Stepwise low concentration atropine for myopic control: a 10-year cohort study

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Myopia Control

Background:

• Myopia is a growing public health concern in school-aged children.
• Effective long-term myopia control strategies are crucial to prevent high myopia and associated ocular pathologies.
• Atropine eye drops are a recognized treatment for myopia control, with varying concentrations and administration protocols.

Purpose of the Study:

• To analyze refractive changes in school children over 10 years using a stepwise low-concentration atropine regimen.
• To evaluate variables associated with myopia progression in this cohort.
• To assess the long-term efficacy of different atropine concentrations for myopia control.

Main Methods:

• A 10-year prospective study involving 23 school children (mean age 6.96 years) with initial myopia.
• Initial prescription of low-concentration atropine (0.05%), with stepwise dose increases for rapid progression (≥0.5D/half-year).
• Multivariate mixed-effect analysis to identify risk factors for myopia progression.

Main Results:

• The mean initial spherical equivalent was -1.25 D, with an overall mean myopic progression of -0.30 D/year.
• Younger age, female sex, higher initial myopia, and increased atropine concentration were significant risk factors for progression.
• Children maintaining lower atropine concentrations (≤0.1%) exhibited significantly slower progression over 10 years compared to those requiring higher concentrations (>0.1%).

Conclusions:

• A stepwise low-concentration atropine approach may be effective for sustained myopia control in school students.
• Children unresponsive to lower atropine concentrations may be at higher risk of rapid progression, even with higher doses.
• Consideration of additional or alternative myopia control treatments may be necessary for non-responders.