The Impact of Clinical Atropine Use in Taiwanese Schoolchildren: Changes in Physiological Characteristics and Visual Functions

Abstract

Taiwan is commonly noted for its high prevalence of myopia, as well as a long history of more than 20 years of using atropine to control myopia. However, the clinical implications are rarely discussed. This is a cross-sectional study investigating the influence of topical atropine instillation on ocular physiology, visual function, and visual discomfort in children. Aged 7 to 12 years, 212 schoolchildren were recruited and divided into the atropine group and the non-atropine group. Physiological characteristics such as pupil size and intraocular pressure were measured, and a variety of visual functions was also evaluated. A questionnaire was used to investigate the side effects and visual complaints caused by atropine treatment. There was a significant difference in pupil size (OD: 5.40 ± 0.90 vs. 6.60 ± 1.01 mm; OS: 5.42 ± 0.87 vs. 6.64 ± 1.00 mm, p < 0.001) between the two groups. Reductions in near visual acuity, accommodation, convergence ability, and stereopsis were observed in the atropine group. The horizontal pupil diameter enlarged, and visual functions were greatly affected after administration of topical atropine. The changes in visual function during atropine therapy need to be carefully monitored by clinicians, while patient compliance is usually the key to success.

The use of progressive addition lenses to improve the daily visual function of children receiving topical atropine treatment

“…Previous studies have shown that the near heterophorias shifted in the exo direction after wearing the addition lenses, 28,29 and our work published in 2021 also indicated that the heterophoria tended to be more exo in participants receiving atropine, compared with the controls 13 . The results of the present study showed that heterophorias measured at the Harmon distance through the near addition were significantly more exo (−3.90 ± 4.91△) than with the distance correction (2.91 ± 5.62△; p < 0.0001).…”

“…Subjects with a high lag of accommodation and esophoria have been reported to show better efficacy of myopia control by using bifocal or multifocal spectacle lenses; 28,29 therefore, it is recommended to include a heterophoria test as part of the routine examination at the follow‐up visits. Furthermore, for children treated with medium or high concentrations of topical atropine, the stereopsis and NPC test could be useful to screen possible binocular vision anomalies 13 . The participants reported adherence to wearing the PAL and their visual function was significantly improved, thus supporting the combination of PAL+ atropine therapy, particularly for children who received higher doses of atropine to slow down fast myopic development.…”

“…The reduced visual acuities observed with atropine treatment were consistent with their visual complaints, particularly at school (Table 3). The most commonly discussed side effects of atropine are photophobia and an increased lag of accommodation 13,24,25 . However, the visual performance of myopic children at school was often not considered.…”

“…For example, the expression of c‐Fos, NFκB, IL‐6 and TNF‐α 12 upon treatment with atropine was downregulated, which may be associated with myopic development retardation. However, some clinical trials have suggested that there is a limited risk of ocular side effects from atropine treatment, including photophobia, reduced near vision or ocular irritation resulting from the preservatives 13–15 . The atropine in the treatment of myopia (ATOM) study found that decreased amplitude of accommodation and near visual acuity accompanied the 2‐year use of 1% atropine 16 .…”

Effects of low-concentration atropine eye drops on the optical quality of the eyes in myopic children

“…Previous studies showed that pupil size showed different changes according to the concentration of atropine in the eye drops; thus, we propose that the optical quality may have decreased because of the change in pupil diameter. [ 21 22 23 ]…”