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The Child Eye Health Study

The Child Eye Health Study: A Better Approach to Eye Exams for Children

Summary of the Impact: 

Eye exams for children often involve eye drops to measure their prescription because young eyes can adjust their focus much more effectively than adult eyes. Cyclopentolate temporarily relaxes the eye’s focusing ability, but it can sting, and current guidelines suggest waiting 30 minutes after instilling cyclopentolate before testing can begin. These factors can make the process stressful for children and parents alike and limit the number of patients seen by the clinic in a day.

This study investigated whether using a numbing drop, proxymetacaine before cyclopentolate could reduce stinging and shorten wait times without compromising test results. The research found that prescription measurements equivalent to those obtained after the standard 30-minute wait could be achieved in 10 minutes when proxymetacaine was used beforehand.

By reducing waiting times and making the process less distressing, this approach could enable clinics to see more children daily, improve patient cooperation, and facilitate early detection of vision issues. This is especially important as 80% of a child’s learning is visual, and regular, stress-free eye exams can support their development and education.

A paper entitled 'Impact of Proxymetacaine on the Dynamics of Cyclopentolate in White 6-7-year-olds' was published in Ophthalmic and Physiological Optics, a leading multidisciplinary journal focused on vision science and optometry research.

Research Description:

To accurately determine a child’s prescription, the eye’s focusing ability (accommodation) must be fully relaxed. Without this, measurements may be skewed by the eye’s natural ability to focus on near objects, leading to an incorrect prescription. Cyclopentolate is an eye drop used to relax the eye, but it can sting upon instillation and requires a 30-minute wait for the effect to take hold. Proxymetacaine, a numbing drop, can be used beforehand to reduce stinging and, in theory, improve the absorption of cyclopentolate.

This study focused on white children aged 6–7 years, who typically have stronger accommodation than older children. It addressed two key questions:

  1. Can prescription measurements be obtained earlier than the current 30-minute guideline in this younger population?
  2. Does using proxymetacaine make a difference in how quickly cyclopentolate takes effect?

The findings showed that measurements equivalent to those taken 30 minutes after cyclopentolate alone could be achieved 10 minutes after using proxymetacaine and cyclopentolate together. This reduced wait time means that clinics can see more patients without compromising clinical outcomes.

Description of the Impact:

This research can potentially enhance the efficiency and accessibility of paediatric eye care. Reducing wait times from 30 to 10 minutes means clinics can see more children daily, which is particularly valuable in busy practices or regions with limited access to eye care.

By facilitating timely and less stressful eye exams, the findings support the regular monitoring of children’s vision, ensuring that issues are detected and managed early. Previous studies have shown that children better tolerate proxymetacaine than cyclopentolate alone, with fewer children crying or resisting cyclopentolate eye drops when proxymetacaine is used beforehand. Although comfort was not measured directly in this study, reducing stinging and wait times helps to make eye exams less intimidating and more manageable for young children. As learning is heavily visually dependent, making comprehensive eye care less daunting can help children achieve their full potential in education and development.

While this study focused on white children, it lays the groundwork for future research to determine whether the findings are applicable across different ethnicities. Ultimately, the approach offers a framework for evidence-based improvements to paediatric eye care, promoting better outcomes for children globally.

What SDG goals does this contribute to?

  • 3.8: Good health and well-being for all ages – Enhancing the efficiency of paediatric eye care facilitates, early diagnosis and treatment of vision problems, improving overall health outcomes.
  • 3.8.1: Coverage of essential health services. This study directly enhances the quality and accessibility of essential paediatric eye care services. By shortening the exam process and improving tolerability, the approach may increase coverage and uptake, especially in resource-constrained or time-limited clinical settings.
  • 4.1.1: Quality Education – Vision problems in children can negatively impact learning and academic performance. Reducing barriers to effective eye exams supports children’s education, long-term development and ability to achieve minimum proficiency levels in reading and mathematics.
  • 10.2: Reduced Inequalities – Providing a practical, evidence-based protocol facilitates equitable access to eye care for all children, fostering greater health equality. Although the study is limited to white children, the future-facing ambitions of extending findings to other populations, especially under-represented or marginalised groups, supports more equitable access to diagnostics. Improved procedures can mitigate disparities in healthcare experience and outcomes, especially for children less likely to access routine care.

Evidence/Sources to Corroborate Research Impact:

Testimonials:

Testimonial 1 (parent):

"In our past experience, getting drops has been a real ordeal for [our child]. There has been tears every time and I have brought a pillow for them in the car as they would fall asleep afterwards. We have never had this experience getting the drops done in TU Dublin. I also think they worked a lot more quickly than ones she has gotten in previous years."

Testimonial 2 (professional):

"I find that using proxymetacaine drops before cycloplegia is hugely beneficial in practice. Children and teens can better tolerate cyclopentolate, and it takes effect significantly faster. The application of the drops is easier – the first drop (proxymetacaine) is cool from the fridge and the child notices the drop is chilled which distracts from the slight sting and it is something to talk about to distract them. Then the cyclopentolate drop is room temperature. So as the proxymetacaine is in, the child hardly feels the second drop at all. Both the parents and children prefer it." – Orla McAnallen, Barrett Opticians

Research References:

 

The Child Eye Health Study: A Better Approach to Eye Exams for Children Case Study