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Choi KY, Wong GTK, Chan SSH, Lam TC, Chan HHL. Interaction of retinal electrophysiology and novel orthokeratology lens use on myopia control efficacy in children. Br J Ophthalmol 2024:bjo-2023-324347. [PMID: 39332846 DOI: 10.1136/bjo-2023-324347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/16/2024] [Indexed: 09/29/2024]
Abstract
AIMS The relationship between retinal electrophysiological function and myopia progression was evaluated in school-aged children wearing Breath-O-Correct Orthokeratology (OK) lenses compared with those wearing single vision (SV) lenses over 24 months. METHODS In this randomised, single-blind, parallel controlled trial, children aged 8-12 years with -1.00 to -4.00 D of myopia were recruited. Retinal function was evaluated using global-flash multifocal electroretinography at baseline before OK or SV treatment. Axial length was evaluated at 6-month intervals up to 24 months. The main outcome measures were axial elongation (AE) between groups and the interactive effect of baseline retinal function. RESULTS A total of 70 children (43 OK, 9.8±1.3 years; 27 SV, 9.5±1.4 years) completed the 2-year study and were included in the analysis. The 2-year normalised AE was 0.37±0.37 mm in the OK group and 0.60±0.41 mm in the SV group, respectively. For children in the SV group, the amplitude of the central inner retinal response was negatively correlated with axial length elongation (p=0.03). In contrast, this relationship between retinal electrophysiology and AE was not observed in OK group, indicating that they were independent of each other in children treated with OK (p=0.33). CONCLUSION A weak retinal electrophysiological response was a risk factor for rapid AE in SV controls. However, OK treatment can lower this risk factor and significantly reduce AE in school-aged children.
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Affiliation(s)
- Kai Yip Choi
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
| | - Gigi Tsz King Wong
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
| | - Sonia Seen Hang Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
| | - Thomas Chuen Lam
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
- Centre for Eye and Vision Research, 17W Hong Kong Science Park, Hong Kong SAR, Hong Kong
| | - Henry Ho-Lung Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
- Centre for Eye and Vision Research, 17W Hong Kong Science Park, Hong Kong SAR, Hong Kong
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Ho CL. Context of Atropine Adherence in Preschool Children with Early-Onset Myopia: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1087. [PMID: 39334620 DOI: 10.3390/children11091087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 09/30/2024]
Abstract
The use of atropine is currently one of the most effective methods used to prevent myopia progression. The purpose of this study was to investigate atropine adherence in preschool children with myopia, to explain the context of treatment through caregivers, and to identify barriers and facilitators of using atropine. We conducted in-depth interviews with 60 caregivers of children (parents, kindergarten teachers and nurses) in four different areas ranging from large cities to rural areas in Taiwan. Based on the social ecological theory model, the recorded text was systematically analyzed, extracted, edited and indexed by NVivo 12 Plus. After interviewing caregivers, we determined the barriers and facilitators at the four levels of influence (children, parents, school, and hospital and society). Barriers included the side effects, parental neglect, lack of understanding of long-term drug use, lack of conducive environment, and lack of friendly medical services. Facilitators included overcoming side effects, parental responsibility, myopia progression on treatment adherence, teacher support, management by nurses, navigation by ophthalmologists, and model learning. Hence, establishing a social support network, discussing the experience of individualized drug use in preschool children, and establishing a friendly medical intervention strategy can raise awareness among parents regarding myopia, and improve atropine adherence in preschool children.
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Affiliation(s)
- Ciao-Lin Ho
- Department of Child Care and Education, Hungkuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, Taichung City 433304, Taiwan
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Zhang XJ, Zhang Y, Yip BHK, Kam KW, Tang F, Ling X, Ng MPH, Young AL, Wu PC, Tham CC, Chen LJ, Pang CP, Yam JC. Five-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 4 Report. Ophthalmology 2024; 131:1011-1020. [PMID: 38494130 DOI: 10.1016/j.ophtha.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE To evaluate (1) the long-term efficacy of low-concentration atropine over 5 years, (2) the proportion of children requiring re-treatment and associated factors, and (3) the efficacy of pro re nata (PRN) re-treatment using 0.05% atropine from years 3 to 5. DESIGN Randomized, double-masked extended trial. PARTICIPANTS Children 4 to 12 years of age originally from the Low-Concentration Atropine for Myopia Progression (LAMP) study. METHODS Children 4 to 12 years of age originally from the LAMP study were followed up for 5 years. During the third year, children in each group originally receiving 0.05%, 0.025%, and 0.01% atropine were randomized to continued treatment and treatment cessation. During years 4 and 5, all continued treatment subgroups were switched to 0.05% atropine for continued treatment, whereas all treatment cessation subgroups followed a PRN re-treatment protocol to resume 0.05% atropine for children with myopic progressions of 0.5 diopter (D) or more over 1 year. Generalized estimating equations were used to compare the changes in spherical equivalent (SE) progression and axial length (AL) elongation among groups. MAIN OUTCOMES MEASURES (1) Changes in SE and AL in different groups over 5 years, (2) the proportion of children who needed re-treatment, and (3) changes in SE and AL in the continued treatment and PRN re-treatment groups from years 3 to 5. RESULTS Two hundred seventy (82.8%) of 326 children (82.5%) from the third year completed 5 years of follow-up. Over 5 years, the cumulative mean SE progressions were -1.34 ± 1.40 D, -1.97 ± 1.03 D, and -2.34 ± 1.71 D for the continued treatment groups with initial 0.05%, 0.025%, and 0.01% atropine, respectively (P = 0.02). Similar trends were observed in AL elongation (P = 0.01). Among the PRN re-treatment group, 87.9% of children (94/107) needed re-treatment. The proportion of re-treatment across all studied concentrations was similar (P = 0.76). The SE progressions for continued treatment and PRN re-treatment groups from years 3 to 5 were -0.97 ± 0.82 D and -1.00 ± 0.74 D (P = 0.55) and the AL elongations were 0.51 ± 0.34 mm and 0.49 ± 0.32 mm (P = 0.84), respectively. CONCLUSIONS Over 5 years, the continued 0.05% atropine treatment demonstrated good efficacy for myopia control. Most children needed to restart treatment after atropine cessation at year 3. Restarted treatment with 0.05% atropine achieved similar efficacy as continued treatment. Children should be considered for re-treatment if myopia progresses after treatment cessation. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Xiangtian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mandy P H Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Hong Kong Eye Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Hong Kong Eye Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China.
