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Age Effect on Treatment Responses to 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia
Fen Fen Li1, Yuzhou Zhang1, Xiujuan Zhang1
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Insights
Younger children show a poorer response to low-concentration atropine in myopia management. Higher atropine concentrations are needed for younger individuals to achieve similar results as older children on lower doses.
Area of Science:
- Ophthalmology and Optometry
- Pediatric Eye Care
- Myopia Control Research
Background:
- Myopia progression is a significant concern in children.
- Atropine eye drops are used to slow myopia progression.
- The Low-Concentration Atropine for Myopia Progression (LAMP) Study investigated atropine efficacy.
Purpose of the Study:
- To analyze the impact of patient age and other factors on the effectiveness of low-concentration atropine treatment for myopia.
- To determine if age influences treatment response in the LAMP Study cohort.
Main Methods:
- Secondary analysis of a 2-year randomized trial involving 350 children (aged 4-12 years).
- Children received 0.05%, 0.025%, or 0.01% atropine or placebo (placebo group switched to 0.05% in year 2).
- Generalized estimating equations evaluated factors like age, gender, baseline refraction, parental myopia, outdoor time, near work, and compliance on spherical equivalent (SE) and axial length (AL) changes.
Main Results:
- Younger age was consistently associated with poorer treatment response (higher SE progression and AL elongation) across all atropine concentrations.
- A concentration-dependent effect was observed: higher atropine concentrations showed better efficacy across all age groups (Ptrend <0.05).
- For example, 6-year-olds on 0.05% atropine had similar SE progression to 8-year-olds on 0.025% and 10-year-olds on 0.01%.
Conclusions:
- Younger children exhibit a diminished treatment response to low-concentration atropine (0.05%, 0.025%, 0.01%).
- To achieve comparable myopia reduction, younger children require higher atropine concentrations compared to older children receiving lower doses.
- All studied atropine concentrations were well-tolerated across all age groups.
Purpose:
To investigate the effect of age at treatment and other factors on treatment response to atropine in the Low-Concentration Atropine for Myopia Progression (LAMP) Study.
Design:
Secondary analysis from a randomized trial.
Participants:
Three hundred fifty children aged 4 to 12 years who originally were assigned to receive 0.05%, 0.025%, or 0.01% atropine or placebo once daily, and who completed 2 years of the LAMP Study, were included. In the second year, the placebo group was switched to the 0.05% atropine group.
Methods:
Potential predictive factors for change in spherical equivalent (SE) and axial length (AL) over 2 years were evaluated by generalized estimating equations in each treatment group. Evaluated factors included age at treatment, gender, baseline refraction, parental myopia, time outdoors, diopter hours of near work, and treatment compliance. Estimated mean values and 95% confidence intervals (CIs) of change in SE and AL over 2 years also were generated.
Main Outcome Measures:
Factors associated with SE change and AL change over 2 years were the primary outcome measures. Associated factors during the first year were secondary outcome measures.
Results:
In 0.05%, 0.025%, and 0.01% atropine groups, younger age was the only factor associated with SE progression (coefficient of 0.14, 0.15, and 0.20, respectively) and AL elongation (coefficient of -0.10, -0.11, and -0.12, respectively) over 2 years; the younger the age, the poorer the response. At each year of age from 4 to 12 years across the treatment groups, higher-concentration atropine showed a better treatment response, following a concentration-dependent effect (Ptrend <0.05 for each age group). In addition, the mean SE progression in 6-year-old children receiving 0.05% atropine (-0.90 diopter [D]; 95% CI, -0.99 to -0.82) was similar to that of 8-year-old children receiving 0.025% atropine (-0.89 D; 95% CI, -0.94 to -0.83) and 10-year-old children receiving 0.01% atropine (-0.92 D; 95% CI, -0.99 to -0.85). All concentrations were well tolerated in all age groups.
Conclusions:
Younger age is associated with poor treatment response to low-concentration atropine at 0.05%, 0.025%, and 0.01%. Among concentrations studied, younger children required the highest 0.05% concentration to achieve similar reduction in myopic progression as older children receiving lower concentrations.
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