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Chen PJ, Hsia Y, Tsai TH, Su CC, Huang JY, Wang TH. Impact of atropine use for myopia control on intraocular pressure in children: A comprehensive review including postpupil dilation intraocular pressure changes. Taiwan J Ophthalmol 2024; 14:179-189. [PMID: 39027062 PMCID: PMC11254001 DOI: 10.4103/tjo.tjo-d-24-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/02/2024] [Indexed: 07/20/2024] Open
Abstract
Topical atropine has been widely used for controlling myopia progression in children, yet its long-term efficacy and safety, including potential intraocular pressure (IOP) elevation, are still being studied. The mydriasis and cyclopegia induced by atropine may reduce traction on the trabecular meshwork, together with pigment released into anterior chamber due to the friction between the iris and lens during pupil dilation, may obstruct and reduce the trabecular outflow. This review first explores postdilation IOP changes across different groups - healthy individuals, glaucoma patients, and children. The response to pupil dilation varies widely, with IOP potentially increasing or decreasing. Glaucoma patients, whether with open or closed-angle glaucoma, may experience more significant IOP rises postdilation. The second section examines IOP effects in children using topical atropine for myopia, where most of the 25 reviewed studies showed nonsignificant IOP changes, although slight increases were observed in a few. In addition, no alterations in the retinal nerve fiber layer thickness were found. However, the research on children's IOP under topical atropine is constrained by small sample sizes, cross-sectional studies, brief follow-ups, and often lacks control groups or pretreatment IOP measurements. Given the extended atropine use for myopia and the significant individual variation in IOP response, we recommend routine IOP monitoring for children receiving topical atropine.
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Affiliation(s)
- Pao-Ju Chen
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jehn-Yu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsing-Hong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Qin G, Chen J, Hu L, Qi Y, Xu L, He W, Yu S, Pazo EE, He X. Protocol for a parallel assignment prospective, randomised, double-blinded, placebo-controlled trial to evaluate the efficacy of 0.01% atropine for near work-induced transient myopia and myopic progression in China. BMJ Open 2023; 13:e079833. [PMID: 38128934 DOI: 10.1136/bmjopen-2023-079833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Assessment of near work-induced transient myopia (NITM) is important for permanent myopia development and progression. Atropine eye drop has been reported to be beneficial in reducing initial NITM and slowing down myopic progression. This study aimed to investigate the efficacy of 0.01% atropine in treating NITM and its possible association with the progression of refractive change in Chinese myopic children. METHODS AND ANALYSIS The study is designed as a parallel assignment prospective, randomised, double-blinded, placebo-controlled trial conducted at He Eye Specialist Hospital in Shenyang, China. One hundred fifty participants will be randomly assigned in a 1:1 ratio to receive 0.01% atropine or placebo eye drop once nightly bilaterally for 1 year. Initial NITM, cycloplegic refraction, axial length, best-corrected visual acuity, intraocular pressure and pupil diameter will be measured at baseline, 4 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks. Visual Function Questionnaire will be administered at baseline and each follow-up visit. Adverse events also will be monitored and documented at each subsequent follow-up visit. ETHICS AND DISSEMINATION A parallel assignment prospective, randomised, double-blinded, placebo-controlled trial to evaluate the efficacy of 0.01% atropine for near work-induced transient myopia and myopic progression registered on 10 September 2023. Ethics approval number: IRB (2023) K025.01. The study's findings will be shared regardless of the effect's direction. TRIAL REGISTRATION NUMBER NCT06034366.
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Affiliation(s)
- Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Jiayan Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Lan Hu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yifan Qi
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- College of Public Health, He University, Shenyang, China
| | - Sile Yu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- College of Public Health, He University, Shenyang, China
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Xingru He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- College of Public Health, He University, Shenyang, China
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Tian J, Wei S, Li S, An W, Bai W, Liang X, Du J, Wang N. The effect of atropine 0.01% eyedrops on relative peripheral refraction in myopic children. Eye (Lond) 2023; 37:356-361. [PMID: 35094028 PMCID: PMC9873619 DOI: 10.1038/s41433-021-01923-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Relative peripheral refraction (RPR) is a significant factor that participates in myopic development. Here, we evaluated the effects of atropine 0.01% eyedrops, as an antimyopia drug, on RPR. METHODS Seventy-three children were enrolled from a randomized, double-blinded, placebo-0.01% atropine eyedrops cross-over trial. The study group had used the placebo for one year and then crossed over to atropine 0.01% eyedrops for half a year. The control group had used 0.01% atropine for one year and then crossed over to placebo eyedrops for half a year. Central and horizontal peripheral refractions (15° and 30° at the temporal and nasal retina) were measured under non-cycloplegia and cycloplegia. RESULTS No significant differences in age, gender, and central refraction were identified between the two groups (P > 0.05). Under non-cycloplegia, the control group showed significant relative hyperopia in the temporal 30° retina and the nasal retina (P = 0.031; P < 0.001; P < 0.001). In the study group, the relative hyperopia in the temporal 30° retina disappeared (P = 0.983). After cycloplegia, the control group had less myopia in central refractions and less hyperopia in temporal RPR (P < 0.001; P = 0.039; P < 0.001). The study group did not present significant changes in central refractions and temporal RPR (P = 0.122; P = 0.222; P = 0.475). CONCLUSIONS For myopic children, atropine 0.01% eyedrops can alleviate relative hyperopia in the temporal retina and the hyperopic shift before cycloplegia. The effect might participate in myopia control.
