Decreased effectiveness of 0.01% atropine treatment for myopia control during prolonged COVID-19 lockdowns

Erdinest, Nir; London, Naomi; Levinger, Nadav; Lavy, Itay; Pras, Eran; Morad, Yair

doi:10.1016/j.clae.2021.101475

Cited by 18 publications

(30 citation statements)

References 7 publications

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“…European children spend more time outdoors, which might have influence on progression reduction comparing with Asian children 19 , 28 . As demonstrated during COVID confinement, children who were stable under 0.01% atropine had decreased effectiveness because of extended time indoors 29 . These findings may support the different response to atropine among patients from a different socio-cultural background.…”

Section: Discussionmentioning

confidence: 94%

A multicenter Spanish study of atropine 0.01% in childhood myopia progression

Pérez-Flores

Macías-Murelaga

Barrio-Barrio

2021

Sci Rep

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To evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective, multicenter study was designed. Children aged between 6 and 14 years, with myopia between − 2.00 D to − 6.00 D, astigmatism < 1.50 D and documented previous annual progression greater than − 0.5 D (cycloplegic spherical equivalent, SE) were included. Once nightly atropine 0.01% eye drops in each eye were prescribed to all participants for 12 months. Age, gender, ethnicity and iris color were registered. All patients underwent the same follow-up protocol in every center: baseline visit, telephone consultation 2 weeks later and office controls at 4, 8 and 12 months. At each visit, best-corrected visual acuity, and cycloplegic autorefraction were assessed. Axial length (AL), anterior chamber depth and pupil diameter were measured on an IOL Master (Carl Zeiss Meditec, Inc, Dublin, CA). Adverse effects were registered in a specific questionnaire. Mean changes in cycloplegic SE and AL in the 12 months follow-up were analyzed. SE progression during treatment was compared with the SE progression in the year before enrollment for each patient. Correlation between SE and AL, and annual progression distribution were evaluated. Progression risk factors were analyzed by multivariate logistic regression analyses. Of the 105 recruited children, 92 completed the treatment. Mean SE and AL changes were − 0.44 ± 0.41 D and 0.27 ± 0.20 mm respectively. Mean SE progression was lower than the year before treatment (− 0.44 ± 0.41 D versus − 1.01 ± 0.38 D; p < 0.0001). An inverse correlation between SE progression and AL progression (r: − 0.42; p < 0.0001) was found. Fifty-seven patients (62%) had a SE progression less than − 0.50 D. No risk factors associated with progression could be identified in multivariate analyses. Mean pupil diameter increment at 12-months visit was 0.74 ± 1.76 mm. The adverse effects were mild and infrequent, and decreased over the time. Atropine 0.01% is effective and safe for myopia progression control in a multicentric Spanish children cohort. We believe this efficacy might be extensible to the myopic pediatric population from Western countries with similar social and demographic features. More studies about myopia progression risk factors among atropine treated patients are needed.

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Section: Discussionmentioning

confidence: 94%

A multicenter Spanish study of atropine 0.01% in childhood myopia progression

Pérez-Flores

Macías-Murelaga

Barrio-Barrio

2021

Sci Rep

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“…A total of five studies monitored the changes in axial length (AL) during the COVID-19 lockdown. (31,32,34,36,37) Two of these studies reported an increase in AL during the lockdown (ranging from 0.08-0.31 mm) (31,32). Another two studies found faster AL elongation during the lockdown (0.47 mm/year compared to 0.29 mm/year (36), the rate of AL increase ranging from 0.03-0.05 mm/month (37)).…”

Section: Resultsmentioning

confidence: 99%

“…(31,32,34,36,37) Two of these studies reported an increase in AL during the lockdown (ranging from 0.08-0.31 mm) (31,32). Another two studies found faster AL elongation during the lockdown (0.47 mm/year compared to 0.29 mm/year (36), the rate of AL increase ranging from 0.03-0.05 mm/month (37)). Whereas the only study from China (34) reported no difference of AL before and after that lockdown period (0.01 mm, p = 0.37).…”

