EFFECT OF PHENYLEPHRINE HYDROCHLORIDE ON AMPLITUDE

OF ACCOMODATION

BY

MBANAJA PEACEPUL.N.

201318833667

A THESIS SUBMITTED TO THE DEPARTMENT OF OPTOMETRY,

SCHOOL OF HEALTH SCIENCE TECHNOLOGY,

FEDERAL UNIVERSITY OF TECHNOLOGY,OWERRI

SUPERVISED BY

DR.E.C. ESENWAH

1
 TABLE OF CONTENT

Title page

Table of Content

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background

1.2 Statement of Problems

1.3 Objective of Study

1.4 Research Questions

1.5 Research Hypothesis

1.6 Significance of study

1.7 Scope of Study

1.8 Limitations of study

CHAPTER TWO

LITERATURE REVIEW

CHAPTER THREE

3. 0 MATERIALS AND METHODS

2
3.1 Area of Study

3.2 Research Design

3.3 Population of Study

3.3.1 Inclusion Criteria

3.3.2 Exclusion criteria

3.4 Sample Size Determination

3.5 Sampling Technique

3.6 Instruments and Materials for Data Collection

3.6 Validation of Instrument

3.7 Procedure and Data Collection

3.8 Procedure for Data Analysis

3.8 Ethical Consent

REFERENCES

3
 Abstract
Phenylephrine hydrochloride (PHCL) is a medication that is used to dilate the pupil
to achieve mydriasis. The study was carried out to determine the effect of 5%
phenylephrine on amplitude of accommodation of 30 subjects between the ages of
18-30 years old with a mean age of 23.20+2.38 participated in the study. The
amplitude of accommodation (AA) was assessed before and after 15 and 30 minutes
instillation of 5% phenylephrine hydrochloride. The mean amplitude of
accommodation values were 9.215+2.14 before the installation and 8.238+1.50 after
15 minutes instillation of 5% phenylephrine hydrochloride and 8.050+1.57 after 30
minutes of instillation of 5% phenylephrine hydrochloride. Statistical analysis with
version 21 of spss software using a two tailed paired sample test at 0.05 level of
significance showed a significant difference between baseline AA and after 15mins
instillation of 5% PHCL AA (p(0.03)<0.05 and between baseline AA and after
30mins instillation of 5% PHCL AA (p(0.00<0.05) but showed no significant
difference between 15 and 30mins (p(0.558)>0.05). it was found that
5%phenylephrine hydrochloride has an effect amplitude of accommodation, but the
effect is modest than that seen in cyclopegia, and can be said to be clinically
irrelevant therefore it can be used for researches and clinical examinations to dilate
pupil without hampering accommodation.

4
 CHAPTER ONE

2.0 INTRODUCTION

1.1 BACKGROUND

Phenylephrine Hydrochloride (PHCl) is a selective α-adrenergic receptor agonist

used primarily as a decongestant; an agent to dilate the pupil and to increase blood

pressure (josé et al. 2016). In the clinic it is used as a mydriatic agent, in the form of

eye drops, to dilate the pupil before eye surgery or eye examination. Phenylephrine

hydrochloride have a wide range of concentrations and additives depending on the

desired effect. Concentrations utilized by medical professionals generally come in

doses of 1%, 2.5%, 5% or 10%. 1% formulations are often administered in

combination with cyclopentolate 0.2% for dilated fundus and cycloplegic exams in

newborns less than 3 months. The 2.5% and 5% formulations are the most

commonly used for dilated fundus exams in adults, children over three months, and

as an aid in diagnosing conditions such as episcleritis. The 10% formulation is less

commonly used (due to fear of systemic absorption) in dilated exams and to provide

exposure during surgeries (Evan recharge 2006).

As stated earlier this medication is used to dilate the pupils

for eye examinations or procedures, and to treat certain eye conditions. Phenylephrine

produces its ophthalmic and systemic actions by acting on alpha 1 adrenergic

5
receptors in the pupillary dilator muscle and the vascular smooth muscle, resulting

in contraction of the dilator muscle and contraction of the smooth muscle in the

arterioles of the conjunctiva.