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4
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Simonaviciute D, Gelzinis A, Kapitanovaite L, Grzybowski A, Zemaitiene R. Myopia Control in Caucasian Children with 0.01% Atropine Eye Drops: 1-Year Follow-Up Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1022. [PMID: 39064451 PMCID: PMC11279162 DOI: 10.3390/medicina60071022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Myopia is the most widespread ocular disorder globally and its prevalence has been increasing over the past decades. Atropine eye drops stand out as the only pharmacological intervention used in clinical practice to control myopia progression. The aim of this study was to explore the effect of 0.01% atropine eye drops on myopia progression. Patients and Methods: Healthy children aged 6-12 years with cycloplegic spherical equivalent (SE) from -0.5 D to -5.0 D and astigmatism ≤1.5 D were included. Myopia progression was assessed by changes in SE and axial length (AL) over 1 year and SE changes 1 year before the study enrollment and during the 1-year follow-up. Adverse events were evaluated based on complaints reported by either parents or the children themselves during follow-up visits. Results: The analysis involved 55 patients in the 0.01% atropine eye drops group and 66 in the control group. After the 1-year follow-up, the change in SE was -0.50 (-2.25-0.50) D in the control group compared to -0.50 (-1.50-0.50) D in the 0.01% atropine group (p = 0.935); AL change was 0.31 (0.18) mm in the control group and 0.29 (0.18) mm in the 0.01% atropine group (p = 0.480). The change in SE was -0.68 (-2.0--0.25) D/year before the study and remained similar -0.50 (-2.25-0.25) D over the 1-year follow-up in the control group (p = 0.111); SE change was reduced from -1.01 (-2.0--0.25) D/year before the study to -0.50 (-1.5-0.5) D over the 1-year follow-up in the 0.01% atropine group (p < 0.001). In the 0.01% atropine group, ten (16.4%) children experienced mild adverse events, including blurred near vision, ocular discomfort, photophobia, dry eyes, and anisocoria. Conclusions: Compared to the control group, the administration of 0.01% atropine eye drops demonstrated no significant effect on changes in SE and AL over a 1-year follow-up. However, children in the 0.01% atropine group initially experienced higher myopia progression, which decreased with treatment over the course of 1 year. Future studies should explore the long-term effects, rebound effects, potential genetic associations, and efficacy of higher doses of atropine in managing myopia progression.
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Affiliation(s)
- Dovile Simonaviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania
| | - Arvydas Gelzinis
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania
| | - Laura Kapitanovaite
- Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, 50161 Kaunas, Lithuania
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10-724 Olsztyn, Poland
- Institute for Research in Ophthalmology, 60-554 Poznan, Poland
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania
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Shahsuvaryan ML. Atropine: Updates on myopia pharmacotherapy. Taiwan J Ophthalmol 2024; 14:225-229. [PMID: 39027061 PMCID: PMC11253994 DOI: 10.4103/tjo.tjo-d-22-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/02/2022] [Indexed: 07/20/2024] Open
Abstract
The prevalence of myopia has rapidly increased over the last 30 years, with the World Health Organization estimating a worldwide incidence of 23%, projected to increase to 50% by 2050. The myopia epidemic has prompted a reincarnation in efforts to overcome this challenge. The exploration of atropine use in myopia was a result due to a lack of treatment in effect. This study aimed at reviewing the role of atropine in the management of myopia worldwide based on currently available findings. A literature search was conducted using PubMed/MEDLINE and Google Scholar for studies published up to April 2022 inclusive. Articles with high or medium clinical relevance were selected for this review. Multiple studies have demonstrated the relevance and efficacy rates of different concentrations of atropine, despite still insufficiently explained the exact site and mechanism of action of atropine in slowing myopia progression. Currently available findings highlight that topical atropine opened a new page in pharmacotherapy of myopia and have shown a high therapeutic effect on myopia progression in Asian and European child population, irrespective of ethnicity. There is potential for myopia control with fewer side effects using lower concentrations but still exists a room for improvement, underscoring the requirement of modified atropine topical preparations with increased bioavailability, potentially with nanoparticle formulations, to enable the effective management of myopia.
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Wang Y, Liu F, Zhu X, Liu Y, He JC, Zhou X, Qu X. Effects on radius of curvature and refractive power of the cornea and crystalline lens by atropine 0.01% eye drops. Acta Ophthalmol 2024; 102:e69-e77. [PMID: 37143398 DOI: 10.1111/aos.15679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/02/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The morphological changes in the cornea and crystalline lens have not been closely evaluated after the administration of atropine 0.01%. This study aims to evaluate the radii of curvature and refractive power of the cornea and lens in myopic eyes during atropine 0.01% treatment. METHODS Children aged 6-14 years with myopia <-6.0 D were randomized to receive atropine 0.01% once nightly with single vision lenses or simply wear single vision lenses. Ocular biometric parameters were measured using the IOLMaster 700 biometry and the radii of corneal and lenticular curvature were simulated using a customized program. RESULTS At the 9-month visit, 69 atropine-treated eyes and 50 control eyes were included in the final analyses. In atropine-treated eyes, the posterior corneal surface steepened (-0.05 ± 0.13 mm) and the anterior lenticular surface flattened (0.20 ± 0.69 mm) significantly within 3-6 months, whereas the posterior corneal surface and anterior lenticular surface gradually flattened (0.07 ± 0.23 and 0.32 ± 0.80 mm respectively) in the control eyes over 9 months. The difference in the change of corneal refractive power was significant between groups (-0.03 ± 0.18 D vs. 0.11 ± 0.24 D, p = 0.001), while that in the change of lenticular refractive power was statistically insignificant (0.01 ± 0.92 D vs. -0.22 ± 0.86 D, p = 0.161). CONCLUSIONS The administration of atropine 0.01% exhibited a clinically short and subtle impact on the cornea and lens, which may shed light on new targets of action for atropine in inhibiting myopia.
