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March 1, 2024
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The evidence supporting the use of topical low-dose atropine in treating juvenile-onset myopia is so strong that it is a cornerstone of treatment. The peer-reviewed literature supports the need to include low-dose atropine in the armamentarium of eye care practitioners treating children and adolescents with progressive myopia. Over the last few years, several peer-reviewed papers that demonstrate its safety and efficacy have been published. The following summarizes five of these:
Paper #1: Four-Year Progression of Myopic Maculopathy in Children and Adolescents with High Myopia
Published in JAMA Ophthalmology in 2024, this study provides compelling evidence that myopic maculopathy is a growing concern for children and adolescents with high myopia. The study followed 387 patients over four years and found that the prevalence of myopic maculopathy increased significantly from 8.3% to 28.2%. In addition, the progression of myopic maculopathy was detected in 67 of 548 eyes (12.2%) with 88 lesion changes. This alarming increase highlights the urgent need for early detection and intervention to prevent potential vision loss.
The study also identified several risk factors for myopic maculopathy, including older age, higher myopia degree, longer axial length, and thinner choroidal thickness. These findings are crucial in identifying the at-risk population and tailoring interventions to prevent progression.
Myopic maculopathy is a serious issue that requires attention and action. The use of interventions such as low-dose atropine has shown promise in slowing myopia progression and preventing the development of myopic maculopathy. Early detection and intervention with low-dose atropine can significantly reduce the risk of vision loss, and the findings of this study should encourage health care providers to prioritize myopia control for children and adolescents with high myopia.
Jiang, F., Wang, D., Xiao, O., Guo, X., Yin, Q., Luo, L., … & Li, Z. (2024). Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia. JAMA Ophthalmology.
Paper #2: Stepwise Low Concentration Atropine for Myopic Control: A 10-year Cohort Study
Myopia is a growing concern among children and adolescents, and the need for effective and safe myopia control strategies has never been more pressing. This study by Chuang et al. (2021) provides compelling evidence that stepwise low-concentration atropine therapy is a promising treatment option for myopia control in children and adolescents.
The study included over 370 children aged 4 to 13 years, and the results showed that the stepwise low-concentration atropine therapy significantly reduced the progression of myopia compared to the control group. This is a significant finding that highlights the potential of low-concentration atropine therapy in preventing myopia progression and its associated complications, such as myopic maculopathy.
Furthermore, the study demonstrated the safety of long-term use of low-concentration atropine. There were no significant adverse effects related to the use of low-dose atropine, and there were no reports of serious adverse events such as allergic reactions or ocular inflammation. This means that low-concentration atropine therapy is a safe and well-tolerated treatment option for children and adolescents with myopia.
“With a 10-year regular follow-up, the strength of this study is that the clinical use of low concentration atropine resulted in a positive effect on myopic control throughout the childhood and teenage period.”
In conclusion, the study by Chuang et al. (2021) provides strong evidence that stepwise low-concentration atropine therapy is an effective and safe strategy for myopia control in children and adolescents. Eye care practitioners should consider this treatment option as part of their armamentarium in treating children and adolescents with progressive myopia to prevent potential vision loss.
Chuang, M. N., Fang, P. C., & Wu, P. C. (2021). Stepwise low concentration atropine for myopic control: a 10-year cohort study. Scientific Reports, 11(1), 17344.
Paper #3: Prevention of Myopia Shift and Myopia Onset Using 0.01% Atropine in Pre-myopic Children
This study, published in the European Journal of Pediatrics in 2023, aimed to evaluate the effectiveness and safety of 0.01% atropine eye drops in preventing the development and progression of myopia in pre-myopic children. The study included 60 children aged 6 to 12 years who had no or mild myopia (less than -1.00 diopter) and were randomized to receive either 0.01% atropine eye drops or a placebo for 24 months.
The results showed that the use of 0.01% atropine eye drops significantly reduced the incidence of myopia onset and the progression of myopia in pre-myopic children. The cumulative incidence of myopia was significantly lower in the atropine group compared to the placebo group (9.6% vs. 28.7%), and the mean myopia progression was significantly lower in the atropine group (-0.36 diopters) compared to the placebo group (-0.70 diopters).
