Differential Effects on Ocular Biometrics by 0.05%, 0.025%, and 0.01% Atropine

Li, Fen Fen; Kam, Ka Wai; Zhang, Yuzhou; Tang, Shu Min; Young, Alvin L.; Chen, Li Jia; Tham, Clement C.; Pang, Chi Pui; Yam, Jason C.

doi:10.1016/j.ophtha.2020.06.004

Cited by 56 publications

(69 citation statements)

References 17 publications

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“…There is some controversy regarding the effect of atropine 0.01% on AL growth. The atropine effect in myopia progression reduction in children is from slowing the AL growth and not related to corneal or lenticular changes [28]. The ATOM studies quote AL growth in the atropine 0.01% group to be 0.41 mm in two years [12].…”

Section: Plos Onementioning

confidence: 99%

Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01%

2021

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Purpose Identifying axial length growth rate as an indicator of fast progression before initiating atropine 0.01% for myopia progression in children. Method From baseline, axial length growth over six months was measured prospectively. Subjects were then initiated on atropine 0.01% if axial length growth was greater than 0.1mm per 6 months (fast progressors), axial length and spherical equivalent change measurements recorded every six months. The rate of change was compared to the baseline pre-treatment rate. If axial length change was below the threshold, subjects received monitoring only. Results 73 subjects were identified as fast progressors and commenced atropine 0.01%, (mean baseline refraction of OD -2.9±1.6, OS -2.9±1.8 and a mean baseline axial length OD 24.62 ± 1.00 mm, OS 24.53 ± 0.99 mm). At six months, the mean paired difference of axial length growth rate was significantly reduced by 50% of baseline (all 73 subjects, p<0.05). 53 subjects followed to 12 months, and 12 to 24 months maintained a reduced growth rate. Change in mean spherical equivalent was significantly reduced compared to pre-treatment refractive error (mean paired difference p<0.05) and at each subsequent visit. 91 children were slow progressors and remained untreated. Their axial length growth rate did not change significantly out to 24 months. Spherical equivalent changed less than -0.5D annually in this group. Conclusion Identifying fast progressors before treatment initiation demonstrated a strong treatment effect with atropine 0.01% reducing their individual rate of myopia progression by 50%. Another large group of myopic children, slow progressors, continued without medical intervention. A baseline axial length growth rate is proposed as a guideline to identify fast progressors who are more likely to benefit from atropine 0.01%.

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Section: Plos Onementioning

confidence: 99%

Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01%

2021

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“…1 In fact, AL elongation contributed most of the SE progression and antimyopic effects of low-concentration atropine acting mainly on decreasing the AL elongation, as described in our cohort. 5 We found no difference in the changes in corneal curvature and lens power caused by any atropine concentrations compared with placebo over 1 year. 5 We also observed that…”

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confidence: 51%

“…5 We found no difference in the changes in corneal curvature and lens power caused by any atropine concentrations compared with placebo over 1 year. 5 We also observed that…”

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confidence: 51%

“…changes in the SE and AL during myopia progression would not be completely parallel, and their ratio is approximately 0.7 to 0.8. 5 This point is the reason for the 27% decrease in SE progression and 12% decrease in axial elongation when using the 0.01% atropine group compared with the placebo group. That finding could partly explain the discrepancy of SE progression and AL elongation in current I-ATOM study when compared with the LAMP study.…”

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confidence: 98%

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Re: Saxena et al.: Atropine for treatment of childhood myopia in India: multicentric randomized trial (Ophthalmology. 2021;128:1367-1369)

