Aim: To study the effectiveness of atropine in retarding progressive axial myopia in the age group 5 to 15.
Materials and Methods: This prospective interventional cohort study included children aged 5–15 years. Both the eyes of myopic children with progressive increase of ≥−0.5D sphere/year with the best-corrected vision of ≥6/6 were treated with once a day application of 0.01% atropine eye drops. The progression of myopia after 1-year follow-up was analyzed.
Outcome measures:Outcome was measured by the visual acuity using snellens chart every month till 12 months.
Results: 50 eyes of 25 myopes were included in the study. The mean age was 10 years. The mean baseline sphere was −5.0D. Duration of follow-up was12 months. The baseline rate of progression was reduced from −0.8D/year (range −0.5D/year to −3D/year) to −0.1D/year (range 0D/year to −1.0D/year) after atropine therapy.
Conclusion: Atropine eye drops was well tolerated and efficacious for the retardation of progressive myopia.
Atropine eye drops are used to retard the progression of myopia since 1960. We started using 1% atropine eye drops for progressive simple axial myopic children aged 6–12 years following the publication of ATOM 1 study in 2006 . However, that practice never became popular among the fellow ophthalmologists in India. Since the publication of the ATOM 2 study , we are noticing more ophthalmologists resorting to atropine eye drops to reduce the progression of myopia in children because the low-dose atropine (0.01%) is practically free from the important side effects of blurring and photophobia. Moreover, 0.01% atropine drop does not lead to a rebound increase after a sudden cessation of treatment [3-5].
In the coming years, it is expected that a routine use of topical atropine may become an important preferred practice pattern, not only in slowing the myopic shift in the school-going children but also in the prevention of the onset of myopia in high-risk children [6,7].
1% concentration of atropine may still be indicated for the myopes with rapid progression, higher myopia at baseline, during the years of active growth, and among the “poor” responders of lower concentrations of atropine. In ATOM 2 study, 1% atropine drop was found to have a higher efficacy (78%) in comparison to 0.01% (50% efficacy) and 20% myopes were diagnosed as “poor” responders to lower concentrations of atropine (i.e., 0.01%, 0.1%, and 0.5%).
In this prospective interventional cohort study, we included children aged 5–15 years with the best-corrected vision ≥6/6 and a documented myopic progression of ≥−0.5D/year (calculated from sequential cycloplegic refractions of immediate past 1 year).
Only those patients who did not miss or stop the atropine eye drops during the study period were included for the analysis. The progression of myopia after 1-year follow-up was analyzed Outcome was measured by the visual acuity using snellens chart every month till 12 months. The vision and refraction assessment was done under cycloplegia with a routine use of duochrome test. Paired t-test was used as a test of significance to compare pre- and post-treatment progression.
50 eyes of 25 myopes were included in the study. The mean age was 10 years. The mean baseline sphere was −5.0D. Duration of follow-up was12 months. The baseline rate of progression was reduced from −0.8D/year (range −0.5D/year to −3D/year) to −0.1D/year (range 0D/year to −1.0D/year) after atropine therapy.
There is a clear evidence that atropine eye drops has dose dependent efficacy for retarding the myopia, 1% being most
effective (78%) followed by 0.5%, 0.1%, and 0.01% (50%
effective) , and the rebound effect on cessation is least
with 0.01% followed by 0.1%, 0.5%, and 1% [2,3,16]. Sudden
cessation of atropine drops during the years of increasing
height can be associated with the rebound increase in myopia
progression [2,3,16]. Nevertheless, even after the rebound
progression, the absolute myopia progression after 3 years was
significantly lower in the atropine group compared with placebo
In establishing clinical treatment algorithms, sudden
stoppage of atropine 1 year or after 2 years of treatment is
never necessary, and it was possible that if atropine had been
continued longer in the ATOM studies, particularly in children
whose myopia increased after atropine was stopped, and then,
the overall effect may have been even better .
In ATOM 2 study, 3%-4% of patients developed allergic
dermatitis and conjunctivitis . We excluded four patients due
to atropine-related side effects. Previous studies have reported a
lack of any significant side effects of atropine on the intraocular
pressure and accommodative amplitude, and hence, both these
parameters were not evaluated in this study [1,2].
Even though there was no history of raised body
temperature or facial erythema in our study, the instructions to
perform punctal occlusion, keeping the lid closed for 5 min after
instillation of the eye drops, and wiping the atropine solution
from the facial skin if there is any overspill may be given to
reduce the risk of systemic side effects.
At present, questions remain , which children would best
benefit from treatment (e.g., in terms of age, level of myopia,
rate of progression, and family risk factors), when and how
atropine should be started and stopped, and for how long it
should be used, whether to use 1% atropine eye drops for the
rapid progressors or for those who do not respond adequately
to lower concentrations of atropine. More and larger surgeries