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    Atropine explored as treatment for childhood myopia

    ATOM trials show eye drops may be effective approach to inhibit myopia progression

     

    Effective at lower concentrations

    “Atropine eye drops reduce myopia progression and axial elongation in children in a dose-related manner, but appear to be still highly effective even at lower concentrations,” Dr. Tan said.

    “The drops are safe, and there are no serious adverse effects, and at the lowest concentrations, the clinical side-effects of pupil dilation and loss of accommodation are greatly minimized,” he said.

    The ATOM2 study showed that atropine 0.01% has the best therapeutic index and slows myopia progression by 50% to 60%, Dr. Tan noted.

    The main clinical advantage of the 0.01% dose lies in the fact the pupil dilation is only about 1 mm, and the minimal loss of accommodation of only about 4 D (which means children still have about 12 D of remaining accommodation) results in no loss in near vision, he added.

    There also appears to be no rebound effect upon cessation of 0.01% atropine, unlike the higher doses, he said.

    Going forward, researchers must look further at appropriation treatment duration, when to start and stop dosing, and whether any newer alternative anti-muscarinic agents have an improved therapeutic index, Dr. Tan said.

    A new ATOM study in Japan, led by Shigeru Kinoshita, MD, of Kyoto Prefectural University, is now under way, Dr. Tan said. There is also a formulation of atropine (Myopine) that is compounded by Dr. Tan’s hospital pharmacy. It has been used in about 1,000 children since 2014.

    The basic treatment pattern that clinicians are recommending is use of atropine for 2 years and if there is no myopia progression, then stop and observe for 2 years.

    The child can start atropine if myopia progresses again. If there were moderate response over the 2 years, the child would likely continue atropine for a third year. If myopia progresses more, the child may need a higher dose, Dr. Tan said.

    The use of treatment may be combined with behavioral modifications, such as encouraging children to play outside more, Dr. Tan said.

     

    References

    1. Chua WH, Balakrishnan V, Chan YH, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006;113:2285-2291.

    2. Chia A, Chua WH, Cheung YB, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012;119:347-354.

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