et al. 2021

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TO THE EDITOR: Saxena et al 1 conducted a multicenter, doublemasked, placebo-controlled randomized clinical trial in India and reported 1-year data proving efficacy of 0.01% atropine drops in decreasing myopia progression. We congratulate the authors for a careful trial with important results.Atropine is an emerging therapy for myopia control in children with proven efficacy and safety. The widespread use of lowconcentration atropine, especially in east Asia, may help to prevent the myopia progression for the high-risk children. The authors demonstrated a good efficacy in the 0.01% atropine group with mean spherical equivalent (SE) progression of e0.16 AE 0.4 diopters (D) and only 13% of children (n ¼ 6) with myopia progression of >0.5 D in 1 year, but no significant difference in axial length (AL) changes between the 0.01% atropine and placebo groups. 1 Accordingly, treatment efficacy of the low-concentration 0.01% atropine seems to be different from other studies. There are possible explanations.First, Saxena et al 1 reported a relatively slow progressing cohort, with only e0.35 AE 0.40 D progression in the placebo group over 1 year. The progression was faster at e0.81 AE 0.53 D in the placebo group of the LAMP study in the first year. 2 We concur with the authors that there could be ethnic difference in myopia progression between Indian and Chinese children, although environmental and lifestyle can play a role as well. 1 Second, an age effect in various cohorts should be noted. The mean age was 10.6 AE 2.2 years in the 0.01% atropine group in I-ATOM but 9.5 AE 1.5 years (range, 6e14 years) in ATOM-2, and 8.23 AE 1.83 years (range, 4e12 years) in LAMP. 1e3 Recently, we showed faster progression and poorer treatment response demonstrated in younger children. 4 Younger children required a higher concentration of 0.05% atropine to achieve a similar efficacy as that for older children receiving lower concentrations of 0.01% atropine. For example, the myopia progression of 10-year-olds in the 0.01% group was similar to the 8-year-olds in the 0.025% group and 6-year-olds in the 0.05% group over 2 years. 4 An older age could contribute in part to the higher efficacy of 54% in I-ATOM study to 27% in LAMP study.Third, there was no significant difference in axial length (AL) change between the 0.01% and placebo groups although good efficacy in reduction SE progression. The authors explained that these findings corroborated with the results of ATOM-2 and LAMP study where favorable effects of 0.01%. 1 In fact, AL elongation contributed most of the SE progression and antimyopic effects of low-concentration atropine acting mainly on decreasing the AL elongation, as described in our cohort. 5 We found no difference in the changes in corneal curvature and lens power caused by any atropine concentrations compared with placebo over 1 year. 5 We also observed that

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“…Compared with 0.5% and 0.1% atropine, The lowest concentration of 0.01% atropine thus seems to retain e cacy and is a viable concentration for reducing myopia progression in children, while less side effects and rebound [9] A recent study showed that 0.05%, 0.025% and 0.01% atropine responded in a concentration-dependent manner, with 0.05% being the optimal concentration for myopia control. [10] Therefore, the optimal concentration of atropine is still controversial. At present, 0.01% of atropine is the most commonly used drug for myopia control in East Asia, especially in Taiwan and Singapore.…”

Section: Objectivementioning

confidence: 99%

The Effect of Atropine Alone or Combined with Orthokeratology for Children with Myopia: A Meta-Analysis

wang

Meng

Qie

et al. 2021

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Objective: To evaluate the effect of atropine alone or combined with orthokeratology on myopia control by meta-analysis system.Methods: The current study searched PubMed, Cochrane Library, EMBASE, MEDLINE, Web of science, Ovid to collect eligible studies. The Weighted mean difference (WMD) of mean changes in axial elongation between the atropine alone or combined with orthokeratology group and the orthokeratology (ortho-k) group was used as evaluation index. Results: Twelve studies were eventually included, involving 671 children in the atropine alone and 547 children in the atropine combined with orthokeratology（AOK） group. This meta-analysis showed that the mean axial elongation of atropine alone was faster than that of ortho-k alone. [WMD=0.06mm, 95％CI(0.02~0.10), p＜0.007]. The function of AOK for slowing axial elongation was affected by the baseline diopter of children. The WMD in -1~-3D subgroup was -0.10 mm(95％CI,-0.14~-0.05,P＜0.00001),which mens that the AOK was more effective than OK alone in retarding axial elongation. In -3~-6D, WMD is -0.04mm (95% Cl, -0.11~0.03), and there is not statistically significant between two groups (P<0.30).Conclusion: This study suggested that ortho-k monotherapy is better in slowing axial elongation than atropine monotherapy in children with myopia. For children with low degree of myopia, the combination of ortho-k and 0.01% atropine is more effective than ortho-k monotherapy in slowing axial elongation in children. But there is no significant difference between two treatments in children with moderate degree of myopia.

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Differential Effects on Ocular Biometrics by 0.05%, 0.025%, and 0.01% Atropine

Cited by 56 publications

References 17 publications

Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01%

Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01%

Re: Saxena et al.: Atropine for treatment of childhood myopia in India: multicentric randomized trial (Ophthalmology. 2021;128:1367-1369)

The Effect of Atropine Alone or Combined with Orthokeratology for Children with Myopia: A Meta-Analysis

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