The Combined Effect of Low-dose Atropine with Orthokeratology in Pediatric Myopia Control: Review of the Current Treatment Status for Myopia

Sánchez‐González, José‐María; De-Hita-Cantalejo, Concepción; Baustita-Llamas, María-José; Sánchez-González, María Carmen; Capote-Puente, Raúl

doi:10.3390/jcm9082371

Cited by 26 publications

(25 citation statements)

References 90 publications

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“…Studies have evaluated the ability of atropine in myopia control and its side effects at different concentrations [ 17 , 18 ]. Atropine, an anticholinergic that causes pupillary dilation, is contraindicated in glaucoma [ 31 , 32 , 33 , 34 ]. Because of a shallow anterior chamber in children, ophthalmologists have a concern regarding whether using atropine for treating children with myopia will affect their IOP due to the induction of mydriasis by muscarinic antagonists [ 27 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the total duration (X8) is related to high IOP in children with myopia because total time-lapse exhibited the onset of myopia and atropine exposure. A longer total duration suggests that the patient had myopia onset at a younger age and was using atropine for an extended period [ 32 , 33 , 34 , 35 ]. The total duration of atropine usage should be considered when following IOP in children with myopia.…”

Section: Discussionmentioning

confidence: 99%

“…However, long-term atropine application has raised concerns among some ophthalmologists [ 27 , 28 , 29 ]. Atropine can paralyze the pupillary muscle, increasing resistance and impeding the flow of the aqueous humor, which might increase intraocular pressure (IOP) [ 30 , 31 , 32 , 33 ]. We aimed to identify factors that predict incident IOP in patients with myopia after atropine use.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning

Chen

Jhou

et al. 2020

JCM

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Atropine is a common treatment used in children with myopia. However, it probably affects intraocular pressure (IOP) under some conditions. Our research aims to analyze clinical data by using machine learning models to evaluate the effect of 19 important factors on intraocular pressure (IOP) in children with myopia treated with topical atropine. The data is collected on 1545 eyes with spherical equivalent (SE) less than −10.0 diopters (D) treated with atropine for myopia control. Four machine learning models, namely multivariate adaptive regression splines (MARS), classification and regression tree (CART), random forest (RF), and eXtreme gradient boosting (XGBoost), were used. Linear regression (LR) was used for benchmarking. The 10-fold cross-validation method was used to estimate the performance of the five methods. The main outcome measure is that the 19 important factors associated with atropine use that may affect IOP are evaluated using machine learning models. Endpoint IOP at the last visit was set as the target variable. The results show that the top five significant variables, including baseline IOP, recruitment duration, age, total duration and previous cumulative dosage, were identified as most significant for evaluating the effect of atropine use for treating myopia on IOP. We can conclude that the use of machine learning methods to evaluate factors that affect IOP in children with myopia treated with topical atropine is promising. XGBoost is the best predictive model, and baseline IOP is the most accurate predictive factor for endpoint IOP among all machine learning approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning

Chen

Jhou

et al. 2020

JCM

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“…Therefore, as long as long-term stability and microbiological safety are considered, appropriately unpreserved ophtioles and vials can also be used. Facing the additive effect of atropine with orthokeratology, the use of preservative-free solutions might allow a more gentle treatment, sparing the integrity of and avoiding toxicity to the corneal epithelium [ 38 , 78 , 79 ].…”

Section: Discussionmentioning

confidence: 99%

Corneal Penetration of Low-Dose Atropine Eye Drops

Austermann

Schaeffel

Mathis

et al. 2021

JCM

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Major studies demonstrating the inhibition of myopia in children and juveniles by low-dose atropine eye drops provide little information on the manufacturing process and the exact composition of the atropine dilutions. However, corneal penetration might significantly vary depending on preservatives, such as benzalkonium chloride (BAC), and the atropine concentration. Since there is a trade-off between side effects, stability, and optimal effects of atropine on myopia, it is important to gain better knowledge about intraocular atropine concentrations. We performed an ex vivo study to determine corneal penetration for different formulations. Atropine drops (0.01%) of different formulations were obtained from pharmacies and applied to the cornea of freshly enucleated pig eyes. After 10 min, a sample of aqueous humor was taken and atropine concentrations were determined after liquid–liquid extraction followed by high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS). The variability that originated from variations in applied drop size exceeded the differences between preserved and preservative-free formulations. The atropine concentration in the anterior chamber measured after 10 min was only 3.8 × 10−8 of its concentration in the applied eye drops, corresponding to 502.4 pM. Obviously, the preservative did not facilitate corneal penetration, at least ex vivo. In the aqueous humor of children’s eyes, similar concentrations, including higher variability, may be expected in the lower therapeutic window of pharmacodynamic action.

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“…Several studies have investigated the effect of combining low-dose atropine eye drops with orthokeratology in attempts to enhance efficacy. Recent meta-analyses of these studies [ 11 , 12 , 13 ] have concluded that this combination can significantly improve efficacy in slowing progression relative to the efficacy of orthokeratology alone.…”

Section: Introductionmentioning

confidence: 99%

Multifocal Orthokeratology versus Conventional Orthokeratology for Myopia Control: A Paired-Eye Study

Loertscher

Backhouse

Phillips

2021

JCM

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We conducted a prospective, paired-eye, investigator masked study in 30 children with myopia (−1.25 D to −4.00 D; age 10 to 14 years) to test the efficacy of a novel multifocal orthokeratology (MOK) lens compared to conventional orthokeratology (OK) in slowing axial eye growth. The MOK lens molded a center-distance, multifocal surface onto the anterior cornea, with a concentric treatment zone power of +2.50 D. Children wore an MOK lens in one eye and a conventional OK lens in the fellow eye nightly for 18 months. Eye growth was monitored with non-contact ocular biometry. Over 18 months, MOK-treated eyes showed significantly less axial expansion than OK-treated eyes (axial length change: MOK 0.173 mm less than OK; p < 0.01), and inner axial length (posterior cornea to anterior sclera change: MOK 0.156 mm less than OK, p < 0.01). The reduced elongation was constant across different baseline progression rates (range −0.50 D/year to −2.00 D/year). Visual acuity was less in MOK vs. OK-treated eyes (e.g., at six months, MOK: 0.09 ± 0.01 vs. OK: 0.02 ± 0.01 logMAR; p = 0.01). We conclude that MOK lenses significantly reduce eye growth compared to conventional OK lenses over 18 months.

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The Combined Effect of Low-dose Atropine with Orthokeratology in Pediatric Myopia Control: Review of the Current Treatment Status for Myopia

Cited by 26 publications

References 90 publications

Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning

Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning

Corneal Penetration of Low-Dose Atropine Eye Drops

Multifocal Orthokeratology versus Conventional Orthokeratology for Myopia Control: A Paired-Eye Study

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