Onset of action: Rapid

Time to peak effect: within 30 to 60 minutes

Total recovery of accommodation takes 3 hours

Side effects include

I. Burning or stinging sensation in the eyes

II. Headache or brow ache

III. sensitivity of eyes to light

IV. watering of eyes

Accommodation

Solani, et al.,(2016) defined accomodation as the eye’s mechanism by which it

adjusts its power to focus on objects at different distances. Accommodation is

mediated by the parasympathetic fibers of cranial nerve III (oculomotor The

accommodative response may be stimulated by the known or apparent size and

distance of an object or by blur, chromatic aberration, or a continual oscillation of

6
ciliary tone. With accommodation, the lens diameter decreases, the lens equator

moves away from the sclera and the curvature of the anterior and posterior lens

surfaces changes, resulting in dioptric power increases in the lens and eye. 4,6,7 In

distance vision, the crystalline lens is held in a relatively relaxed state under the

tension of the zonules of Zinn (the suspensory ligament Parasympathomimetic drugs

(eg, pilocarpine) induce accommodation, whereas parasympatholytic medications

(eg, atropine) block accommodation. When the eye is in an unaccommodated state,

the radius of curvature of the crystalline lens is compressed (khurana and

khurana,2012).

Accommodation response can be stimulated by either placing a target closer to the

eyes or placing minus lens before the eyes. This will cause an increase in the

vergence of the light entering into the eyes making them to focus at a point behind

the retina and thus, leaving a blur circle(Grosvenor,2007).

Components of accommodation

Proximal Accommodation: it is the accommodation due to the influence or

knowledge of apparent nearness of an object.”it is stimulated by targets located

7
within 3m of the individual”, hence its name(Benjamin, 2006). Proximal

accommodation is stimulated by perceptual cues.

Reflex Accommodation: it is the autonomic adjustment of refractive state to obtain

and maintain a sharply defined and focused retinal image (Benjamin, 2006). This

occurs for blur up to approximately 2.00 diopters. Beyond this, voluntary

accommodative effort is required. It is the largest and most important component of

accommodation both under monocular and binocular conditions.

Tonic accommodation: it is the accommodation is revealed in the absence of blur,

disparity, and proximal inputs as well as any voluntary or unusual learned aspects.

There is no stimulus for tonic accommodation, as there is for the other components.

Rather, it is presumably reflects baseline neutral innervation from the midbrain and

thus represents stable input (Benjamin, 2006).

Vergence Accommodation: it is the accommodation induced by the innate

neurologist linking and action of disparity vergence. This gives rise to the

convergence accommodation/convergence (CAFC) ratio, which is approximately

0.04D per meter angle (MA) in young adults. This is the second major component

of accommodation (Benjamin, 2006).-±

8
Amplitude of accommodation

The amplitude of accommodation (AA) is the amount of change in the eye’s

refractive power that is produced by accommodation. It diminishes with age and

may be affected by some medications and diseases. Adolescents generally have 12-

16 D of accommodation, whereas adults at age 40 have 48 D.After age 50,

accommodation decreases to less than 2 D. It can also be the greatest increase in

refractive power an eye can undergo. Amplitude of accommodation can be simply

calculated by taking the reciprocal of the near point of accommodation, expressed

in meters.(Grosvenor, 2007). ] The point at which accommodation is maximally

exerted is called the Near Point of Accommodation (NPA). Amplitude of

Accommodation (AA) is the amount of accommodation exerted to move

the focus from the far point to the near point(chiranjit, et al., 2018).

Methods of determining Amplitude of Accommodation (AA)

There are different methods of determining a patient’s amplitude of accommodation,

some of them include:

The push-up-to-blur/; the subjects will monocularly viewed a near-point card,

while wearing their correct prescriptions, accommodation Convergence Rule

which will be placed in the primary fixation position, on the brow above the eye

9
being tested, subjects will asked to view a single line of text on the near-point card.

The target will be placed in front of the subject’s right eye at 40cm and brought

closer to the subject until the first sustained blur is reported. The speed of the target

will be the same. The distance at which the first sustained blur is reported is known

as the near point of accommodation, amplitude of accommodation is calculated by

dividing the distance of the sustain blur by 100.

Push away method: subjects monocularly fixate the near chart, while wearing their

correct prescription. Accommodation Convergence Rule will be placed in the

primary fixation position, on the brow above the eye being tested, subjects were

asked to view a single line of text on the near-point card. The target is placed 0.5

cm in front of the subject’s right eye, so the print could not be read. The target is

moved away from the subject’s face in a smooth manner until the subject

Reported that he or she could identify a specified letter on the chart.