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Affiliation(s)
- Yuliang Wang
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Fang Liu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingxue Zhu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yujia Liu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ji C He
- Department of Vision Science, New England College of Optometry, Boston, Massachusetts, USA
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaomei Qu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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Jawaid I, Saunders K, Hammond CJ, Dahlmann-Noor A, Bullimore MA. Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners. Eye (Lond) 2024; 38:434-441. [PMID: 37717107 PMCID: PMC10858250 DOI: 10.1038/s41433-023-02718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/18/2023] Open
Abstract
The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the benefits of slowing myopia progression are considered against the side-effects of near blur and photophobia. More recently, randomised trials have focused on determining the optimum concentration of atropine leading to low-concentration atropine being used to manage myopia progression by practitioners across the world. Currently, in the United Kingdom, there is no licensed pharmacological intervention for myopia management. The aim of this review is to interpret the available data to inform clinical practice. We conducted a narrative review of the literature and identified peer-reviewed randomised controlled trials using the search terms 'myopia' and 'atropine', limited to the English language. We identified two key studies, which were the Atropine in the Treatment Of Myopia (ATOM) and Low-concentration Atropine for Myopia Progression (LAMP). Further studies were identified using the above search terms and the references from the identified literature. Atropine 0.01% has a modest effect on controlling axial length progression. Atropine 0.05% appears to be superior to atropine 0.01% in managing myopia progression. There is a dose-dependent rebound effect when treatment is stopped. Atropine is a well-tolerated, safe, and effective intervention. Treatment would be needed for several years and into adolescence, until axial length progression is stable.
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Affiliation(s)
- Imran Jawaid
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
| | - Kathryn Saunders
- School of Biomedical Sciences, Ulster University, Northern Ireland, UK
| | - Christopher J Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, King's College London, London, UK
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Sun H, Bu F, Xin X, Yan J. Incidence of Adverse Events Induced by Atropine in Myopic Children: A Meta-Analysis. J Clin Pharmacol 2023; 63:1377-1386. [PMID: 37492894 DOI: 10.1002/jcph.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/23/2023] [Indexed: 07/27/2023]
Abstract
A large number of studies have evaluated the efficacy of low-dose atropine in preventing or slowing myopic progression. However, it is challenging to evaluate the ocular safety from these studies. We aimed to evaluate the incidence of adverse events induced by atropine in children with myopia. We performed a systematic literature search in several databases for studies published until November 2022. The incidence of adverse events induced by atropine was pooled by a common-effect (fixed-effect) or random-effects model. Subgroup analyses were conducted according to drug doses, types of adverse events, and ethnicity. A total of 31 articles were ultimately included in the study. The overall incidence of adverse events for atropine was 5.9%, and the incidence of severe adverse events was 0.0%. The most commonly reported adverse events were photophobia (9.1%) and blurred near vision (2.9%). Other adverse events including eye irritation/discomfort, allergic reactions, headache, stye/chalazion, glare, and dizziness occurred in less than 1% of the patients. The incidence of atropine-induced adverse events varied depending on the drug doses. A lower dose of atropine was associated with a lower incidence of adverse events. There was no significant difference in the incidence of adverse events for low-dose atropine between Asian and White children. Our study suggests photophobia and blurred near vision are the most frequently reported adverse events induced by atropine. Low-dose atropine is safer than moderate- and high-dose atropine. Our study could provide a safe reference for ophthalmologists to prescribe atropine for myopic children.
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Affiliation(s)
- Hong Sun
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Fengjiao Bu
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiu Xin
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jingchao Yan
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
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9
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Guggenheim JA, Walline JJ. Identifying non-responders to treatments for myopia. Ophthalmic Physiol Opt 2023; 43:945-946. [PMID: 37162175 DOI: 10.1111/opo.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
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10
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Ruan J, Zhang Y, Chen Y. Influence of overnight orthokeratology on tear film and meibomian glands in myopic children: a prospective study. BMC Ophthalmol 2023; 23:136. [PMID: 37013481 PMCID: PMC10071684 DOI: 10.1186/s12886-023-02883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Orthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8-15 years. METHODS This prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups. RESULTS At the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 μm and 18.65 ± 0.04 μm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests. CONCLUSIONS The stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses.
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Affiliation(s)
- Jing Ruan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Yu Zhang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Huayuan Road, Haidian District, Beijing, 100191, China.
| | - Yueguo Chen
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Huayuan Road, Haidian District, Beijing, 100191, China.
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Simonaviciute D, Grzybowski A, Lanca C, Pang CP, Gelzinis A, Zemaitiene R. The Effectiveness and Tolerability of Atropine Eye Drops for Myopia Control in Non-Asian Regions. J Clin Med 2023; 12:jcm12062314. [PMID: 36983313 PMCID: PMC10058902 DOI: 10.3390/jcm12062314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/25/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Myopia is the most common ocular disorder worldwide with an increasing prevalence over the past few decades. It is a refractive error associated with excessive growth of the eyeball. Individuals with myopia, especially high myopia, are prone to develop sight-threatening complications. Currently, atropine is the only drug that is used to slow myopia progression in clinical practice. However, there are still areas of uncertainty such as treatment strategy, optimal concentration when considering risk–benefit ratio and active treatment period. Since the prevalence of myopia is much higher in Asian countries, most of the research on myopia control has been conducted in Asia. Data on the efficacy and tolerability to atropine eye drops in the non-Asian population remains limited. In this review, we summarize the results of published clinical trials on the effectiveness and tolerability of atropine eye drops for myopia control in non-Asian regions. The efficacy was evaluated by the mean change in spherical equivalent (SE) or axial length (AL). The tolerability of atropine eye drops was analyzed based on patients complains and adverse events. The results of this review suggest that 0.01% atropine eye drops are effective in non-Asian regions achieving less side effects compared to 0.5% concentration.
