Treatment outcomes of myopic anisometropia with 1% atropine: a pilot study
Lixia Lin1, Weizhong Lan, Yunru Liao
1*MD †MD, PhD State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China (LL, LW, ZF, YZ); Section of Neurobiology of the Eye, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany (LW); Graduate School of Cellular and Molecular Neuroscience, University of Tuebingen, Tuebingen, Germany (LW); Ophthalmic Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (LY); and Aier Eye Hospital Group, Changsha, Hunan, China (CC, YZ).
Insights
This study found that 1% atropine effectively reduced myopic anisometropia in children. However, benefits may decrease after stopping treatment, indicating a potential rebound effect.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Myopia Management
Background:
- Myopic anisometropia, an unequal refractive error, can impact binocular vision and visual development in children.
- Effective management strategies are crucial for preventing amblyopia and promoting optimal visual outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of 1% atropine sulfate as a monocular treatment for myopic anisometropia in pediatric patients.
- To assess the reduction in interocular refractive and axial length differences.
- To monitor for any adverse effects associated with atropine treatment.
Main Methods:
- A pilot study involving 22 children diagnosed with myopic anisometropia.
- Participants received one drop of 1% atropine sulfate in the more myopic eye every three days before sleep.
- Treatment efficacy was measured by the reduction in anisometropia (≤0.5 diopters) and axial length differences, with follow-up for 7-16 months. Subjective symptoms and electroretinograms were used to assess safety.
Main Results:
- Of 13 completers, 10 (76.9%) achieved the success criteria, with anisometropia reduced from 1.82 D to 0.47 D (p < 0.001).
- Refraction in treated eyes decreased by 0.63 D (p = 0.007), while untreated eyes increased by -0.72 D (p < 0.001).
- The treatment was well-tolerated, with no significant adverse effects or electroretinogram abnormalities detected.
Conclusions:
- Monocular 1% atropine sulfate is a promising treatment for reducing myopic anisometropia in children, demonstrating significant efficacy.
- While generally safe and well-tolerated, a potential rebound effect necessitates informing patients about attenuated benefits after treatment cessation.
- Further research is warranted to explore long-term outcomes and optimal treatment durations.
Purpose:
To investigate the safety and efficacy of the treatment of myopic anisometropia with 1% atropine.
Methods:
Twenty-two children with myopic anisometropia were prescribed 1% solution of atropine sulfate to the more myopic eye, one drop before sleep every 3 days. Children were visited every 3 to 4 months until the degree of anisometropia was no more than 0.5 diopters (D) ("Success") or unchanged after 9 months of treatment ("No effect"). The treatment effect was assessed by comparing the interocular imbalance in refraction and axial length before and after the treatment. A detailed questionnaire about subjective symptoms in each visit and an electroretinogram in the end were administered to evaluate the side effects of this treatment.
Results:
The subjects were followed for 7 to 16 months. Six subjects withdrew participation on their own accord, and three were excluded because of inconstant usage of drug. Of the 13 remaining subjects, the refraction of the treated eyes decreased by 0.63 ± 0.59 D (p = 0.007), whereas that of the untreated eyes increased by -0.72 ± 0.65 D (p < 0.001). A corresponding trend was also found in the change of the axial length. Accordingly, the level of anisometropia was reduced from 1.82 ± 0.73 D to 0.47 ± 0.65 D (p < 0.001) and 10 (76.9%) of the 13 subjects were designated a "Success." One percent atropine was well tolerated by the children, and no electroretinogram abnormality was detected.
Conclusions:
The results from this pilot study indicate that monocular usage of a solution of 1% atropine sulfate is an effective treatment to reduce anisometropia, although with some tolerable side effects. Nevertheless, an attenuated benefit was observed after cessation of atropine treatment. Thus, participants should be informed of a possible rebound effect before the administration of atropine for myopic anisometropia.
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