Which low‐dose atropine for myopia control?

Khanal, Safal; Phillips, J. R.

doi:10.1111/cxo.12967

Cited by 22 publications

(20 citation statements)

References 11 publications

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“…There are several limitations to our study. Current clinical practice has generally moved away from the earlier practice of prescribing higher concentrations of atropine (0.5–1%) to the use of low-dose atropine, typically 0.01–0.05% 43 , 44 . Our study used 0.3% atropine, and so the effects we observed may be more apparent and rapid than that expected with low-dose atropine.…”

Section: Discussionmentioning

confidence: 99%

Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia

Chiang

Turnbull

Phillips

2020

Sci Rep

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Atropine eye drops and myopic retinal defocus each slow progression of myopia (short-sight). They also cause thickening of the choroid, and it has been suggested that the thickening is a precursor for reduced eye growth and slowed myopia progression. We investigated whether choroidal thickening due to optical defocus would add to thickening due to atropine when both were applied simultaneously. Addition would suggest that combining the two clinical treatments may improve efficacy of myopia control. We studied 20 children receiving 0.3% atropine daily for myopia control, over a period of 6 months. We imposed short periods of retinal defocus (1 h of myopic or hyperopic defocus (± 2.00D)) both before, and after 1 week and 3 and 6 months of atropine treatment. Prior to atropine, myopic or hyperopic defocus caused significantly thicker or thinner choroids respectively (± 12 µm, p < 0.001). After one week of atropine alone, thickness had increased (+ 21 µm; SD 17 µm; p < 0.001), and it increased further (by + 13 µm; SD 6 µm; p < 0.001) when exposed to myopic defocus. Atropine abolished choroidal thinning in response to hyperopic defocus. These effects remained the same after 3 and 6 months of atropine treatment. Our results show that additive effects of atropine and optical defocus are present at the level of the choroid, and suggest that combining optical and pharmaceutical treatments is likely to enhance efficacy of clinical myopia control.

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Section: Discussionmentioning

confidence: 99%

Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia

Chiang

Turnbull

Phillips

2020

Sci Rep

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“…The significance level was similar to what we found in our analysis (p = 0.0015). However, Khanal and Philips [33] have recently concluded after re-analyzing data of the ATOM2 study [12] and the LAMP study [15] that there is only little evidence that this dose had a significant effect on axial growth. They even argue that treatment with 0.01% atropine might delay the implementation of an effective dose in a myopic child and that 0.025% or 0.05% should be used instead.…”

Section: Evaluation Of the Treatment Effects Of Atropinementioning

confidence: 99%

A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting

Kaymak

Graff

Schaeffel

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Background Several randomized controlled studies have demonstrated the beneficial effects of 0.01% atropine eye drops on myopia progression in children. However, treatment effects may be different in a routine clinical setting. We performed a retrospective analysis of our clinical data from children to investigate the effect of 0.01% atropine eye drops on myopia progression in a routine clinical setting. Methods Atropine-treated children were asked to instill one drop of 0.01% atropine in each eye every evening at 5 days a week. Myopic children who did not undergo atropine treatment served as controls. Objective refraction and ocular biometry of 80 atropine-treated and 103 untreated children at initial visit and 1 year later were retrospectively analyzed. Results Myopic refractions in the treated and untreated children at initial visit ranged from −0.625 to −15.25 D (−4.21 ± 2.90 D) and from −0.125 to −9.375 D (−2.92 ± 1.77 D), respectively. Ages at initial visit ranged from 3.2 to 15.5 years (10.1 ± 2.7 years) in the treated and from 3.4 to 15.5 years (11.2 ± 3.0 years) in untreated children. Two-factor ANOVA for age and atropine effects on axial length growth confirmed that axial length growth rates declined with age (p<0.0001) and revealed a significant inhibitory effect of atropine on axial length growth (p<0.0015). The atropine effect on axial length growth averaged to 0.08 mm (28%) inhibition per year. Effects on refraction were not statistically significant. Conclusion The observed atropine effects were not very distinctive: Statistical analysis confirmed that atropine reduced axial length growth, but to an extent of minor clinical relevance. It was also shown that beneficial effects of 0.01% atropine may not be obvious in each single case, which should be communicated with parents and resident ophthalmologists.

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“…Fu et al reported that 0.01% atropine significantly reduced myopia progression over a 12-month period as measured by AL when compared with a control group (average 0.14 mm, p = 0.004) (19). However, Khanal et al [21] asserted that 0.01% atropine could not slow the abnormal eye enlargement, thus delaying implementing an effective dose. Li et al [22] have pointed out that this phenomenon may be due to the sample size among previous studies powered primarily based on SER change and concluded that a larger sample size is needed to detect the difference in AL elongation between the 0.01% atropine and placebo groups.…”

Section: Introductionmentioning

confidence: 99%

Is 0.01% Atropine an Effective and Safe Treatment for Myopic Children? A Systemic Review and Meta-Analysis

Tsai

Chen

Wang

et al. 2021

JCM

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Several conflicting results regarding the efficacy of 0.01% atropine in slowing axial elongation remain in doubt. To solve this issue and evaluate the safety of 0.01% atropine, we conducted a systematic review and meta-analysis with the latest evidence. The review included a total of 1178 participants (myopic children). The efficacy outcomes were the mean annual progression in standardized equivalent refraction (SER) and axial length (AL). The safety outcomes included mean annual change in accommodative amplitude, photopic and mesopic pupil diameter. The results demonstrated that 0.01% atropine significantly retarded SER progression compared with the controls (weighted mean difference [WMD], 0.28 diopter (D) per year; 95% confidence interval (CI) = 0.17, 0.38; p < 0.01), and axial elongation (WMD, −0.06 mm; 95% CI = −0.09, −0.03; p < 0.01) during the 1-year period. Patients receiving 0.01% atropine showed no significant changes in accommodative amplitude (WMD, −0.45 D; 95% CI = −1.80, 0.90; p = 0.51) but showed dilated photopic pupil diameter (WMD, 0.35 mm; 95% CI = 0.02, 0.68; p = 0.04) and mesopic pupil diameter (WMD, 0.20 mm; 95% CI = 0.08, 0.32; p < 0.01). In the subgroup analysis of SER progression, myopic children with lower baseline refraction (>−3 D) and older age (>10-year-old) obtained better responses with 0.01% atropine treatment. Furthermore, the European and multi-ethnicity groups showed greater effect than the Asian groups. In conclusion, 0.01% atropine had favorable efficacy and adequate safety for childhood myopia over a 1-year period.

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Which low‐dose atropine for myopia control?

Cited by 22 publications

References 11 publications

Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia

Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia

A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting

Is 0.01% Atropine an Effective and Safe Treatment for Myopic Children? A Systemic Review and Meta-Analysis

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