Findings from a recent study published in the British Journal of Ophthalmology evaluated the effectiveness and sustainability of weekly 1% atropine use on children’s myopia progression.
Give me some background.
In 2006, the ATOM (Atropine for the Treatment of Childhood Myopia) study demonstrated that myopic progression and axial elongation were significantly slowed with daily topical 1% atropine compared to placebo treatment.
- However: Photophobia and blurred vision during treatment—as well as a notable rebound effect after cessation—made daily topical 1% atropine difficult to translate to broader clinical practice.
Consequently, researchers targeted lower concentrations of atropine (ex., 0.5%, 0.1%, 0.01%), and in 2012, ATOM-2 revealed that the 0.01% atropine group had the lowest total myopia progression with less visual side effects.
This contributed to the popularity of 0.01% atropine eye drops for myopia control in pediatric patients.
Bring me back to this study.
A recent study suggested that reducing the frequency of 1% atropine could result in a lower side effect profile compared with daily doses.
- However: The efficacy of reducing the frequency of high-concentration atropine remains unclear.
As such: Researchers sought to elucidate the long-term efficacy of weekly topical 1% atropine for myopia control.
Talk about the study.
In this retrospective study, investigators reviewed the medical records of myopic children (aged 3-15 years) receiving weekly 1% atropine for more than 1 year.
Axial length (AL) and spherical equivalent refraction (SER) were collected at every visit, and changes in AL or SER over time were analyzed.
The performance of short-term AL change to predict atropine-poor responders (defined as AL change >0.2 mm/year) was also measured.
Findings?
In total, 694 participants (mean age: 8.83 years) were included in the study, and a 0.20 mm axial elongation per year was observed after the second year of treatment.
Below are the percentages of participants who completed long-term follow-up visits and the respective change in AL:
- 1 year
- 256 (36.9%) patients
- Cumulative change in AL: 0.05 mm
- 2 years
- 250 (36.0%) patients
- Cumulative change in AL: 0.24 mm
- 3 years
- 143 (20.6%) patients
- Cumulative change in AL: 0.47 mm
- 4 years
- 45 (6.5%) patients
- Cumulative change in AL: 0.56 mm
Weekly use of 1% atropine resulted in 0.19D/year SER reduction and 0.14 mm/year AL increase, with a suppressive effect that was sustainable over the 4-year study period.
Anything else?
Older age and lower initial myopic refraction were independently associated with less myopic progression.
The study authors noted that a decrease in AL of more than 0.04 mm during the initial 2 months could serve as an indicator for identifying fast progressors (i.e., AL change >0.2 mm/year) over a 2-year period, with sensitivity and specificity rates of 0.78 and 0.73, respectively.
What was the side effect profile?
The study authors noted that almost all participants reported experiencing photophobia and near-blurred vision; however, photochromic and progressive multifocal glasses were able to alleviate these issues.
- Meaning: This study showed that a part-time treatment strategy could also be relatively well tolerated for a prolonged period of time.
Expert opinion?
Below are takeaways from the study that the authors highlighted:
- ~75.7% of children under 9 years old were good responders to atropine
- In those with low myopia, especially SER within -1.00D, achieved mild better treatment effect that those with low myopia
Meaning: Considering the notable myopia growth in participants with lower degrees of myopia and younger children, the study authors recommended that eyecare practitioners consider commencing weekly high-dose atropine treatment in younger patients (<9 years) and those in the initial stages of myopia.
Take home.
These findings suggest that weekly 1% atropine may be a potentially effective treatment with longer-lasting effects for children with myopia control, especially in younger patients and those with lower myopia.