 Minus-lens-to-blur method (sheard’s technique) Here, minus lenses will be

introduced before of the patient eye(s), until he reports that the 20/20 or 6/6 line

of the N-series near chart placed at 40cm is blurred sustainably. For example, if

a -4.00D will be added to report blur, then the AA will be 4.00+ 2.50=6.50D

NB: +2.50 was gotten by dividing 100 with the testing distance of

(Grosvenor,2007)

10
Duane- Hofstetter’s Formula: Duane formulated a method for determining AA based

on age. This formula is shown below.

a) Maximum AA=25.0-0.40×Age

b) Average AA=18.5-0.30×Age

c) Minimum AA=15.-0.25×Age

Donder’s table of expectancy: Donders developed a table of expected value of AA

based on age. From the table below, AA decreases with increase in age. [Eliot 2008

Age (Tears) AA (Diopters)

10 14.00

15 12.00

20 10.00

25 8.50

30 7.00

35 5.50

40 4.50

45 3.50

50 2.50

55 1.75

11
60 1.00

65 0.50

70 0.25

75 0.00

12
1.2 Statement of Problems

Clinicians have faced the challenge of carrying out clinical examinations in the eye

through a small pupil and thus have relied on pharmacological agent such as

phenylephrine hydrochloride to dilate the pupil, however, these pharmacological

agents do not only cause dilation of the pupil but also affects accommodation which

affects accommodative examination. Some researches have suggested some loss of

functional accommodation after PHCl instillation, this thesis will help clinicians

know the actual effects of PHCl on the accommodative system of the human eye

1.3 Objective of Study

a) General objective

 To determine the effect of 5% phenylephrine hydrochloride on amplitude of

accommodation.

b) Specific objective

I. To determine the demographic information of the subjects

II. To determine the Amplitude of accommodation of young adult

before the administration of 5% phenylephrine hydrochloride.

III. To determine the Amplitude of accommodation of young adults

after 15minutes instillation of 2.5% phenylephrine

hydrochloride.

13
 IV. To determine the Amplitude of accommodation of young adults

after 30minutes instillation of 2.5% phenylephrine

hydrochloride.

V. To determine if there is any significant difference between

amplitude of accommodation before and after 15 and 30 minutes

instillation of 5% phenylephrine hydrochloride.

1.4 Research Questions

This research work attempts to provide answers to the following questions;

• What is the amplitude of accommodation of subject before the administration

of 5% phenylephrine hydrochloride?

• What is the amplitude of accommodation of subject after 15minutes of

administration of 5% phenylephrine hydrochloride? What is the amplitude of

accommodation of subject after 30minutes of administration of 5%

phenylephrine hydrochloride?

• Is there a specific difference in AA of young adults before and after

administration of 5% phenylephrine hydrochloride?

14
1.5 Research Hypothesis

• HO1- The amplitude of accommodation before and after 15 and 30minutes

instillation of 5% phenylephrine hydrochloride are the same

• HA1- The amplitude of accommodation before and after 15 and 30minutes

instillation of 5% phenylephrine hydrochloride are not the same

1.6 Significance of study

This study provided the information on the effect of phenylephrine hydrochloride on

amplitude of accommodation. It will help the optometrists to make a right choice in

use of diagnostic drug during clinical examinations and also for research purposes.

1.7 Scope of Study

This scope of study involved the measurement of the subjects’ amplitude of

accommodation before the administration of 5% phenylephrine hydrochloride and

after 15 and 30 minutes administration of 5% phenylephrine hydrochloride. The

values obtained before and after 15 and 30 minutes were then compared.

15
1.8 Limitations of study

The problems that I may encountered during the course of this research were;

 Difficulty convincing subjects to instill phenylephrine hydrochloride into

their eyes

 Some subjects were scared of the stinging sensation caused by phenylephrine

hydrochloride therefore refused to participate

 Difficulty bringing the subjects to the Optometry Teaching Clinic ,Federal

University of Technology Owerri.

16
 CHAPTER TWO

LITERATURE REVIEW

Phenylephrine hydrochloride is a mydriatic used widely for various indications.

Phenylephrine hydrochloride is a mydriatic used widely for various indications. It is

sold in concentrations of 10% and 5% drops. Systemic cardiovascular effects like

elevated blood pressure and arrhythmias are reported by the use of 10%

Phenylephrine in susceptible individuals. The effectivity of lower concentrations

(5% and 2.5%) for mydriasis have been reported; blue irides respond favorably to

2.5% concentration while dark irides require 10% concentration().

