Research Review

Side Effects of Topical Atropine in Caucasian Myopic Children

April 15, 2021

By Dwight Akerman, OD, FAAO, FBCLA

The LAMP study (low-concentration atropine for myopia progression) from Hong Kong addressed safety and efficacy of atropine in concentration increments of 0.01%, 0.025%, and 0.05% compared to placebo. This study concluded that 0.05% was most effective with a sufficient safety profile regarding side effects such as mydriasis and reduced accommodation leading to light sensitivity and reading difficulties. However, no data on side effects have been published so far in Caucasian children receiving 0.05% atropine for myopia control. 

Before commencement of bilateral atropine treatment with 0.05% atropine, 19 myopic children aged 5 to 15 years were treated in only one eye at bedtime, leaving the other eye as a control. Pupil size, accommodation amplitude, and near visual acuity were measured at 10 a.m. the next day and compared to the untreated contralateral control eye. The results were then compared to a cohort of 18 children whose treatment with 0.01% atropine commenced similarly. 

Twelve children (63%) reported visual impairment or reading difficulties. Anisocoria was 2.9 ±1.1 mm. In comparison, 0.01% atropine led to a significantly less anisocoria of 0.8 ±0.7 mm. Accommodation was decreased by -4.2 ±3.8D in 0.05% atropine treated eyes, whereas 0.01% atropine induced hypo-accommodation of -0.05 ±2.5 D. Near visual acuity was not significantly reduced in eyes treated with 0.05% atropine compared to 0.01% atropine. 

The researchers concluded that their data indicate more substantial side effects with 0.05% topical atropine in European Caucasian myopic school children than recently reported in Asian children, potentially compromising acceptance and compliance among Caucasian children.

Abstract

Side effects of topical atropine 0.05% compared to 0.01% for myopia control in German school children: a pilot study 

Lutz JoachimsenNavid FarassatTim BleulDaniel BöhringerWolf A LagrèzeMichael Reich 

Purpose: Based on findings of the Asian low-concentration atropine for myopia progression study, a concentration of 0.05% has been proposed as a good compromise between safety and efficacy for myopia control. However, no data on side effects have been published so far in Caucasian children receiving this dose. 

Methods: Prior to commencement of bilateral atropine treatment with 0.05% atropine, 19 myopic children aged 5 to 15 years were treated in only one eye at bedtime leaving the other eye as a control. Pupil size, accommodation amplitude and near visual acuity were measured at 10:00 a.m. the next day and compared to the untreated contralateral control eye. The results were then compared to a cohort of 18 children whose treatment with 0.01% atropine commenced in a similar fashion. 

Results: Twelve children (63%) reported visual impairment or reading difficulties. Anisocoria was 2.9 ± 1.1 mm. In comparison, 0.01% atropine led to a significantly less anisocoria of 0.8 ± 0.7 mm (p < 0.0001). Accommodation was decreased by – 4.2 ± 3.8 D in 0.05% atropine treated eyes, whereas 0.01% atropine induced hypoaccommodation of – 0.05 ± 2.5 D (p < 0.01). Near visual acuity was not significantly reduced in eyes treated with 0.05% atropine compared to 0.01% atropine (p = 0.26). 

Conclusion: Compared to 0.01%, our data indicate stronger more relevant side effects of 0.05% topical atropine in young Caucasian children with progressive myopia as recently reported in Asian children, potentially compromising acceptance, and compliance. 

Joachimsen, L., Farassat, N., Bleul, T., Böhringer, D., Lagrèze, W. A., & Reich, M. (2021). Side effects of topical atropine 0.05% compared to 0.01% for myopia control in German school children: a pilot study. International Ophthalmology, 1-8.

DOI: https://doi.org/10.1007/s10792-021-01755-8

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