Pilot Study of Levodopa Dose as Treatment for Residual Amblyopia in Children Aged 8 Years to Younger Than 18 Years

Repka, Michael X.; Kraker, Raymond T.; Beck, Roy W.; Atkinson, C. Scott; Bacal, Darron; Bremer, Don L.; Davis, Patricia L.; Gearinger, Matthew D.; Glaser, Stephen R.; Hoover, Darren L.; Laby, Daniel M.; Morrison, David G.; Rogers, David L.; Sala, Nicholas A.; Suh, Donny W.; Wheeler, Maynard B.

doi:10.1001/archophthalmol.2010.178

Cited by 39 publications

(22 citation statements)

References 10 publications

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“…In the developing brain, over-activation of the DA system has been shown to produce schizophrenia-like behavioral changes (Angrist, 1994). Consistent with these preclinical studies, some mild side effects were noted in a L-DOPA clinical trial in a small number of myopic children, including nausea, headache, fatigue, mood changes, emesis, dizziness, dry mouth, decreased appetite, and night mares; the use of carbidopa, a peripheral dopa decarboxylase inhibitor, in combination with L-DOPA reduced the side effects (Angrist, 1994; Repka et al, 2010). Moreover, in developing children treated with stimulants for attention deficit disorder (ADD)/attention deficit hyperactivity disorders (ADHD) that work by increasing extracellular dopamine levels in the brain (including Ritalin, Adderall, and Dexedrine), common side effects include feeling restless and jittery, difficulty sleeping, loss of appetite, headaches, upset stomach, irritability, mood swings, depression, dizziness, racing heartbeat, and tics (Jeffers et al, 2013; Salardini et al, 2016).…”

Section: Da Signaling and Myopia: Therapeutic Strategies And Clinimentioning

confidence: 80%

Dopamine signaling and myopia development: What are the key challenges

Zhou

Pardue

Iuvone

et al. 2017

Progress in Retinal and Eye Research

230

203

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In the face of an “epidemic” increase in myopia over the last decades and myopia prevalence predicted to reach 2.5 billion people by the end of this decade, there is an urgent need to develop effective and safe therapeutic interventions to slow down this “myopia booming” and prevent myopia-related complications and vision loss. Dopamine (DA) is an important neurotransmitter in the retina and mediates diverse functions including development, visual signaling, and refractive development. Inspired by the convergence of epidemiological and animal studies in support of the inverse relationship between outdoor activity and risk of developing myopia and by the close biological relationship between light exposure and dopamine release/signaling, we felt it is timely and important to critically review the role of DA in myopia development. This review will revisit several key points of evidence for and against DA mediating light control of myopia: 1) the causal role of extracellular retinal DA levels, 2) the mechanism and action of dopamine D1 and D2 receptors and 3) the roles of cellular/circuit retinal pathways. We examine the experiments that show causation by altering DA, DA receptors and visual pathways using pharmacological, transgenic, or visual environment approaches. Furthermore, we critically evaluate the safety issues of a DA-based treatment strategy and some approaches to address these issues. The review identifies the key questions and challenges in translating basic knowledge on DA signaling and myopia from animal studies into effective pharmacological treatments for myopia in children.

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Section: Da Signaling and Myopia: Therapeutic Strategies And Clinimentioning

confidence: 80%

Dopamine signaling and myopia development: What are the key challenges

Zhou

Pardue

Iuvone

et al. 2017

Progress in Retinal and Eye Research

230

203

View full text Add to dashboard Cite

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“…In addition, we used a dosage of levodopa 0.76 mg/kg with carbidopa 0.17 mg/kg three times per day. We tested this higher dosage in a pilot study 12 during which it was well tolerated and associated with VA improvement. This dosage is greater than that commonly used by many investigators (about 0.51 mg/kg/tid).…”

Section: Discussionmentioning

confidence: 99%

“…Studies investigating the use of levodopa as amblyopia treatment have also shown improvement in VA. 4,5,7,8, 10–16 However, some participants experience partial regression after stopping the medication. 4,7,8,10–12,14 …”

mentioning

confidence: 99%

A Randomized Trial of Levodopa as Treatment for Residual Amblyopia in Older Children

et al. 2015

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Objective To assess the efficacy and short-term safety of levodopa as adjunctive treatment to patching for amblyopia. Design Randomized, placebo-controlled trial. Participants One hundred thirty-nine children 7 to 12 years of age with residual amblyopia resulting from strabismus, anisometropia or both combined (20/50 to 20/400) following patching. Methods Sixteen weeks of oral levodopa or placebo administered 3 times a day while patching the fellow eye 2 hours per day. Main Outcome Measures Mean change in best-corrected amblyopic-eye visual acuity at 18 weeks. Results At 18 weeks, amblyopic-eye visual acuity improved from randomization by an average of 5.2 letters in the levodopa group and 3.8 letters in the placebo group (difference adjusted for baseline visual acuity = +1.4 letters, 1-sided P=0.06; 2-sided 95% confidence interval = −0.4 to +3.3 letters). No serious adverse effects from levodopa were reported during treatment. Conclusions For children 7 to 12 years of age with residual amblyopia following patching therapy, oral levodopa while continuing to patch 2 hours per day does not produce a clinically or statistically meaningful improvement in visual acuity compared with placebo and patching.

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“…Nevertheless, citation still means that the study is active in the scientific debate. Moreover, we should acknowledge that number of citation does not necessarily translate into clinical or scientific impact (40) . Fourth, a presumable circumstance that may had contributed to the low citation of papers from the Brazilian journals was its relative low IF [in 2011, the IF of ABO was 0.326, and the IF of RBO was 0.129] in comparison to the group of the foreign journals (in 2011, the average of IF was 3.692), because there is a tendency of authors to publish their best articles in journals with higher IF, perpetuating this situation (4) .…”

Section: Discussionmentioning

confidence: 99%