in the age group 20-40 years, were subjects of this masked study. The criteria for

inclusion in the study were normal general health, no systemic hypertension or

diabetes mellitus. The cases with any active ocular disease, shallow anterior

chambers and patients on any systemic or topical drugs were excluded. The cases

were divided into 4 groups of 10 patients each. Fresh aqueous solution of

Phenylephrine hydrochloride was prepared in concentrations of 10%, 5%, 2.5 and

1.25%. The drugs were coded and used random

Sakar et al.,(2012) carried out a research on the effect of phenylephrine

hydrochloride on static and dynamic characteristics of accommodation. A

total of 16 Indian adult. The test was repeated four times; before and after

17
 instillation of different concentrations of phenylephrine 2.5%,5% and 10%;

using a high-contrast, high spatial frequency visual target displayed on one of

the two liquid-crystal display screens that were placed at 67 and 33 cm,

respectively, in front of the subject. The visual target was electronically

switched between the two screens, once every 4 s, thereby creating an

accommodative demand of 1.5 D. The viewing was monocular while AR was

recorded bilaterally. The result was that the peak velocity of accommodation

with no PHCl significantly was larger than those with all three concentrations

of PHCl, while the data for the three drug concentrations were not

significantly different from each other. According to the authors, the

reduction in accommodative performance is modest and does not carry a large

clinical significance, meaning that PHCl could therefore be used to achieve

pupil mydriasis without dramatically hampering accommodation.

Also in 2012, Richland et al., carried out a study on the effect of phenylephrine on

the ciliary muscle and accommodation. Measurements of pupil size,

accommodation, and ciliary muscle thickness were made both before and 30 min

after instillation of 1% proparacaine and 2.5% phenylephrine. Accommodation was

measured in three ways: subjectively using a push-up technique and Royal Air Force

(RAF) rule, and objectively using both the Grand Seiko auto refractor and Power

Refractor. Images of the temporal ciliary muscle were acquired using the Visante

18
Anterior Segment Optical Coherence Topographer (OCT). Ciliary muscle images

were objectively analyzed using a computer-based segmentation technique. The

result was that the amplitude of accommodation using the push-up test was reduced

by about 1 D with phenylephrine (p < 0.001)

There was statistically significant thickening of the anterior region and thinning of

the posterior region of the ciliary muscle with accommodation (p < 0.001, all

locations). Phenylephrine did not affect either baseline ciliary muscle thickness or

the accommodative contraction of the muscle (p > 0.09).

Therefore it was concluded that Low-dose phenylephrine does not affect ciliary

muscle dimensions, ciliary muscle contractility, or accommodative response to a 4

D near target

Gimpel et al., (1994) carried out a study to determine the effects of PHCl

2.5% on the subjective amplitude of accommodation in 160 healthy eyes

without the prior use of a topical anesthetic. The Near point of

accommodation was measured monocularly by Donders’ push-up method

After the instillation of a single drop of PHCl 2.5% into the test eye,

measurements were repeated for the test eye and contralateral eye every

5 min for 30 min and then every 10 min until a total time period of 90 min.

By 30 min, a net decrease in the subjectively assessed average AA of

19
1.22 D occurred, that is, a net reduction of 10.9% compared to the initial

baseline readings. At 60 min, a reduction of 1.39 D was recorded This

study clearly confirmed that PHCl could reduce the Amplitude of

accommodation as assessed subjectively.

Ostrin et al.,(2004) studied effects of PHCl 10% on pupil diameter and

accommodation were then studied in rhesus monkeys, as they represent a

unique model for human accommodation because they have high AA and

an accommodative mechanism and anatomy as man. The Static and

dynamic EW-stimulated AR were studied in five iridectomized rhesus

monkeys before and after phenylephrine instillation. After the baseline

recordings, two doses of 0.1 mL PHCl 10% were instilled topically,

separated by 2 minutes. The effects of PHCl were not statistically different

before and after PHCl administration. The conclusion was that although

there are individual differences before and after the instillation of PHCl,

these differences are not systematic, and within the resolution of the

methods there are no significant effects of PHCl on amplitude of

accommodation.