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Affiliation(s)
- Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Shifei Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Shiming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Wenzai An
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Weiling Bai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Xintong Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Jialing Du
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, 100730, Beijing, China.
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Jiménez R, Redondo B, Galán T, Machado P, Molina R, Vera J. Impact of dual-focus soft contact lens wear on near work-induced transient myopia. Clin Exp Optom 2022; 106:296-302. [PMID: 35073496 DOI: 10.1080/08164622.2022.2029684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Dual-focus soft contact lenses are effective in slowing myopia progression; however, their influence on near work-induced transient myopia (NITM) remains unknown. When performing a 5-min near task at 20 cm, we observed that dual-focus soft contact lens wear induced greater lags of accommodation and a lower initial NITM than single-vision soft contact lenses, which provides relevant information for better understanding the impact of using this optical design on the accommodative function. BACKGROUND NITM has been proposed as a myogenic factor, although it is a matter of debate by the scientific community. The main objective of this study was to assess the short-term effect of wearing dual-focus soft contact lenses for myopia control on the steady-state accommodative response and NITM. METHODS Twenty-four young myope adults wore, on two different days, dual-focus and single-vision soft contact lenses, while the accommodative response was dynamically measured with an open-field autorefractor during the execution of the NITM task. The shift and the time required to recover baseline levels in the refractive state after performing the 5-min near task (20 cm) were the main dependent variables. RESULTS We found a lower magnitude of accommodation during the execution of the near task with the dual-focus in comparison to the single-vision soft contact lenses (p < 0.001). There was a lower initial NITM with the dual-focus when compared to the single-vision lenses (corrected p-value = 0.003, Cohen's d = 0.68), but no statistically significant differences were observed for decay duration (p = 0.984). CONCLUSIONS Dual-focus soft contact lens wear causes a reduced accommodative response during a near task, and an initial small myopic shift at distance after a 5-min period of near viewing. The current findings may help to understand the mechanisms involved in myopia control with this optical strategy.
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Affiliation(s)
- Raimundo Jiménez
- Claro (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Granada, Spain
| | - Beatriz Redondo
- Claro (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Granada, Spain
| | - Tomás Galán
- Claro (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Granada, Spain
| | - Pedro Machado
- Claro (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Granada, Spain
| | - Rubén Molina
- Claro (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Granada, Spain
| | - Jesús Vera
- Claro (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Granada, Spain
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Yang N, Bai J, Liu L. Low concentration atropine combined with orthokeratology in the treatment of axial elongation in children with myopia: A meta-analysis. Eur J Ophthalmol 2021; 32:221-228. [PMID: 33678055 DOI: 10.1177/1120672121998903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the effect of low concentration atropine combined with Orthokeratology (OK) lens compared with the OK lens on the changes of axial length in children with moderate and low myopia by meta-analysis. METHODS Databases such as PubMed, Web of Science, Embase, and Cochrane Library were comprehensively searched to collect related studies on atropine combined with the OK lens in the treatment of children with moderate and low myopia. The retrieval time was from the establishment of the database to December 2020. The standardized mean difference (SMD) and its 95% confidence interval (CI) were selected as the effect to analyze the changes of the axial length of the eye axis in children with low and moderate myopia treated with low concentration atropine combined with OK lens. RESULTS A total of eight articles were included in this study. Compared with OK lens treatment, low concentration atropine combined with the OK lens significantly slowed down the axial elongation of low and moderate myopia, SMD = -0.68(95% CI: -0.86--0.50, p < 0.05). According to the subgroup analysis of treatment time, when the treatment time was less than or equal to 6 months, SMD = -0.63(95% CI: -0.88--0.37, p < 0.05), when the treatment time was 1 year, SMD = -0.76(95% CI: -1.08--0.43, p < 0.05), and when the treatment time was 2 years, SMD = -0.69(95% CI: -1.07--0.31, p < 0.05). CONCLUSION Low concentration atropine combined with the OK lens is more effective than the OK lens in the treatment of children with low to moderate myopia in reducing axial elongation.