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Affiliation(s)
- Dovile Simonaviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania
- Correspondence:
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10-724 Olsztyn, Poland
- Institute for Research in Ophthalmology, 60-554 Poznan, Poland
| | - Carla Lanca
- Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou 515051, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Arvydas Gelzinis
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania
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12
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Zhang M, Qiu W, An M, Sun Y, Zhang Z, Yu C. Analysis of the reports of low-concentration atropine in controlling myopia in children. J Fr Ophtalmol 2023; 46:239-248. [PMID: 36797093 DOI: 10.1016/j.jfo.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 02/16/2023]
Abstract
PURPOSE To evaluate the efficacy of 0.01% atropine to slow the progression of myopia in children. METHODS We searched PubMed, Embase, ClinicalTrials.gov, CNKI, Cqvip and Wan fang databases from inception to January 2022, including RCTs (randomized controlled trials) and non-RCTs (non-randomized controlled trials). The search strategy was 'myopia' OR 'refractive error' and 'atropine.' Two researchers independently reviewed the articles, and stata12.0 was used for meta-analysis. The Jadad score was used to assess the quality of RCT, and the Newcastle-Ottawa scale was used for non-RCTs. RESULTS Five RCTs and two non-RCTs (1 prospective non-randomized controlled study, 1 retrospective cohort study) were identified (including 1000 eyes). Results of the meta-analysis showed statistical heterogeneity among the 7 included studies (P=0. 026, I2 =47.1%). According to different durations of atropine use - 4 months, 6 months and greater than 8 months, subgroup analysis results showed that the axial elongation of all experimental groups relative to control groups were respectively -0.03mm (95% [CI], (confidence interval), -0.07 to 0.01), -0.07mm (95% [CI], -0.10 to -0.05), -0.09mm (95% [CI], -0.12 to -0.06). Each P was greater than 0.05, which indicated that there is little heterogeneity among the subgroups. CONCLUSIONS In this meta-analysis of the short-term efficacy of atropine in myopia patients, it was found that there was little heterogeneity when grouped by usage time. It is suggested that the use of atropine in the treatment of myopia is not only related to its concentration but also related to the duration of use.
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Affiliation(s)
- M Zhang
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - W Qiu
- Qingdao Municipal Hospital, Qingdao, China.
| | - M An
- Qingdao Municipal Hospital, Qingdao, China.
| | - Y Sun
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - Z Zhang
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - C Yu
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
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13
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Nucci P, Lembo A, Schiavetti I, Shah R, Edgar DF, Evans BJW. A comparison of myopia control in European children and adolescents with defocus incorporated multiple segments (DIMS) spectacles, atropine, and combined DIMS/atropine. PLoS One 2023; 18:e0281816. [PMID: 36795775 PMCID: PMC9934319 DOI: 10.1371/journal.pone.0281816] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To evaluate the efficacy of a myopia control spectacle lens (DIMS) at slowing the progression of myopia in a population of European children in comparison with 0.01% atropine and combined DIMS and atropine. METHODS The study was a non-randomised experimenter-masked prospective controlled observational study of individuals aged 6-18 years with progressing myopia but no ocular pathology. Participants were allocated, according to patient/parent choice, to receive 0.01% atropine eyedrops, DIMS (Hoya® MiyoSmart®) spectacles, combined atropine+DIMS or single vision spectacle lenses (control group). The key outcome variables, cycloplegic autorefraction spherical equivalent refraction (SER) and axial length (AL), were measured at baseline and after three, six, and 12 months. RESULTS Of the 146 participants (mean age 10.3y ±3.2), 53 received atropine, 30 DIMS spectacles, 31 atropine+DIMS, and 32 single vision control spectacles. Generalized linear mixed model analysis revealed for SER, whilst controlling for age and SER at baseline, at each stage all treatment groups had significantly reduced progression compared with the control group (p<0.016). For AL, whilst controlling for baseline age and AL, at 6 and 12 months all treatment groups had significantly less progression than the control group (p<0.005). For SER only, in pairwise comparisons at 12 months the atropine+DIMS group had significantly reduced progression compared with the DIMS only and Atropine only groups (p<0.001). CONCLUSION In a European population, DIMS and atropine are effective at reducing myopia progression and axial elongation in progressing myopia and are most successful at reducing myopia progression when used in combination.