In 1998 Eyeson-Annan et al., performed a study to identify any significant

difference between maximum pupil dilation and accommodation after

PHCl 10% alone and PHCl 10% combined with tropicamide 1%, 47
20
subjects participated in the study. The subjects’ AA was measured

binocularly using a near-reading chart at the 0.7 line. The first dilation

regimen, one drop of 0.4% oxybuprocaine hydrochloride was instilled into

the right eye and then the left eye of each subject, followed 30 seconds

later by one drop of PHCl 10% and 5 minutes later by a second drop and a

third drop 5 minutes later. Oxybuprocaine hydrochloric acid was instilled

into the subjects’ eyes to improve absorption of the PHCl. In the second

dilation regimen, one drop of 0.4% oxybuprocaine hydrochloride was

instilled into the right eye and then the left eye of each subject, followed

30 seconds later by one drop of PHCl 10% and followed 30 seconds later

by one drop of tropicamide 1%, repeating the instillation of these two

chemical agents 5 and 10 minutes later. The authors tested also a reversal

regimen to counteract the effects of the mydriasis, by instilling one drop

of 0.4% oxybuprocaine hydrochloride into the right eye and then the left

eye of each subject, followed 30 seconds later by a drop of thymoxamine

hydrochloride 0.5. The authors concluded that accommodation was

impaired significantly more after PHCL and tropicamide than after PHCl

alone. Thus, PHCl alone had no significant effect on the AA of the

subjects,with mean values of 1.60 D and 1.57 D at 20 min and 40 min after

instillation of dilating drops, respectively, in comparison with a baseline

21
 value of 1.53 D. However, tropicamide in combination with PHCl had

significantly decreased the mean AA of the subjects, obtaining values of

0.70 D and 0.80 D at 20 min and 40 min after dilating drops. Measuring 40

minutes after reversal with thymoxamine resulted in a mean

accommodation value of 1.12 D, which still was significantly lower than

the baseline value.

Mordi et al.,(1986)stated the conclusions of a different study to analyze the

effect of the topical instillation of PHCl on accommodation using 10

Caucasian within the age range between the age of 20-26 years. Donders’

push-up method [41] was used to measure the amplitude while the subject

read the words in the 0.62 M test target at 40 cm. Amplitude measurements

were measuredd before and after every 5 min until the subject’s minimum

value was reached, and then the measurements were taken every 20 min

until 50% recovery of the amplitude occurred. Pupil size was measured

under the same lighting conditions. The conclusion was that administration

of PHCl 2.5% does inhibit accommodation by about 15% when used alone

and by over 25% when preceded by anesthetic instillations.

Chawdhary et al., carried out a study on mydriasis use of phenylephrine using a total

of number of 40 subject within the age-group of 21-30years. Inclusion criteria in

the study were normal general health, no systemic hypertension or diabetes mellitus.
22
The cases with any active ocular disease, shallow anterior chambers and patients on

any systemic or topical drugs were excluded. The cases were divided into 4 groups

of 10 patients each. Fresh aqueous solution of Phenylephrine hydrochloride was

prepared in concentrations of 10%, 5%, 2.5 and 1.25%. The study we found out that

that there was no statistically significant difference between mydriatic effects of

these concentrations. Phenylephrine hydrochloride causes mydriasis with a small but

significant reduction in accommodation, in other words phenylephrine can be used

in researches to achieve mydriasis without hampering accommodation.

Starvart,et al.,(2015) carried out a research on the cardiovascular adverse effect of

phenylephrine eye drop, with a total of 916 participants. With phenylephrine, 2.5%,

at 20 to 30 minutes and 60 minutes or longer after administration, neither BP nor HR

changed at either time. Following the application of 10%, a mean increase in HR by

4.48 beats/min (95% CI, 1.09-7.88; P = .01) was present at 20 to 30 minutes

following application of phenylephrine, 10%, and HR decreased by 60 minutes or

longer with no changes detected compared with baseline. They concluded that

phenylephrine, 2.5%, leads to no clinically relevant change in BP or HR, and the

changes in BP and HR seen with phenylephrine, 10%, are short lived. Thus,

phenylephrine, 2.5%, is safe to use in clinical routine.

23
 CHAPTER THREE

3. 0 MATERIALS AND METHODS

3.1 Area of Study

This research was carried out in the Optometry Teaching Clinic of Federal

University of Technology Owerri (FUTO), IMO state, South- Eastern Nigeria.

Owerri is the capital of Imo State. It lies within the rain forest belt, has an average

annual temperature of 25 0C maximum of 32 0C. Owerri falls within longitude 7.03E

and latitude of 5.48N.

FUTO has an estimated student population of about 25000,comprising males and

females, who are within the age bracket of 18- 30 years.

24
3.2 Research Design

This research made use of a pre-test and post-test methods design to measure the

amplitude of accommodation of the subjects before and after 30mins and 60mins

administration of 5% phenylephrine hydrochloride.

3.3 Population of Study

The subjects used for this study were student volunteers, both male and female

students of Federal University of Technology Owerri. These volunteers were

selected according to the inclusive and exclusive criteria listed below.

