Comparisons of atropine versus cyclopentolate cycloplegia in myopic children

Abstract

Clinical relevance: In clinical practice, 1% atropine and 1% cyclopentolate are used as cycloplegia agents to diagnose refractive error. The influence of 1% atropine on ocular biometry is obscure, and the impact of 1% cyclopentolate remains controversial. Background: This study aims to compare the effects of atropine versus cyclopentolate cycloplegia on ocular biometry in myopic children and to determine the sites of action for atropine. Methods: A total of 207 myopic children aged 6-12-years were included in the analysis. All participants underwent comprehensive eye examinations before and after cyclopentolate cycloplegia, after which they were randomly assigned into two groups, A and B, in a ratio of 1:1, to receive 1% or 0.01% atropine, respectively. The treatment was administered once every night for a week. Participants were re-examined one week later. Results: Cyclopentolate cycloplegia caused a decrease in choroidal thickness (−3 ± 9 μm, p = 0.001), elongation of axial length (9 ± 16 μm, p < 0.001), loss of lens power (−0.14 ± 0.37 dioptre, p < 0.001), and a hyperopic shift (0.14 ± 0.22 dioptre, p < 0.001) in both groups. However, ocular biometry showed different changes after one-week use of 1% or 0.01% atropine (all p < 0.001). In Group A, choroid thickening (24 ± 13 μm, p < 0.001) and reduced axial length (−30 ± 27 μm, p < 0.001) were observed after atropine cycloplegia, with greater changes in lens power (0.50 ± 0.37 dioptre, p < 0.001) and spherical equivalent (0.52 ± 0.23 dioptre, p < 0.001). Group B showed a slight increase in choroidal thickness following one-week use of 0.01% atropine (6 ± 9 μm, p < 0.001), but other biometric measures showed no significant changes. Conclusion:Cyclopentolate and atropine cycloplegia have different effects on ocular biometry. Both 1% cyclopentolate cycloplegia and 0.01% atropine resulted in choroidal thickening, indicating that the choroid may be a site of action for atropine.

Effect of 0.01% Atropine on Accommodation in Myopic Teenagers

“…Although the changes in AL were not significant compared with baseline at 1 week, the decrease in AL was observed. This trend was consistent with the findings of Ye et al (2021 ). These findings suggest that the improved effect of 0.01% atropine eye drop instillation on SE might be affected by the shortened AL.…”

Effects of Atropine Treatment on Choroidal Thickness in Myopic Children

“…The study design has been previously described. 30 In brief, 207 children aged 6 to 12 years with myopic refraction of at least −0.5 diopter (D) and astigmatism of less than −2.0 D in both eyes were enrolled in this randomized clinical trial. After excluding those with ocular diseases or severe systemic diseases, previous use of myopia interventions (such as atropine, pirenzepine, or orthokeratology lens), or allergy to atropine and cyclopentolate, children were randomly assigned to one of two groups in a ratio of 1:1: group A received 1% atropine (Dishan, Shenyang Xingqi Pharmaceutical Co., LTD., Shenyang, China), and group B received 0.01% atropine (Myopine, Shenyang Xingqi Eye Hospital Co., LTD., Shenyang, China), in both eyes.…”

“…Examination procedures were performed as previously described. 30 Briefly, each participant underwent a series of ophthalmic examinations, including measurement of intraocular pressure using a noncontact tonometry (NT-1000; Nidek, Tokyo, Japan), pupil size using an IOL-Master 700 (Carl Zeiss Meditec AG, Jena, Germany), best-corrected distance VA in the logMAR, near VA under best-corrected distance spectacle correction at 40 cm, and near point of accommodation with best-corrected distance spectacle correction. The accommodation amplitude was calculated as the inverse of the near point of accommodation.…”

“…The parameters were previously described. 30 The segmentation of each layer was automatically obtained using the built-in software, and manual segmentation was performed where the software misjudged the borderline of each layer. To determine the reproducibility of manual correction, 20 images that needed manual segmentation were randomly selected and corrected twice by a specific technician.…”

A Real-World Study on Myopia Control 6 Months After Withdrawal of 1% Atropine Eye Gel

“…After 2 consecutive weeks of dropwise administration of 1% atropine, the paralysis of the ciliary muscles was more complete. 15,16 When paralyzed, the ciliary muscles are relaxed, which leads to the tight pulling of the suspensory ligaments, the thinning of the lens, the shortening of the ocular axis, and a decrease in spherical equivalent. 17 This suggests that the sphere and ocular axial length of the treatment group in that study had already been significantly reduced at baseline.…”