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You the Parents of 'Young Kids with Myopia whose vision is getting blurrier', always have many questions as they discover the possibilities of how they can help their children with Myopia Control. Low Dose Atropine Eye drops have a low risk and a good success, but where is the research for the hungry investigative parent?
Well its Just below !
The take home message is that low dose atropine appears successful in slowing Myopia progression.
Read on McDuff!
Journal Scan / Research · July 02, 2019
Acta Ophthalmologica
Matteo Sacchi, Massimiliano Serafino, Edoardo Villani, Elena Tagliabue, Saverio Luccarelli, Francesco Bonsignore, Paolo Nucci
Abstract
PURPOSE; To evaluate the efficacy and safety of atropine 0.01% in slowing myopia progression in European paediatric patients.
Retrospective, medical records review study. Medical charts of paediatric patients with a myopia progression > 0.5 D/year treated with atropine 0.01% for at least 1 year were included. Patients receive a complete ophthalmic examination before and 12 months after initiation of atropine treatment. A group of myopic untreated children serves as a control group. The rate of myopia progression at baseline and 12 months after treatment with atropine was evaluated. The rate of myopia progression in treated and untreated patients was also compared. Adverse events were recorded.
Medical records of 52 treated and 50 control subjects were analysed. In the atropine group, the mean rate of myopia progression after 12 months of treatment (-0.54 ± 0.61 D) was significantly slower compared with the baseline progression (-1.20 ± 0.64 D; p < 0.0001) and to the progression in the control group (-1.09 ± 0.64; p < 0.0001). The responders patients were 41/52 (79%), whereas 11/52 patients (21%) showed a progression > 0.50 D despite treatment. The only adverse event was temporary photophobia in five patients (9.6%), severe adverse events were not reported, and none of the patients discontinued the treatment.
Low-dose atropine significantly slowed the rate of myopia progression in European paediatric patients with a favourable safety profile.
Currently, there is a lot of interest in slowing the progression of myopia since a higher degree is associated with greater morbidity in terms of vision.1-6 Contrary to what is stated in the introduction of this paper, there are three methods which have been shown to effectively slow the progression of myopia: atropine of various doses, orthokeratology, and multifocal contact lenses.1,7-9 The ATOM 2 study suggests that atropine 0.01% is the most effective agent to slow myopic progression in Asian children.10
According to Sacchi et al, their study is the first to evaluate the effect of atropine 0.01% in a European population.
It should be noted, however, that there are a number of studies whose findings do not support the ATOM 2 finding.11,12 One of the problems with the ATOM 2 study is that the measurements of axial length reduction and refractive error reduction are not consistent with each other. As a matter of fact, the LAMP study did not find a difference between placebo and atropine 0.01% when axial length changes rather than refractive error were used as the primary outcome.12 With this in mind, the authors state that they were performing the only retrospective study of European children placed on atropine 0.01% for 1 year. In this retrospective study they did not measure axial length, which is clearly a more sensitive measure of treatment effect, and their treatment period was only 1 year. In other studies, methods to slow myopic progression were greater in the first year, but slowed in the second year.13 Lastly, the control group was not a prospective, randomized population, and was therefore not a true control. The rate of progression in the control group was slower than in the atropine group; thus, not matched.
With the above in mind, the authors report here that their atropine 0.01% group at the end of the year progressed −0.54 D ± 0.61 D (spherical equivalent) versus the control group −1.20 D ± 0.64D, which was statistically and clinically significant. The atropine group had 79% responders versus 21% non-responders—that is, more than 0.5 D per year of progression. According to the authors, this compares favorably with the finding with atropine 0.01% in the ATOM 2 study.10 However, the authors conclude that “atropine can be considered the only approach for the control of myopia currently evidence based.” This conclusion is incorrect because both orthokeratology and multifocal soft lenses do as well if not better in controlling myopia progression. It should also be noted that, although the authors feel that a mean of 0.54 D is an adequate rate of progression, we believe that clinicians should strive for a better level. This can be attained by using a higher concentration of atropine as supported by the LAMP study12 and Shih et al,11 using orthokeratology, multifocal soft lenses, or combined treatment such as atropine and orthokeratology. In summary, this paper by Sacchi et al provides further support for the use of atropine 0.01% in slowing the progression of myopia, but must be put in perspective.
References
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