3.3.1 Inclusion Criteria

Ocularly healthy students between the of 18-30 years

3.3.2 Exclusion criteria

I. Those who are hypertensive

II. Those who have primary angle closure glaucoma

III. Those who are not healthy and with ocular diseases.

3.4 Sample Size Determination

Minimum sampling size is determined using Fischer’s, formular

25
n=z²pq/d²

n= the minimum sample size

Z= the standard normal deviates usually set at 1.96 at 95% confidence interval

P= the proportion of the total population required for the study

d= the absolute sampling error to be tolerated which is set as 5%(0.05)

q=1-p

3.4 Sampling Technique

3.5 Cluster sampling technique was used for this study. Cluster sampling refers to

a type of sampling method.

3.6 Instruments and Materials for Data Collection

i. Snellen distance visual acuity chart

ii. N-series near visual acuity chart,

iii. Meter rule,

iv. Ophthalmoscope,

v. 5% Phenylephrine hydrochloride eye drop

vi. P en tourch

vii. Phorophter or trial lens case

26
3.6 Validation of Instrument

The instruments used for this research work was approved by the National agency

for food, drug administration and control(NAFDAC) and the Optometrist and

Dispensing Opticians Registration Board of Nigeria(ODORBN)

3.7 Procedure and Data Collection

I. Informed consent was given to the subject before the procedures.

II. Subjects were screened through case history, external examination,

opthalmoscopy, visual acquity test. Subjects who meet the inclusion

criteria will proceed for the test.

III. Subjective refraction was carried out on subjects.

IV. AA of subjects was determined using the push up to blur method before

the administration of .5% phenylephrine hydrochloride.

V. AA of subjects was repeated using the push up to blur method after

15mins and 30mins administration of 5% phenylephrine

hydrochloride.

27
 VI. AA of subjects before and after the administration of 2.5%

phenylephrine hydrochloride was compared and any significant

difference will be noted.

3.8 Procedure for Data Analysis

The data was analyzed using the statistical package for social sciences(SPSS)

software.

3.9 Ethical Consent

Ethical consent was obtained from the Ethical Committee of School of Health

Technology, Federal University of Technology, and Owerri. Informed consent was

obtained from the volunteers that was used for this study.

28
 CHAPTER FOUR

A total number of 30 subjects were used for this research, comprising of 7 males and

23 females. Abbreviations used in this research work include; “n” which represents

number of subjects while % which represents percentage.

Table 4.1 Age distribution

Age N

17-18 01 3.33

19-20 04 13.33

21-22 05 16.67

23-24 13 43.33

25-26 06 20.00

27-28 01 3.33

29-30 0 0

TOTAL 30 100

The table above shows the age range of 23-24 had the highest frequency of

13(43.33) with 25-26, with the frequency of 6(20.00), 18-20 and 21-22 had the same

frequency of 5(16.67), 27.28 had frequency of 1(3.33) while the 29-30 years do not

have frequency

29
Table 4.2 Age and gender distribution

Age group Male % Female %

(yrs)

17-18 0 28.57 3 13.04

21-20 2 0 5 21.74

23-24 4 57.14 9 39.13

25-26 0 0 0 29.09

27-28 1 14.29 0 0

29-30 0 0 0 0

TOTAL 7 100 23 100

The table above showed that the age range between 23-24 had 4 numbers (57.14%)

of male subjects and 9 number (39.13%) of female subjects. 18-20 had 2 numbers

(13.04) of female subjects, 27-28 had 1 number (14.29) of male subject and 0 number

of female subjects. 21-22 and 29-30 years had 0 number of male subjects and 5

number (21.74) and 0 number of female subjects respectively.

30
 Table 4.3 Statistical data of subjects

Gender minimum, maximum, range, standard deviation and variation of male

and female and AU.

Statistical data of subjects

N Range Minimum Maximu Mean Standard Varianc

value m value deviation e

statistic Std

s error

Male 7 9 19 28 23.00 1.195 3.162 10.000

Female 23 8 18 26 23.26 .454 2.179 4.747

AU 30 10 18 28 23.20 .435 2.384 5.683

This table showed the statistical results on age of the subjects with the mean age of

the entire subject as 23.20 and maximum age as 28, minimum 18 and the range as

10 and standard deviation as 2.384. The mean age of males as 23.00, maximum age

as 28, minimum age as 19, range as 9 and standard deviation as 3.162 while for the

females their mean age as 23.26 maximum age as 26, minimum age as 18, and range

as 8 and standard deviation as 2.977

31
Table 4.4 Amplitude of accommodation before administration of 5%

phenylephrine hydrochloride of all subjects

A (Diopters) N %

3.5-4.0 1 1.67

4.5-5.0 1 1.67

5.5-6.0 4 6.67

6.5-7.0 7 11.67

7.5-8.0 10 16.67

8.5-9.0 7 11.67

9.5-10.0 14 23.33

10.5-11.0 8 13.33

11.5-12.0 1 1.67

12.5-13.0 6 10

13.5-14.0 1 1.67

TOTAL 60 100.00

The table showed the highest frequency AA range of 9.5-10.0 with the frequency of

