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Inducement and Evaluation of a Murine Model of Experimental Myopia
Published on: January 22, 2019
Long-Term Outcomes and Predictors of Stepwise Atropine Concentration Adjustment in Paediatric Myopia Management
Sun Young Shin1, Shin Hae Park2
1Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. eyeshin@catholic.ac.kr.
Insights
Most children required increased low-dose atropine concentrations for myopia control. Younger age and faster axial length elongation at baseline predicted progression, indicating a need for tailored myopia management strategies.
Area of Science:
- Ophthalmology
- Pediatric Optometry
Background:
- Myopia control in children is crucial to prevent vision impairment.
- Low-dose atropine is a common treatment for slowing myopia progression.
Purpose of the Study:
- To assess long-term outcomes of stepwise adjusted low-dose atropine for pediatric myopia control.
- To identify baseline factors predicting the need for higher atropine concentrations.
Main Methods:
- Retrospective analysis of 651 children (5-12 years) treated with atropine for ≥5 years.
- Stepwise escalation of atropine concentration (0.025% to 0.125%) based on myopic shift (≥0.50 D/6 months).
- Cox and linear regression models analyzed predictors of escalation and refractive error change.
Main Results:
- 91.1% of children required escalation beyond 0.025% atropine.
- Younger age at initiation predicted earlier escalation to higher concentrations.
- Faster axial length elongation and younger age were associated with faster myopia progression.
Conclusions:
- Stepwise adjusted low-dose atropine provides acceptable long-term myopia control in many children.
- Early identification of risk factors is essential for personalized myopia management.
- Higher atropine concentrations may be necessary for effective myopia control in certain pediatric populations.
Purpose:
To evaluate long-term real-world treatment responses and baseline factors in children who received low-dose atropine for myopia control and required stepwise concentration adjustments.
Methods:
This retrospective study included 651 of 1032 children (651 right eyes) aged 5-12 years at initiation, treated with daily atropine for at least 5 years (mean follow-up, 6.1 years). All began with 0.025% atropine, with escalation to 0.05%, 0.05% plus 0.025% in the late afternoon and finally to 0.125% at bedtime plus 0.025% in the late afternoon if the spherical equivalent (SE) showed a myopic shift ≥0.50 D over 6 months. Baseline characteristics were summarised across stepwise treatment pathways. A baseline-only Cox model was used to evaluate predictors of time to first escalation from 0.025 to 0.05%. Multivariable linear regression identified factors associated with annual SE change.
Results:
Mean age at baseline was 7.9 years, with annual SE and axial length (AL) changes of -0.41 D and 0.23 mm, respectively. Escalation from 0.025 to 0.05% occurred in 91.1%; of these, 70.8% required an additional 0.025% afternoon dose and 57.6% escalated to 0.125% plus 0.025% in the afternoon. Across stepwise comparisons, children requiring higher-intensity regimens tended to be younger and were less likely to show AL reduction at 3 months. In the baseline-only Cox model, younger age at initiation was independently associated with earlier escalation to 0.05% (p < 0.001). In multivariable regression, faster progression was most strongly associated with greater annual AL elongation (p < 0.001) and was also associated with younger age at initiation and SE ≤ -3.00 D at age 7-8 years (all p ≤ 0.02).
Conclusions:
Most children required escalation beyond 0.025%, and many progressed despite using 0.05% atropine. The mean annual SE change of -0.41 D suggests acceptable long-term myopia control under stepwise atropine adjustment, highlighting the need for early risk stratification and tailored strategies.
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