The study concluded that 0.01% atropine eye drops are an effective and safe treatment option for preventing the development and progression of myopia in pre-myopic children. Not only did the study show that 0.01% atropine slowed the progression of myopia in children who were already myopic, but it also prevented onset by showing lower rates of children becoming myopic. The findings of this study provide further evidence supporting the use of low-dose atropine as a myopia control strategy in children.
Wang, W., Zhang, F., Yu, S., Ma, N., Huang, C., Wang, M., … & Fu, A. (2023). Prevention of myopia shift and myopia onset using 0.01% atropine in pre-myopic children—a prospective, randomized, double-masked, and crossover trial. European Journal of Pediatrics, 1-10.
Paper #4: Effective Decrease in Myopia Progression with Two Mechanisms of Management
The results of this 2023 study by Erdinest et al. are compelling evidence for a more effective approach to managing myopia progression in children. The study included 66 children with myopia, aged 6 to 16, who were administered either low-dose atropine eye drops or multifocal contact lenses. After six months, both groups showed significant decreases in myopia progression compared to baseline measurements. However, the group that received both treatments demonstrated a significantly greater decrease in myopia progression than the group that received only one of the treatments.
This study highlights the importance of combining different management techniques to maximize their effectiveness in slowing down the progression of myopia in children. The authors suggest that the multifocal contact lenses may reduce peripheral hyperopic defocus, while the low-dose atropine may reduce accommodative demand and axial elongation. This optimal combination not only shows promising results but is also well tolerated by children, with no significant adverse effects reported.
Atropine 0.01%, itself, showed a 71.7% decrease in myopia progression at the end of three years vs. single vision glasses only (0.78 vs 0.22 at three years).
This study is a step forward in providing eye care practitioners with a more effective and safer approach to managing myopia progression in children. Further research should be conducted to confirm the findings and determine the most optimal combination of treatments. Nonetheless, this study’s results are a significant breakthrough for those who suffer from myopia, as it provides renewed hope for a more effective and comprehensive treatment approach.
Erdinest, N., Atar-Vardi, M., Lavy, I., London, N., Landau, D., Pras, E., & Morad, Y. (2023). Effective Decrease in Myopia Progression With Two Mechanisms of Management. Journal of Pediatric Ophthalmology & Strabismus, 1-7.
Paper #5: Preservatives and pH in Low‐dose Atropine Formulations for Clinical Trials
The review conducted by Iribarren, R. et al. (2023) highlights the importance of optimizing the pH level of low-dose atropine formulations for clinical trials. The findings demonstrate that atropine formulations with lower pH levels exhibit better stability and efficacy over time. This has significant implications for the development of low-dose atropine formulations and could help improve the treatment of myopia in children. These findings should encourage researchers and pharmaceutical companies to invest more time and resources in developing atropine formulations with optimized pH levels. By doing so, they could potentially improve the effectiveness of the treatment and help prevent and slow down the progression of myopia in children. This is particularly important as myopia rates are increasing globally, and there is a growing need for more effective treatments.
In conclusion, the review by Iribarren, R. et al. (2023) provides valuable insights into the role of preservatives and pH in low-dose atropine formulations for clinical trials. Highly variable formulations are likely to lead to highly variable results in clinical trials and should be considered as a contributing factor to the wide range of efficacy in studies reported in the literature. The findings should encourage researchers to invest more time and resources in developing optimized atropine formulations, which could significantly impact the treatment of myopia in children.
Iribarren, R., Cunha, C., Kaymak, H., & Grzybowski, A. (2023). Preservatives and pH in low‐dose atropine formulations for clinical trials. Acta Ophthalmologica.
Low-dose atropine has been proven to be an effective treatment for juvenile-onset myopia, and the evidence keeps mounting. Don’t let juvenile-onset myopia go untreated when a safe and effective intervention is available.
This article is sponsored by Sydnexis.