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Affiliation(s)
- Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Andrea Lembo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan San Giuseppe Hospital, Milan, Italy
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Rakhee Shah
- Research Department, Institute of Optometry, London, United Kingdom
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, University of London, London, United Kingdom
| | - David Francis Edgar
- Research Department, Institute of Optometry, London, United Kingdom
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, University of London, London, United Kingdom
| | - Bruce John William Evans
- Research Department, Institute of Optometry, London, United Kingdom
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, University of London, London, United Kingdom
- * E-mail:
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14
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Foo LL, Lim GYS, Lanca C, Wong CW, Hoang QV, Zhang XJ, Yam JC, Schmetterer L, Chia A, Wong TY, Ting DSW, Saw SM, Ang M. Deep learning system to predict the 5-year risk of high myopia using fundus imaging in children. NPJ Digit Med 2023; 6:10. [PMID: 36702878 PMCID: PMC9879938 DOI: 10.1038/s41746-023-00752-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Our study aims to identify children at risk of developing high myopia for timely assessment and intervention, preventing myopia progression and complications in adulthood through the development of a deep learning system (DLS). Using a school-based cohort in Singapore comprising of 998 children (aged 6-12 years old), we train and perform primary validation of the DLS using 7456 baseline fundus images of 1878 eyes; with external validation using an independent test dataset of 821 baseline fundus images of 189 eyes together with clinical data (age, gender, race, parental myopia, and baseline spherical equivalent (SE)). We derive three distinct algorithms - image, clinical and mix (image + clinical) models to predict high myopia development (SE ≤ -6.00 diopter) during teenage years (5 years later, age 11-17). Model performance is evaluated using area under the receiver operating curve (AUC). Our image models (Primary dataset AUC 0.93-0.95; Test dataset 0.91-0.93), clinical models (Primary dataset AUC 0.90-0.97; Test dataset 0.93-0.94) and mixed (image + clinical) models (Primary dataset AUC 0.97; Test dataset 0.97-0.98) achieve clinically acceptable performance. The addition of 1 year SE progression variable has minimal impact on the DLS performance (clinical model AUC 0.98 versus 0.97 in primary dataset, 0.97 versus 0.94 in test dataset; mixed model AUC 0.99 versus 0.97 in primary dataset, 0.95 versus 0.98 in test dataset). Thus, our DLS allows prediction of the development of high myopia by teenage years amongst school-going children. This has potential utility as a clinical-decision support tool to identify "at-risk" children for early intervention.
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Affiliation(s)
- Li Lian Foo
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gilbert Yong San Lim
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Carla Lanca
- grid.418858.80000 0000 9084 0599Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal ,grid.10772.330000000121511713Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.415572.00000 0004 0620 9577Asia Pacific Eye Centre, Gleneagles Hospital, Singapore, Singapore
| | - Quan V. Hoang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.21729.3f0000000419368729Dept. of Ophthalmology, Columbia University, Columbia, SC USA
| | - Xiu Juan Zhang
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C. Yam
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China ,grid.490089.c0000 0004 1803 8779Hong Kong Eye Hospital, Hong Kong, China ,grid.415197.f0000 0004 1764 7206Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China ,grid.10784.3a0000 0004 1937 0482Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China ,Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
| | - Leopold Schmetterer
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Audrey Chia
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel S. W. Ting
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Marcus Ang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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15
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Childhood myopia - a global perspective. Graefes Arch Clin Exp Ophthalmol 2023; 261:41-42. [PMID: 36227372 PMCID: PMC9558269 DOI: 10.1007/s00417-022-05867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
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Lee SS, Lingham G, Blaszkowska M, Sanfilippo PG, Koay A, Franchina M, Chia A, Loughman J, Flitcroft DI, Hammond CJ, Azuara‐Blanco A, Crewe JM, Clark A, Mackey DA. Low‐concentration atropine eyedrops for myopia control in a multi‐racial cohort of Australian children: A randomised clinical trial. Clin Exp Ophthalmol 2022; 50:1001-1012. [PMID: 36054556 PMCID: PMC10086806 DOI: 10.1111/ceo.14148] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia-control approach in Australian children. METHODS Children (6-16 years; 49% Europeans, 18% East Asian, 22% South Asian, and 12% other/mixed ancestry) with documented myopia progression were enrolled into this single-centre randomised, parallel, double-masked, placebo-controlled trial and randomised to receive 0.01% atropine (n = 104) or placebo (n = 49) eyedrops (2:1 ratio) instilled nightly over 24 months (mean index age = 12.2 ± 2.5 and 11.2 ± 2.8 years, respectively). Outcome measures were the changes in spherical equivalent (SE) and axial length (AL) from baseline. RESULTS At 12 months, the mean SE and AL change from baseline were -0.31D (95% confidence interval [CI] = -0.39 to -0.22) and 0.16 mm (95%CI = 0.13-0.20) in the atropine group and -0.53D (95%CI = -0.66 to -0.40) and 0.25 mm (95%CI = 0.20-0.30) in the placebo group (group difference p ≤ 0.01). At 24 months, the mean SE and AL change from baseline was -0.64D (95%CI = -0.73 to -0.56) and 0.34 mm (95%CI = 0.30-0.37) in the atropine group, and -0.78D (95%CI = -0.91 to -0.65) and 0.38 mm (95%CI = 0.33-0.43) in the placebo group. Group difference at 24 months was not statistically significant (p = 0.10). At 24 months, the atropine group had reduced accommodative amplitude and pupillary light response compared to the placebo group. CONCLUSIONS In Australian children, 0.01% atropine eyedrops were safe, well-tolerated, and had a modest myopia-control effect, although there was an apparent decrease in efficacy between 18 and 24 months, which is likely driven by a higher dropout rate in the placebo group.
