Atropine for myopia control
Atropine treatment to slow myopia progression involves the daily use of medicated eye drops. In order to have a lasting effect in reducing myopia, these drops must be used for at least 1-2 years.
Atropine is a therapeutic eye drop which acts to relax the ciliary muscle, the muscle controlling our focussing, called accommodation. Whilst atropine was initially used to treat other conditions, it has been shown to have some effect in controlling myopia progression. Scientists are still unable to agree on just how atropine affects myopia progression, though they can agree that it works to slow myopic change. Most patients are instructed to simply put one drop into each eye before sleep, every day. Children using Atropine need to continue wearing their contact lenses or glasses to be able to see as Atropine does not correct vision during waking hours.
As Atropine is a prescribed medication, it requires a pharmaceutical prescription typically written by a therapeutically endorsed optometrist or eye surgeon. It can be a little difficult to source as low doses need to be specially compounded as they are not commercially available.
1% Atropine works well at slowing myopia progression and is a relatively simple treatment as you instil one drop per day in both eyes at night before going to sleep. However, at this concentration, there can be significant drug side-effects of dilated pupils & glare sensitivity for patients. There are also reported cases of systemic side effects from the medication including dizziness and nausea, as well as hypersensitivity reactions.
From there, studies looked at the effectiveness of weaker concentrations of atropine. 0.01% atropine is considered safe for long-term use in children for myopia control, and is an approach that has also been advocated by paediatric ophthalmologists. Extensive clinical trials on children have shown little to no side effects or adverse reactions at this dosage.
Whilst initial studies for low dose Atropine looked very promising as low dose atropine slowed the progression in the refraction. Over time the clinical evidence that supports the use of low dose atropine has been less convincing as there isn’t the same benefits at reducing axial elongation .
The LAMP study showed that the 0.05% Atropine group had 0.55D change in refraction and 0.39mm change in axial length over 2 yrs.
We continue to read updated evidence, to ensure we provide the safest and most effective management options.
Combination Therapy
Although not a lot of research has been completed in the area of combined therapies, early results of studies where therapies are combined (for example atropine drops used in conjunction with orthokeratology lens wear) are very promising, showing rates of axial length progression even slower than either therapy individually.
This option is usually reserved for children with long axial lengths and a strong family history of myopia, who need a more aggressive treatment option.
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References
1. Li SM, Ji YZ, Wu SS, et al. Multifocal versus single vision lenses intervention to slow progression of myopia in school-age children: A meta-analysis. Surv Ophthalmol 2011;56:451–460. [PubMed]
2. Sankaridurg, P.; Donovan, L.; Varnas, S.; Ho, A.; Chen, X.; Martinez, A.; Fisher, S.; Lin, Z.; Smith, E. L.; Ge, J.; Holden, B.; Holden, B. “Spectacle Lenses Designed to Reduce Progression of Myopia: 12-Month Results.” Optom. Vis. Sci. 2010, 87 (9), 631
3. Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16 interventions for myopia control in children: A network meta-analysis. Ophthalmology 2016;123:697–708.