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Affiliation(s)
- Ning Yang
- Your Bright Eye Clinic of Chengdu Hi-tech Zone, Chengdu, Sichuan, China
| | | | - Li Liu
- Your Bright Eye Clinic of Chengdu Hi-tech Zone, Chengdu, Sichuan, China
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Wu TE, Chen HA, Jhou MJ, Chen YN, Chang TJ, Lu CJ. Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning. J Clin Med 2020; 10:jcm10010111. [PMID: 33396943 PMCID: PMC7794848 DOI: 10.3390/jcm10010111] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 02/07/2023] Open
Abstract
Atropine is a common treatment used in children with myopia. However, it probably affects intraocular pressure (IOP) under some conditions. Our research aims to analyze clinical data by using machine learning models to evaluate the effect of 19 important factors on intraocular pressure (IOP) in children with myopia treated with topical atropine. The data is collected on 1545 eyes with spherical equivalent (SE) less than -10.0 diopters (D) treated with atropine for myopia control. Four machine learning models, namely multivariate adaptive regression splines (MARS), classification and regression tree (CART), random forest (RF), and eXtreme gradient boosting (XGBoost), were used. Linear regression (LR) was used for benchmarking. The 10-fold cross-validation method was used to estimate the performance of the five methods. The main outcome measure is that the 19 important factors associated with atropine use that may affect IOP are evaluated using machine learning models. Endpoint IOP at the last visit was set as the target variable. The results show that the top five significant variables, including baseline IOP, recruitment duration, age, total duration and previous cumulative dosage, were identified as most significant for evaluating the effect of atropine use for treating myopia on IOP. We can conclude that the use of machine learning methods to evaluate factors that affect IOP in children with myopia treated with topical atropine is promising. XGBoost is the best predictive model, and baseline IOP is the most accurate predictive factor for endpoint IOP among all machine learning approaches.
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Affiliation(s)
- Tzu-En Wu
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan;
- School of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Hsin-An Chen
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (H.-A.C.); (Y.-N.C.)
| | - Mao-Jhen Jhou
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, Taiwan; (M.-J.J.); (T.-J.C.)
| | - Yen-Ning Chen
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (H.-A.C.); (Y.-N.C.)
| | - Ting-Jen Chang
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, Taiwan; (M.-J.J.); (T.-J.C.)
| | - Chi-Jie Lu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, Taiwan; (M.-J.J.); (T.-J.C.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Department of Information Management, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Correspondence: ; Tel.: +886-2-2905-2973
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Cheng J, Yang Y, Kong X, Zeng L, Chen Z, Xu J, Zhang C. The Effect of 0.01% Atropine Eye Drops on the Ocular Surface in Children for the Control of Myopia-The Primary Results from a Six-Month Prospective Study. Ther Clin Risk Manag 2020; 16:735-740. [PMID: 32848404 PMCID: PMC7428402 DOI: 10.2147/tcrm.s265945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the effect of 0.01% atropine eye drops on the ocular surface in children for the control of myopia. Methods A total of 72 participants were recruited for this prospective study. Prior to and after 1, 3, and 6 months of 0.01% atropine administration, an ocular surface disease index (OSDI) questionnaire was obtained, Keratograph 5M was used for the measurement of the tear meniscus height (TMH), noninvasive keratographic tear film break-up time (NK-BUT, the first keratographic break-up time, [NK-BUTfirst] and the average keratographic break-up time, [NK-BUTave]), bulbar redness (BR), meiboscore (MS), and anterior segment optical coherence tomography (AS-OCT) was used to calculate the inferior tear meniscus area (TMA). Results After using the 0.01% atropine eye drops for 1 month, 9 subjects complained of discomfort immediately after administration, but this quickly subsided, and 1 subject was temporarily dazzled. All the ocular surface symptoms were mild and occurred rarely. After 3 months, these complaints no longer occurred. Compared with the baseline values, the OSDI scores (0.08 ± 0.28), values of TMH (0.23 ± 0.04 mm), TMA (0.0420 ± 0.0444 mm2), NK-BUTfirst (9.39 ± 5.25 s), NK-BUTave (10.49 ± 4.94 s), BR (0.63 ± 0.37), and MS (0.89 ± 0.70) did not change significantly after 6 months of 0.01% atropine eye drop administration (P > 0.05). Conclusion In this 6-month prospective study, no side effects were observed on the ocular surface after using 0.01% atropine in children.
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Affiliation(s)
- Jingyi Cheng
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shanghai, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, People's Republic of China
| | - Yujing Yang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shanghai, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, People's Republic of China
| | - Xiehe Kong
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, People's Republic of China
| | - Li Zeng
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shanghai, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, People's Republic of China
| | - Zhi Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shanghai, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, People's Republic of China
| | - Jianjiang Xu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shanghai, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, People's Republic of China
| | - Chaoran Zhang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shanghai, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, People's Republic of China
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