0.5% cyclopentolate plus 0.5% tropicamide and 1% cyclopentolate alone for mydriasis of dark irides","volume":"3","author":"Nishizawa AR","year":"1988","journal-title":"Can J Ophthalmol"},{"key":"e_1_2_5_18_1","first-page":"475","article-title":"Comparative study of residual accommodation after installation of the following eyedrops: 1% tropicamide, 1% cyclopentolate and 1% tropicamide, 1% cyclopentolate","volume":"63","author":"Pinheiro RK","year":"2000","journal-title":"Arch Bras Ophthalmol"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-5155(99)00113-6"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-008798"},{"key":"e_1_2_5_21_1","first-page":"1","article-title":"A randomized clinical trial using atropine, cyclopentolate and tropicamide to compare refractive outcome in hypermetropic children with a dark iris; 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