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Affiliation(s)
- Samantha Sze‐Yee Lee
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Magdalena Blaszkowska
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
| | - Paul G. Sanfilippo
- Centre for Eye Research Australia, University of Melbourne Royal Victorian Eye and Ear Hospital East Melbourne Victoria Australia
| | - Adrian Koay
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
- Geraldton Eye Surgery Geraldton Western Australia Australia
| | - Maria Franchina
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
| | - Audrey Chia
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Daniel Ian Flitcroft
- Department of Ophthalmology Children's Health Ireland at Temple Street Dublin Ireland
| | - Christopher J. Hammond
- Departments of Ophthalmology and Twin Research and Genetic Epidemiology King's College London, St. Thomas' Hospital London UK
| | - Augusto Azuara‐Blanco
- School of Medicine Dentistry and Biomedical Science Queen's University Belfast Belfast UK
| | - Julie M. Crewe
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
| | - Antony Clark
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
| | - David A. Mackey
- Centre for Ophthalmology and Visual Sciences(incorporating the Lions Eye Institute) University of Western Australia Perth Western Australia Australia
- Centre for Eye Research Australia, University of Melbourne Royal Victorian Eye and Ear Hospital East Melbourne Victoria Australia
- School of Medicine, Menzies Research Institute Tasmania University of Tasmania Hobart Tasmania Australia
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17
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Hsieh MW, Chang HC, Chen YH, Chien KH. Classification-Based Approaches to Myopia Control in a Taiwanese Cohort. Front Med (Lausanne) 2022; 9:879210. [PMID: 35755021 PMCID: PMC9226386 DOI: 10.3389/fmed.2022.879210] [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: 02/19/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Myopia is a disorder of growing prevalence in school-aged children worldwide, especially in Asia. Although low-dose atropine is recognized as an effective treatment to slow myopia progression, different studies have reported varying efficacies of treatment, and the optimal concentration of low-dose atropine remains an open question. Methods A two-stage approach was conducted in this study. First, an observational study was conducted to plot the axial length growth curve for Taiwanese children. Second, an interventional 2-year study was performed in which different concentrations of low-dose atropine were applied based upon the risk-level status from the first stage. Results A total of 4,091 subjects, consisting of 2,105 boys (51.5%) and 1,986 girls (48.5%), were enrolled in the first stage to plot the axial growth curve for Taiwanese children aged between 3 and 16 years. The percentage of children with myopia increased from 2.3% in 4-year-olds to 88.0% in 16-year-olds. At the second stage, a total of 886 subjects [307 (34.65%) at low risk, 358 (40.41%) at moderate risk and 221 (24.94%) at high risk] were enrolled to receive low-dose atropine based upon the risk level (0.02, 0.03, and 0.05%, respectively). With this approach, the mean annual myopia progression was −0.33, −0.57, and −0.82 D in the low-risk, moderate-risk and high-risk groups, respectively. Applying annual myopic progression < -1.0 D as a criterion for responder, the responder rates were 95.77, 83.52, and 70.59% in the low-risk, moderate-risk, and high-risk groups, respectively. Conclusions We proposed a classification-based approach involving different concentrations of low-dose atropine based upon an individual's risk-level status. With this approach, myopic progression can be effectively controlled in patients without exposure to atropine side effects due to exposure to a higher dose than actually needed.
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Affiliation(s)
- Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.,National Defense Medical Center, Taipei, Taiwan
| | - Hsu-Chieh Chang
- Department of Nursing, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hao Chen
- National Defense Medical Center, Taipei, Taiwan.,Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan
| | - Ke-Hung Chien
- National Defense Medical Center, Taipei, Taiwan.,Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan
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18
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Hong CY, Boyd M, Wilson G, Hong SC. Photorefraction Screening Plus Atropine Treatment for Myopia is Cost-Effective: A Proof-of-Concept Markov Analysis. Clin Ophthalmol 2022; 16:1941-1952. [PMID: 35720738 PMCID: PMC9205435 DOI: 10.2147/opth.s362342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The prevalence of myopia is increasing globally, putting individuals at risk of myopia-associated visual impairment. Low-dose atropine eye drops have been found to safely reduce the risk of progression from myopia to higher levels of myopia and pathological states. In New Zealand, school children have an eye check at age 11. In this study, we aimed to estimate the cost-effectiveness of introducing photorefractive screening for myopia at age 11 in the New Zealand context, with atropine 0.01% eye drops treatment for those screening positive. Patients and Methods A Markov cohort simulation was used to model the impact of screening plus atropine compared to usual care across a lifetime horizon and societal perspective with a 3% discount rate. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER), with utility measured in quality-adjusted life-years (QALYs). Multivariate sensitivity analyses were carried out to investigate factors influencing cost-effectiveness. Results The ICER for screening plus atropine was NZ$1590 (95% CI 1390, 1791) per QALY gained, with 7 cases of lifetime blindness prevented per 100,000 children screened. Conclusion Screening for myopia with photorefraction at age 11 and atropine 0.01% eye drop treatment of children screening positive is likely to be cost-effective. These results suggest that a real-world trial and cost-effectiveness analysis would be worth considering in New Zealand.
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Affiliation(s)
- Chuen Yen Hong
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Correspondence: Chuen Yen Hong, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, Tel +6421 209 1230, Email
| | - Matt Boyd
- Adapt Research Ltd, Reefton, New Zealand
| | - Graham Wilson
- Matai Medical Research Institute, Gisborne, New Zealand
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Lee LC, Hsieh MW, Chen YH, Chen PL, Chien KH. Characteristics of responders to atropine 0.01% as treatment in Asian myopic children. Sci Rep 2022; 12:7380. [PMID: 35513480 PMCID: PMC9072680 DOI: 10.1038/s41598-022-10978-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/15/2022] [Indexed: 01/04/2023] Open
Abstract
Recently, low-concentration atropine (0.01%) has gained increased attention in controlling myopia progression with satisfying effects and minimal side effects. However, studies concerning responders to 0.01% atropine are limited. This retrospective observational cohort study aimed to determine the responder characteristics of 0.01% atropine in Asian children. One hundred forty children (aged between 3 and 15 years) receiving 0.01% atropine were analyzed for the factors influencing annual spherical equivalent changes (SE). The mean age was 9.13 (2.6) years, the mean baseline SE was - 1.56 (1.52) diopters (D), and the mean annual SE change was - 0.52 (0.49) D. A 58.63% responder rate (146/249) of myopic control was achieved with 0.01% atropine in our entire cohort under the criteria of less than 0.5 D of myopic progression annually. The subjects were stratified into 4 subgroups based on a cut-off point of baseline SE of - 1.5 D and baseline age of 9 years. The responder rate differed significantly with the highest being the youngest with the lowest myopia subgroups. Our results demonstrated that children with myopia better than - 1.5 D and younger than 9 years had the highest potential to achieve successful myopic control under 0.01% atropine therapy.
