Preoperative Ptosis Evaluation: A Comparative Analysis of Phenylephrine Drops and Eyelid Taping for Visual Field Testing.

PURPOSE: This study aims to compare the efficacy of phenylephrine 2.5% ophthalmic solution versus traditional upper eyelid taping in evaluating surgical need and insurance reimbursement eligibility for patients with visually significant ptosis.

METHODS

This single-arm, sequential study included 27 eyes with ptosis. Eyes were evaluated under 3 testing conditions: at baseline, after manual eyelid taping, and post phenylephrine instillation. The outcome measures were change in margin reflex distance 1 and superior visual field, assessed using tangent screen VF testing. Participants completed a poststudy questionnaire evaluating their experience.

RESULTS

Margin reflex distance 1 increased from a mean baseline of 0.83 mm to 2.17 mm after phenylephrine (mean improvement 1.33 mm, 95% confidence interval: 1.09-1.57 mm, p < 0.001). Mean VF improved from 6.85° to 21.77° with taping and to 22.56° with phenylephrine. The insurance criterion (≥12° increase) was met in 88.8% of eyes with taping and 92.5% of eyes with phenylephrine, with no significant difference in the proportion of eyes meeting criteria ( p = 1.000). Margin reflex distance 1 and VF changes after phenylephrine instillation showed no positive correlation (rs = 0.13, p > 0.05). Patient satisfaction scores were higher with phenylephrine (4.26 ± 0.81) compared with manual taping (3.67 ± 0.48 (mean difference 0.59, p < 0.001).

CONCLUSIONS

Phenylephrine 2.5% ophthalmic solution provides comparable visual field improvements and significantly higher patient satisfaction compared with manual upper eyelid taping for preoperative VF testing in the context of insurance reimbursement eligibility for patients with ptosis.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05890027.