Aceclidine, brimonidine tartrate, and dapiprazole: comparison of miotic effect and tolerability under different lighting conditions.

Purpose: To evaluate the effect on pupil diameter of three different miotic eye-drops: aceclidine, brimonidine tartrate 0.20% and dapiprazole, when applied topically in normal subjects Methods: The eyes of 30 healthy volunteers were included in this study. Pupil diameter was measured under scotopic, mesopic (4 lux) and photopic (50 lux) conditions, using an infrared pupillometer, in conjunction with a CSOTM topographer. The first measurement was obtained before the sole instillation of the three different kinds of eye drops. Afterwards, measurements were performed after 30, 120 and 240 minutes. Each additional eye medication was tested further after at least a 10 day interval in order to avoid any possible drug interference. Every patient received a questionnaire to grade the tolerability of each kind of eye drops by a subjective scoring system. Results:Aceclidine had an unimportant miotic effect. Brimonidine caused significant miosis within 30 and 120 minutes: then the effect reduced without reaching the initial baseline at the forth hour in all different luminance conditions. Dapiprazole had a quite similar miotic effect to brimonidine but it produced many side effects, including hyperemia and burning, which caused too much discomfort for most of patients. Conclusions: Brimonidine tartrate 0.20% seems to have the best miotic effect together with good patient tolerability in comparison with aceclidine and dapiprazole. The reproducible miotic effect of this eye drop under all lighting conditions might help postoperative refractive patients who report night-vision difficulties related with large pupils.