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Affiliation(s)
- Lung-Chi Lee
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Rd., Neihu Dist., Taipei, 114, Taiwan, ROC
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC
- National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Rd., Neihu Dist., Taipei, 114, Taiwan, ROC
| | - Po-Liang Chen
- Hau-Ming Eye Clinic Center, No. 199, Zhongxing Rd., Xizhi Dist., New Taipei City, 221, Taiwan, ROC.
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Rd., Neihu Dist., Taipei, 114, Taiwan, ROC.
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Wang M, Cui C, Sui Y, Yu SA, Ma JX, Fu AC. Effect of 0.02% and 0.01% atropine on astigmatism: a two-year clinical trial. BMC Ophthalmol 2022; 22:161. [PMID: 35392841 PMCID: PMC8991778 DOI: 10.1186/s12886-022-02385-z] [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: 12/07/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the effects of 0.02% and 0.01% atropine eye drops on ocular and corneal astigmatism over 2 years. Methods A prospective clinic-controlled trail. The cohort study assessed 400 myopic children and divided them into three groups: 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine applied to both eyes once nightly. Control children (n = 120) only wore SV spectacles. Spherical equivalent refractive errors (SER) and corneal curvature were measured every 4 months. The SER and corneal curvature were assessed by cycloplegic autorefraction and IOLMaster. Ocular and corneal astigmatism were calculated by Thibos vector analysis and then split into its power vector components, J0 (with-the-rule astigmatism) and J45 (oblique). Results After 2 years, the ocular astigmatism increased by -0.38 ± 0.29 D, -0.47 ± 0.38 D, -0.41 ± 0.35 D in the 0.02%, 0.01% atropine groups and control group, respectively (p = 0.15). The corresponding corneal astigmatism increased by -0.20 ± 0.34 D, -0.28 ± 0.35 D and -0.26 ± 0.26 D (p = 0.18). The ocular astigmatism J0 increased by 0.19 ± 0.28 D, 0.22 ± 0.36 D, 0.18 ± 0.31 D in the 0.02% atropine, 0.01% atropine and control groups, respectively (p = 0.65). The corresponding corneal astigmatism J0 increased by -0.05 ± 0.34 D, -0.11 ± 0.37 D and -0.13 ± 0.30 D (p = 0.23). There was a small but significant increase in ocular astigmatism (including J0) (all P < 0.05), but there were no changes in the ocular astigmatism J45 and corneal astigmatism (including J0 and J45) in the three groups over time (all p > 0.05). However, there were no significant differences in the changes in ocular astigmatism (including J0) among the three groups. Conclusions Treatment with 0.02% and 0.01% atropine had no clinically significant effect on ocular and corneal astigmatism over 2 years. Trial registration The First Affiliated Hospital of Zhengzhou University, ChiCTR-IPD-16008844. Registered 14/07/2016.
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Affiliation(s)
- Ming Wang
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe road, Zhengzhou, 450000, China
| | - Can Cui
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Yao Sui
- The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shi Jiazhuang, 050000, China
| | - Shi-Ao Yu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe road, Zhengzhou, 450000, China
| | - Jing-Xue Ma
- The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shi Jiazhuang, 050000, China.
| | - Ai-Cun Fu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe road, Zhengzhou, 450000, China.
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21
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Kassam I, Foo LL, Lanca C, Xu L, Hoang QV, Cheng CY, Hysi P, Saw SM. The potential of current polygenic risk scores to predict high myopia and myopic macular degeneration in multi-ethnic Singapore adults. Ophthalmology 2022; 129:890-902. [DOI: 10.1016/j.ophtha.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022] Open
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22
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Gan J, Li SM, Wu S, Cao K, Ma D, He X, Hua Z, Kang MT, Wei S, Bai W, Wang N. Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis. Front Med (Lausanne) 2022; 8:756398. [PMID: 35096861 PMCID: PMC8792607 DOI: 10.3389/fmed.2021.756398] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: To evaluate the efficacy and safety of atropine for slowing myopia progression and to investigate whether the treatment effect remains constant with continuing treatment. Method: Studies were retrieved from MEDLINE, EMBASE, and the Cochrane Library from their inception to May 2021, and the language was limited to English. Randomized controlled trials (RCTs) and cohort studies involving atropine in at least one intervention and placebo/non-atropine treatment in another as the control were included and subgroup analysis based on low dose (0.01%), moderate dose (0.01%–<0.5%), and high dose (0.5–1.0%) were conducted. The Cochrane Collaboration and Newcastle-Ottawa Scale were used to evaluate the quality of RCTs and cohort studies, respectively. Results: Twelve RCTs and fifteen cohort studies involving 5,069 children aged 5 to 15 years were included. The weighted mean differences in myopia progression between the atropine and control groups were 0.73 diopters (D), 0.67 D, and 0.35 D per year for high-dose, moderate-dose, and low-dose atropine, respectively (χ2 = 13.76; P = 0.001, I2 = 85.5%). After removing studies that provided extreme findings, atropine demonstrated a significant dose-dependent effect on both refractive change and axial elongation, with higher dosages of atropine resulting in less myopia progression (r = 0.85; P = 0.004) and less axial elongation (r = −0.94; P = 0.005). Low-dose atropine showed less myopia progression (−0.23 D; P = 0.005) and less axial elongation (0.09 mm, P < 0.001) in the second year than in the first year, whereas in high-dose atropine more axial elongation (−0.15 mm, P = 0.003) was observed. The higher dose of atropine was associated with a higher incidence of adverse effects, such as photophobia with an odds ratio (OR) of 163.57, compared with an OR of 6.04 for low-dose atropine and 8.63 for moderate-dose atropine (P = 0.03). Conclusion: Both the efficacy and adverse effects of atropine are dose-dependent in slowing myopia progression in children. The efficacy of high-dose atropine was reduced after the first year of treatment, whereas low-dose atropine had better efficacy in a longer follow-up period.