14(23.33%), AA range 7.5-8.0 with the frequency of 10(10.67), 10.5-11.0 with the

frequency of 7(11.67%), 12.5-13.0 with the frequency of 4(6.67%) and 3.5-4.0, 4.5-

5.0, 13.5-14.0, range of AA had the least frequency of 1(1.67%)

32
Table 4.5 Amplitude of accommodation (AA) 15mins after the administration

of % phenylephrine hydrochloride of all subjects

AA (Diopters) N %

5.5-6.0 5 8.33

6.5-7.0 19 31.67

7.5-8.0 12 20.00

8.5-9.0 10 16.67

9.5-10 8 13.33

10.5-11 6 10

TOTAL 60 100

The table showed the highest frequency AA range of 6.5-7.0 with the frequency of

19(31.67%), AA range of 7.5-8.0 with the frequency of 12(20.00%), 8.5-9.0 with

the frequency of 10(16.67%), 9.5-10 with the frequency of 6(10.00%) and the least

AA range of 5.5-6.0, with the frequency of 5(8.33%).

33
Table 4.6 Amplitude of accommodation (AA) 30mins after administration of

phenylephrine hydrochloride for all subjects

AA (Diopters) N %

5.5-6.0 10 16.67

7.0-8.0 26 43.33

9.0-10.0 20 33.33

11.0-12.0 4 6.67

TOTAL 60 100

The table showed the highest frequency of 7.0-8.0, AA range with the frequency of

26(43.33%), AA range of 9.0-10.0 with the frequency of 20(33.33%), 5.0-6.0 with

the frequency of 10(16.67%) and the lowest AA range of 11.0-12.0 with the

frequency of 4(6.67%).

34
 Table: Statistical Data on amplitude of accommodation

N Range Minimum Maximu Mean Standard Varianc

value m value deviation e

statistic Std

s error

AA before 60 10.0 4.0 14.0 9.215 .2757 2.1358 4.562

AA before 60 5.0 6.0 11.0 8.238 .1930 1.4949 2.235

15mins

AA before 60 7.0 5.0 12.0 8.050 .2023 1.5669 2.455

30mins

4.2 Testing of hypothesis

HO: The amplitude of accommodation before and after 15 and 30mins instillation

of 5% phenylephrine hydrochloride is the same.

35
Table4.7 Data analysis showing p value for testing of hypothesis using one way

ANOVA

Source of variation p.value

Between groups 0.001

From spps version 21 data output, data analysis using the one way Avova at 0.05

level of significance and 95% confidence interval revealed a p value of 0.001. Since

p (0.001)<0.05, we reject the null hypothesis and accept the alternative.

AA: The amplitude of accommodation before and after 30mins instillation of 5%

phenylephrine hydrochloride is not the same

36
Table

Source of variation Pvalue

Baseline-15mins 0.003

Baseline-30mins 0.000

15mins-Baseline 0.003

30mins –Baseline 0.000

30mins- 15mins 0.558

The mean different is significant at the 0.05 level

The table above shows that the amplitude of accommodation before compared with

the amplitude of accommodation after instillation of 5% PHCL had p-value of 0.003

but when compared after 30mins of instillation had the p-value of 0.000. Amplitude

of accommodation after 15mins compared with the amplitude of accommodation

before that the p-value of 0.003 but when compared with 30mins after, had p-value

of 0.558.

Amplitude of accommodation after 30mins administration of 5% phenylephrine

hydrochloride compared with the amplitude of accommodation before it gave the p-

37
value of 0.000, and when compared with amplitude of accommodation after 15mins

gave the p-value of 0.558.

38
 CHAPTER FIVE

Discussion

This study was done to determine the effect of 50% hydrochloride on amplitude of

accommodation. This study took into account the increment or decrement of

amplitude of accommodation, after hence need to test as effect after instillation.

