A 3-year follow-up study of atropine treatment for progressive myopia in Europeans
Jan Roelof Polling1,2,3, Emily Tan1, Sjoerd Driessen3
1Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Low-dose atropine (0.5%) effectively reduced myopia progression in European children over three years. This treatment is a viable option for managing progressive myopia and preventing high myopia in adulthood.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Clinical Pharmacology
Background:
- Progressive myopia in childhood is a growing concern.
- Atropine is recognized as a potent treatment for childhood myopia.
- Long-term clinical effectiveness data for atropine in myopia management is crucial.
Purpose of the Study:
- To evaluate the 3-year clinical effectiveness of low-dose atropine (0.5%) in managing progressive myopia in children.
- To compare the annual progression of refractive error and axial length before and during atropine treatment.
- To assess the safety and tolerability of atropine treatment in a pediatric cohort.
Main Methods:
- Prospective clinical effectiveness study involving 124 children with progressive myopia.
- Treatment involved atropine 0.5%, with dose adjustments based on axial length response.
- Outcome measures included spherical equivalent (SER) and axial length (AL) changes over 3 years.
Main Results:
- 89% of children persisted with therapy over 3 years, showing a median annual SER progression of -0.25D and AL progression of 0.11mm.
- Dose adjustments (to 1% or tapering) were made for 36% and 29.2% of patients, respectively.
- No rebound progression of axial length was observed; adverse events led to discontinuation in 19.1% of cases.
Conclusions:
- A starting dose of atropine 0.5% significantly decreased myopia progression in European children over 3 years.
- The study supports the use of adjusted-dose atropine for managing children at risk of developing high myopia.
- Atropine treatment demonstrates a favorable risk-benefit profile for long-term myopia control in pediatric populations.
Background:
Atropine is the most powerful treatment for progressive myopia in childhood. This study explores the 3-year effectiveness of atropine in a clinical setting.
Methods:
In this prospective clinical effectiveness study, children with progressive myopia ≥ 1D/year or myopia ≤ -2.5D were prescribed atropine 0.5%. Examination, including cycloplegic refraction and axial length (AL), was performed at baseline, and follow-up. Outcome measures were spherical equivalent (SER) and AL; annual progression of SER on treatment was compared with that prior to treatment. Adjustments to the dose were made after 1 year in case of low (AL ≥ 0.3 mm/year) or high response (AL < 0.1 mm/year) of AL.
Results:
A total of 124 patients were enrolled in the study (median age: 9.5, range: 5-16 years). At baseline, median SER was -5.03D (interquartile range (IQR): 3.08); median AL was 25.14 mm (IQR: 1.30). N = 89 (71.8%) children were persistent to therapy throughout the 3-year follow-up. Median annual progression of SER for these children was -0.25D (IQR: 0.44); of AL 0.11 mm (IQR: 0.18). Of these, N = 32 (36.0%) had insufficient response and were assigned to atropine 1%; N = 26 (29.2%) showed good response and underwent tapering in dose. Rebound of AL progression was not observed. Of the children who ceased therapy, N = 9 were lost to follow-up; N = 9 developed an allergic reaction; and N = 17 (19.1%) stopped due to adverse events.
Conclusion:
In children with or at risk of developing high myopia, a starting dose of atropine 0.5% was associated with decreased progression in European children during a 3-year treatment regimen. Our study supports high-dose atropine as a treatment option for children at risk of developing high myopia in adulthood.
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