June 1, 2022
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
The International Myopia Institute’s white paper on Defining and Classifying Myopia introduced the concept of pre-myopia, which they define as: “A refractive state of an eye of between +0.75 D & -0.50 D in children where a combination of baseline refraction, age, and other quantifiable risk factors provide a sufficient likelihood of the future development of myopia to merit preventative interventions.” In other words, progression is highly likely once a child is identified as pre-myopic, and interventions that reduce the incidence of myopia are necessary.
Researchers from China conducted a retrospective cohort study with 50 children 6 to 12 years old. The aim of the study was to evaluate the efficacy of a 0.025% atropine solution for the prevention of myopic shift and myopia onset in pre-myopic children. Twenty-four children (average age 7.6 years old) were in the 0.025% atropine group, and 26 children (average age: 8.2 years old) were in the control group. All children were followed for a minimum of 12 months.
In multiple linear regression analysis, 0.025% atropine treatment was the only independent variable preventing myopia shift. The authors concluded that nightly administration of one drop of 0.025% atropine may be considered a feasible option for delaying the onset of myopia in pre-myopic children.
Randomized controlled trials with topical low-dose atropine and pre-myopic children are currently underway to corroborate these encouraging results.
Prevention of Myopia Onset with 0.025% Atropine in Pre-Myopic Children
Po-Chiung Fang, Mei-Yung Chung, Hun-Ju Yu, Pei-Chang Wu
Purpose: To evaluate the efficacy of 0.025% atropine solution for prevention of myopic shift and myopia onset in pre-myopic children.
Methods: This study was designed as a retrospective cohort study. Six- to 12-year-old children with spherical equivalent refraction of <+1 diopter (D) (defined as pre-myopia), with cylindrical refraction of <-1 D, without amblyopia, and who received 0.025% atropine eye drops at bedtime every night or no treatment after follow-up for at least 12 months were enrolled. Fast myopic shift is defined as a myopic shift >-0.5 D per year.
Results: Fifty children were enrolled in the study. Twenty-four children (average age 7.6 years old) were in the 0.025% atropine group, and 26 children (average age: 8.2 years old) were in the control group. The mean spherical refraction myopic shift in the 0.025% atropine group was -0.14 +/- 0.24 D/year, significantly lower than that in the control group, -0.58 +/- 0.34 D/year (P < 0.0001). In multiple linear regression analysis, 0.025% atropine treatment was the only independent variable in preventing myopia shift. There were statistically significant differences between the 0.025% atropine group and the control group in myopia onset and fast myopic shift (21% vs. 54%, P = 0.016; 8% vs. 58%, P = 0.0002, respectively). There was no difference between the two groups with regard to the symptom of photophobia (16% vs. 8%, P = 0.409). None of the children in either group complained of near-blurred vision.
Conclusions: Regular topical administration of 0.025% atropine eye drops can prevent myopia onset and myopic shift in pre-myopic schoolchildren for a 1-year period.
Fang, P. C., Chung, M. Y., Yu, H. J., & Wu, P. C. (2010). Prevention of myopia onset with 0.025% atropine in premyopic children. Journal of ocular pharmacology and therapeutics, 26(4), 341-345.