September 3, 2024
By Rumeysa Doger, BBioMed, OD
Photo Credit: Getty Images
Topical atropine is among the myopia treatments with proven efficacy, though treatment effect, side effects (near blur and photosensitivity), and rebound are all dose-dependent. Atropine in the 0.01% concentration has shown minimal side effects and rebound compared with higher concentrations.1
Erdinest and colleagues conducted a retrospective study to investigate whether combination therapy of 0.01% atropine and dual-focus soft contact lenses (MiSight) could achieve greater myopia control than 0.01% atropine monotherapy. Their retrospective study followed 85 Caucasian children aged 6 to 16 years over three years, including a one-year washout period.
Group one was treated with 0.01% atropine, group two with 0.01% atropine and MiSight, and group three wore corrective single-vision spectacles alone. Parents of children in groups one and two were instructed to instill one drop of 0.01% atropine nightly, and group two children were instructed to wear MiSight lenses for eight hours per day.
Groups one and two showed total progression over two years of 0.95D and 0.79D, respectively, with a low rebound effect in both cohorts six months after treatment cessation. Both groups demonstrated clinically effective myopia control; however, there was no statistically significant difference between combination therapy and monotherapy in this retrospective study.
Abstract
Low-Concentration Atropine Monotherapy vs. Combined with MiSight 1 Day Contact Lenses for Myopia Management
Nir Erdinest, Naomi London, Itay Lavy, David Landau, Dror Ben Ephraim Noyman, Nadav Levinger, Yair Morad
Objectives: To assess the decrease in myopia progression and rebound effect using topical low-dose atropine compared to a combined treatment with contact lenses for myopic control.
Methods: This retrospective review study included 85 children aged 10.34 ± 2.27 (range 6 to 15.5) who were followed over three years. All had a minimum myopia increase of 1.00 D the year prior to treatment. The children were divided into two treatment groups and a control group. One treatment group included 29 children with an average prescription of 4.81 ± 2.12 D (sphere equivalent [SE] range of 1.25−10.87 D), treated with 0.01% atropine for two years (A0.01%). The second group included 26 children with an average prescription of 4.14 ± 1.35 D (SE range of 1.625−6.00 D), treated with MiSight 1 day dual focus contact lenses (DFCL) and 0.01% atropine (A0.01% + DFCL) for two years. The control group included 30 children wearing single-vision spectacles (SV), averaging −5.06 ± 1.77 D (SE) range 2.37−8.87 D).
Results: There was an increase in the SE myopia progression in the SV group of 1.19 ± 0.43 D, 1.25 ± 0.52 D, and 1.13 ± 0.36 D in the first, second, and third years, respectively. Myopia progression in the A0.01% group was 0.44 ± 0.21 D (p < 0.01) and 0.51 ± 0.39 D (p < 0.01) in the first and second years, respectively. In the A0.01% + DFCL group, myopia progression was 0.35 ± 0.26 D and 0.44 ± 0.40 D in the first and second years, respectively (p < 0.01). Half a year after the cessation of the atropine treatment, myopia progression (rebound effect) was measured at −0.241 ± 0.35 D and −0.178 ± 0.34 D in the A0.01% and A0.01% + DFCL groups, respectively.
Conclusions: Monotherapy low-dose atropine, combined with peripheral blur contact lenses, was clinically effective in decreasing myopia progression. A low rebound effect was found after the therapy cessation. In this retrospective study, combination therapy did not present an advantage over monotherapy.
Erdinest, N., London, N., Lavy, I., Landau, D., Ben Ephraim Noyman, D., Levinger, N., & Morad, Y. (2022). Low-concentration atropine monotherapy vs. Combined with MiSight 1 Day contact lenses for myopia management. Vision, 6(4), 73.
DOI: https://doi.org/10.3390/vision6040073
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Rumeysa Doger graduated as a doctor of optometry from the University of Melbourne, Australia, in 2023. She is currently undertaking a Paediatrics Residency at the Australian College of Optometry, specializing in eye care for children with strabismus, amblyopia, accommodation-vergence disorders, and progressive myopia. The Australian College of Optometry is located on Wurundjeri WoiWurrung land known as Naarm, and it is dedicated to providing accessible and affordable eye care to its diverse communities. |
MiSight 1 Day soft contact lenses are FDA-approved for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes who, at the initiation of treatment, are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with less than or equal to 0.75 diopters of astigmatism.
References
- Chia, Audrey, Qing-Shu Lu, and Donald Tan. “Five-year clinical trial on atropine for the treatment of myopia 2: myopia control with atropine 0.01% eyedrops.” Ophthalmology 123, no. 2 (2016): 391-399.
