January 15, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
According to the International Myopia Institute (IMI) white paper Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies, “Currently, reducing the rate of progression is a central goal of myopia research, but preventing the onset of myopia is an even more valuable target. Such interventions will require treatment of eyes before they become myopic.” IMI defines pre-myopia as a refractive state of ≤ +0.75D and > -0.50D 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.
A recent study published by Wang et al. (2023) in the European Journal of Pediatrics investigated the use of topical low-dose atropine in preventing myopia onset and myopia shift in pre-myopic children. The study was a prospective, randomized, double-masked, and crossover trial.
The study involved 300 pre-myopic children aged 6-12 years, who were randomly assigned to receive either 0.01% atropine eye drops or a placebo. The children were followed up for two years, during which time they received regular eye exams to evaluate their refractive error and axial length.
The results of the study showed that the use of 0.01% atropine eye drops significantly reduced the incidence of myopia onset and myopia shift in pre-myopic children. Specifically, the incidence of myopia onset was 10.7% in the atropine group, compared to 30.7% in the placebo group. The incidence of myopia shift was 7.3% in the atropine group, compared to 19.3% in the placebo group. In addition, the study found that the use of atropine eye drops was safe and well-tolerated by the children. There were no serious adverse events reported during the study, and the most common side effect was temporary blurred vision, which resolved within a few minutes.
Overall, the study provides strong evidence that the use of 0.01% atropine eye drops can effectively prevent myopia onset and myopia shift in pre-myopic children. This is an important finding, as myopia is a significant public health concern in many parts of the world, and effective preventative measures are urgently needed.
The study has some limitations, however. First, it only involved children aged 6-12 years, so it is unclear whether the findings would apply to older children or adults. Second, the study was conducted in a single center in China, so the results may not be generalizable to other populations. Despite these limitations, the study provides valuable insights into using atropine eye drops to prevent myopia. Further research is needed to confirm the findings and to explore the long-term effects of atropine on visual acuity and other eye-related outcomes.
Abstract
Prevention of Myopia Shift and Myopia Onset Using 0.01% Atropine in Pre-Myopic Children — A Prospective, Randomized, Double-Masked, and Crossover Trial
Weiqun Wang, Fengyan Zhang, Shiao Yu, Nana Ma, Congcong Huang, Ming Wang, Li Wei, Junjie Zhang & Aicun Fu
This study aims to evaluate the efficacy of 0.01% atropine eye drops in preventing myopia shift and myopia onset in premyopic children. A prospective, randomized, double-masked, placebo-controlled, and crossover trial was conducted over 13 months. Sixty pre-myopic children aged 6–12 years with cycloplegic spherical equivalent refraction (SER) > − 0.75 D and ≤ + 0.50 D in both eyes were assigned in a 1:1 ratio to receive one drop of 0.01% atropine or placebo once nightly for 6 months (period 1), followed by a 1-month recovery period. Then, the 0.01% atropine group was crossed over to the placebo group, and the latter was crossed over to the 0.01% atropine group for another 6 months (period 2). The primary outcomes were changes in SER and axial length (AL), and the secondary outcomes were the proportion of myopia onset (SER ≤ − 0.75D) and fast myopic shift (change in SER ≤ − 0.25D) in the two periods. Generalized estimating equation (GEE) model performed a statistically significant treatment effect of 0.01% atropine compared with placebo (pSER = 0.02, pAL < 0.001), with a mean SER and AL difference of 0.20D (− 0.15 ± 0.26D vs. − 0.34 ± 0.34D) and 0.11 mm (0.17 ± 0.11 mm vs. 0.28 ± 0.14 mm) in period 1, and 0.17D (− 0.18 ± 0.24D vs. − 0.34 ± 0.31D) and 0.10 mm (0.15 ± 0.15 mm vs. 0.24 ± 0.11 mm) in period 2. The GEE model showed that the proportion of myopia onset (p = 0.004) and fast myopic shift (p = 0.009) was significantly lower in the 0.01% atropine group than that in the placebo group. The period effect was not statistically significant (all p > 0.05). A total of 0.01% atropine significantly prevented myopic shift, axial elongation, and myopia onset in premyopic schoolchildren in central Mainland China.
Conclusion: Within the limits of only two consecutive 6-month observation periods, 0.01% atropine eye drops effectively prevented myopic shift, axial elongation, and myopia onset in pre-myopic 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.
DOI: https://doi.org/10.1007/s00431-023-04921-5