30 subjects participated in the study (7 males and 23 females’ age range started from

18 years because the study was done in a school environment and equal in 30 years

age. 23-24 years had the highest frequency while 29-30 had no subject. Amplitude

of accommodation begins to decline (koulieris, et al, 2017).

Findings from the study showed that PHCL had an effect on amplitude of

accommodation after 15mins of instillation with the mean of 8.238± 1.4949 lesser

than the mean of amplitude accommodation before administration of 5%.

This is consistent with the result obtained from the study of sarkar, et al,(2012).

In the study, the impacts of phenylephrine hydrochloride on static and dynamic

accommodation were studied, with 2.5%, 5% and 10% concentration of PHCC.

There was decrease in accommodation at similar rates for the three concentrations

however the reduction in accommodative performance is modest and maybe

clinically irrelevant in the eyes.

39
Furthermore, this study showed that the baseline amplitude of accommodation after

30mins instillation of phenylephrine hydrochloride decreased compared to the

baseline amplitude of accommodation between 15mins and 30mins is the same with

the mean value of 8.238 and 8.050 respectively.

Also from the study, different comparisons were carried out within the time interval

amplitude of accommodation was measured with the amplitude of accommodation

before and after 15mins. The mean difference was 0.97671 and level of significance

was ( p (0.03<0.05) which shows that amplitude of accommodation before and after

15mins is not the same.

Amplitude of accomdation before and after 30mins had the mean difference of

1.1650 and significance of (p(0.000<0.05) which indicated that amplitude of

accomdation before and after 30mins of instillation of 5% of phenylephrine

hydrochloride is not the same.

Company with the amplitude of accommodation after 15mins, the amplitude of

accommodation after 15mins compared with the amplitude of accommodation

before instillation of 5% phenylephrine hydrochloride had a mean difference of -

9767 and a level of significance of (p(0.03<0.05), which shows that the amplitude

of accommodation after 15mins after instillation of 5% phenylephrine hydrochloride

is not the same, that means there was no significant difference comparing 15mins

40
and 30mins after administration gave a mean of 1883 and level of significance of

(p(0.558>0.05, shows that amplitude of accommodation between 15 and 30mins

instillation of 5% phenylephrine hydrochloride is the same, that is there is no

significant difference.

Comparing the amplitude of accommodation after 30mins with the other periods;

the amplitude of accommodation after 30mins instillation of 5% phenylephrine

hydrochloride when compared with the amplitude of accommodation before the

instillation gave significant level of p(0.000<0.05), that shows that AA is not the

same, that is there is a significant difference, and when compared with the amplitude

of accommodation after 15mins the level of significance of (p(0.558>0.005) was

found that shows that the amplitude of accommodation between 30 and 15mins after

the instillation of 5% phenylephrine hydrochloride is the same.

5.2 Contribution of knowledge

The study will add to existing literature to provide information on accommodation

and since this study reveals that there is a significant effect of phenylephrine

hydrochloride that do not hamper accommodation, it can be opted in carrying

clinical test that requires dilation without reducing accommodation

41
 CHAPTER SIX

Conclusion

In conclusion, this study has revealed that 5% phenylephrine hydrochloride has a

significant effect on amplitude of accommodation that is modest and clinically

irrelevant after 15 and 30mins of instillation. However, there was no difference

between 15 and 30mins after instillation.

With the difficulty faced by the optometrist, due to small pupils, which requires

dilation in order to view the internal structures, 5% phenylephrine can be used for

dilation without reducing accommodation.

Recommendation

1. Eye health practitioners should adopt the change in diagnosis but the depth of

anterior chamber should be assed, as well as the blood pressures of the patient

2. The cost of the drug should be moderate, to purchase

3. Patients should consult their eye health practitioners if they notice any

undesirable symptoms.

42
Table

Source of variation P value

Baseline-15mins 0.003

Baseline-30mins 0.000

15mins-Baseline 0.003

30mins –Baseline 0.000

30mins- 15mins 0.558

The mean different is significant at the 0.05 level

The table above shows that the amplitude of accommodation before compared with

the amplitude of accommodation after instillation of 5% PHCL had p-value of 0.003

but when compared after 30mins of instillation had the p-value of 0.000. Amplitude

of accommodation after 15mins compared with the amplitude of accommodation

before that the p-value of 0.003 but when compared with 30mins after, had p-value

of 0.558.

Amplitude of accommodation after 30mins administration of 5% phenylephrine

hydrochloride compared with the amplitude of accommodation before it gave the p-

43
value of 0.000, and when compared with amplitude of accommodation after 15mins

gave the p-value of 0.558.

44
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