Section: Resultsmentioning

confidence: 99%

“…A total of seven studies were conducted in cohorts of the same group of children at different ages (Longitudinal cohort), the other four studies were conducted in cohorts of the different groups of children at the same age (Crosssectional cohorts). All studies without myopia preventive intervention found at least one of the following outcomes: increased myopia prevalence (ranging from 7.5-20.5% with a trend of more rising of prevalence in younger age groups (29)), increased myopia incidence (from 7.5% to 15.3%), greater myopia progression (negative SER change ranging from 0.05-0.98 D (29,(31)(32)(33)(34)(35)(36)38) or negative rate of SER changes ranging from 0.05-0.1 D/month (30,37)) during the COVID-19 lockdown. With preventive interventions, a study in Taiwan reported stable myopia prevalence throughout the COVID-19 lockdown (39).…”

Section: Resultsmentioning

confidence: 99%

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The Association Between Environmental and Social Factors and Myopia: A Review of Evidence From COVID-19 Pandemic

Limwattanayingyong

Amornpetchsathaporn

Chainakul

et al. 2022

Front. Public Health

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PurposeTo review the association between children's behavioral changes during the restriction due to the pandemic of Coronavirus disease (COVID-19) and the development and progression of myopia.DesignA literature review.MethodWe looked for relevant studies related to 1) children's behavioral changes from COVID-19 restriction and 2) children's myopia progression during COVID-19 restriction by using the following keywords. They were “Behavior,” “Activity,” “COVID-19,” “Lockdown,” “Restriction,” and “Children” for the former; “Myopia,” “COVID-19,” “Lockdown,” “Restriction” for the latter. Titles, abstracts and full texts from the retrieved studies were screened and all relevant data were summarized, analyzed, and discussed.ResultsChildren were less active and more sedentary during COVID-19 restriction. According to five studies from China and six studies, each from Hong Kong, Spain, Israel, South Korea, Turkey and Taiwan included in our review, all countries without myopia preventive intervention supported the association between the lockdown and myopia progression by means of negative SER change ranging from 0.05–0.6 D, more negative SER change (compared post- to pre-lockdown) ranging from 0.71–0.98 D and more negative rate of SER changes (compared post- to pre-lockdown) ranging from 0.05–0.1 D/month. The reported factor that accelerated myopia is an increase in total near work, while increased outdoor activity is a protective factor against myopia progression.ConclusionThe pandemic of COVID-19 provided an unwanted opportunity to assess the effect of the behavioral changes and myopia in the real world. There is sufficient evidence to support the association between an increase in near work from home confinement or a reduction of outdoor activities and worsening of myopia during the COVID-19 lockdown. The findings from this review of data from the real world may help better understanding of myopia development and progression, which may lead to adjustment of behaviors to prevent myopia and its progression in the future.

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“…To the best of our knowledge, the current analysis is the first report to support that optical treatment using myopic defocus was significantly associated with slower myopia progression during the conditions of the COVID-19 pandemic, which were unfavorable to myopia progression ( Table 2 ). Although low-dose atropine for myopia control was reported to have reduced effectiveness in a recent case series, 31 additional research is required to understand whether other treatments for reducing myopia progression, including orthokeratology and specific soft contact lenses, also retained their efficacy during the pandemic. The results of the current analysis are expected to aid clinicians in managing schoolchildren with myopia who have experienced a drastic decrease in time spent outdoor and their mode of learning during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic

et al. 2022

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Key Points Question Is an optical defocus treatment associated with slowed myopia progression among schoolchildren experiencing lockdown related to the COVID-19 pandemic? Findings In this exploratory analysis of 2 cohort studies including 171 schoolchildren during COVID-19 lockdown, treatment using a defocus incorporated multiple segments lens was associated with 46% less myopia progression and 34% less axial elongation compared with regular single vision lens treatment. Meaning These findings suggest that an optical defocus treatment may be associated with slower myopia progression, which has been exaggerated during the COVID-19 pandemic, among schoolchildren.

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Decreased effectiveness of 0.01% atropine treatment for myopia control during prolonged COVID-19 lockdowns

Cited by 18 publications

References 7 publications

A multicenter Spanish study of atropine 0.01% in childhood myopia progression

A multicenter Spanish study of atropine 0.01% in childhood myopia progression

The Association Between Environmental and Social Factors and Myopia: A Review of Evidence From COVID-19 Pandemic

Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic

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