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Affiliation(s)
- Jiahe Gan
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shanshan Wu
- Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China
| | - Kai Cao
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dandan Ma
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xi He
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ziyu Hua
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shifei Wei
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Weiling Bai
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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23
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Foo LL, Lanca C, Wong CW, Ting D, Lamoureux E, Saw SM, Ang M. Cost of Myopia Correction: A Systematic Review. Front Med (Lausanne) 2021; 8:718724. [PMID: 34926485 PMCID: PMC8677936 DOI: 10.3389/fmed.2021.718724] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Myopia is one of the leading causes of visual impairment globally. Despite increasing prevalence and incidence, the associated cost of treatment remains unclear. Health care spending is a major concern in many countries and understanding the cost of myopia correction is the first step eluding to the overall cost of myopia treatment. As cost of treatment will reduce the burden of cost of illness, this will aid in future cost-benefit analysis and the allocation of healthcare resources, including considerations in integrating eye care (refractive correction with spectacles) into universal health coverage (UHC). We performed a systematic review to determine the economic costs of myopia correction. However, there were few studies for direct comparison. Costs related to myopia correction were mainly direct with few indirect costs. Annual prevalence-based direct costs for myopia ranged from $14-26 (USA), $56 (Iran) and $199 (Singapore) per capita, respectively (population: 274.63 million, 75.15 million and 3.79 million, respectively). Annually, the direct costs of contact lens were $198.30-$378.10 while spectacles and refractive surgeries were $342.50 and $19.10, respectively. This review provides an insight to the cost of myopia correction. Myopia costs are high from nation-wide perspectives because of the high prevalence of myopia, with contact lenses being the more expensive option. Without further interventions, the burden of illness of myopia will increase substantially with the projected increase in prevalence worldwide. Future studies will be necessary to generate more homogenous cost data and provide a complete picture of the global economic cost of myopia.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore.,Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Ting
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,NUS Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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24
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Yuan Y, Zhu C, Liu M, Zhou Y, Yang X, Zheng B, Li Z, Mao X, Ke B. Efficacy of combined orthokeratology and 0.01% atropine for myopia control: the study protocol for a randomized, controlled, double-blind, and multicenter trial. Trials 2021; 22:863. [PMID: 34852833 PMCID: PMC8633914 DOI: 10.1186/s13063-021-05825-1] [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: 03/25/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of myopia is increasing worldwide and is presently recognized as a major public health issue. Researchers and clinicians have been devoted in exploring appropriate clinical interventions to slow its progression in children. Mounting publications have proven that both orthokeratology (OK lens) and 0.01% atropine eyedrop can retard eye growth and myopia progression. However, it remains unclear whether the combination of OK lens and 0.01% atropine has the potential to magnify the effectiveness of myopia control. The present study aims to compare the myopia control efficiency of the combination of OK lens and 0.01% atropine with the monotherapy of OK lens in children. METHODS The present study is a randomized, controlled, double-blind and multicenter clinical trial. A total of 96 children within 8-12 years old were recruited. These participants are treated with the combination of OK lens and 0.01% atropine eyedrop or the combination of OK lens and placebo eyedrop. Each group includes 48 participants. The inclusion criteria are as follows: myopia between - 1.00 and - 4.00 D in either eye and astigmatism of no more than 1.50 D. The follow-up time points will be 1, 6, 12, 18, and 24 months from randomization. The primary outcome is determined by the difference in axial length of the two groups, between the baseline and 24 months from randomization. DISCUSSION The present randomized, controlled clinical trial would indicate the additive effects of the combination of OK lens and 0.01% atropine, and the extent of these effects, in retarding myopia progression and axial elongation in children. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR1800018419 . Registered on 17 September 2018. http://www.chictr.org.cn/showproj.aspx?proj=29216.
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Affiliation(s)
- Ying Yuan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China
| | - Chengcheng Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Mingming Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Yali Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-Sen University, Guangzhou, China
| | - Bingru Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-Sen University, Guangzhou, China
| | - Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-Sen University, Guangzhou, China
| | - Xinjie Mao
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
| | - Bilian Ke
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China. .,National Clinical Research Center for Eye Diseases, Shanghai, China. .,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.
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25
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Cui C, Li X, Lyu Y, Wei L, Zhao B, Yu S, Rong J, Bai Y, Fu A. Safety and efficacy of 0.02% and 0.01% atropine on controlling myopia progression: a 2-year clinical trial. Sci Rep 2021; 11:22267. [PMID: 34782708 PMCID: PMC8592985 DOI: 10.1038/s41598-021-01708-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022] Open
Abstract
Four hundred myopic children randomly received atropine 0.02% (n = 138) or 0.01% (n = 142) in both eyes once-nightly or only wore single-vision spectacles (control group) (n = 120) for 2 years. Spherical equivalent refractive error (SER), axial length (AL), pupil diameter (PD), and amplitude of accommodation (AMP) were measured every 4 months. After 2 years, the SER changes were - 0.80 (0.52) D, - 0.93 (0.59) D and - 1.33 (0.72) D and the AL changes were 0.62 (0.29) mm, 0.72 (0.31) mm and 0.88 (0.35) mm in the 0.02% and 0.01% atropine groups and control group, respectively. There were significant differences between changes in SER and AL in the three groups (all P < 0.001). The changes in SER and AL in the 2nd year were similar to the changes in the 1st year in the three groups (all P > 0.05). From baseline to 2 years, the overall decrease in AMP and increase in PD were not significantly different in the two atropine groups, whereas the AMP and PD in the control group remained stable (all P > 0.05). 0.02% atropine had a better effect on myopia control than 0.01% atropine, and its effects on PD and AMP were similar to 0.01% atropine. 0.02% or 0.01% atropine controlled myopia progression and AL elongation synchronously and had similar effects on myopia control each year.
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Affiliation(s)
- Can Cui
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Xiujuan Li
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Yong Lyu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Li Wei
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Bingxin Zhao
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Shiao Yu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Junbo Rong
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Yanhui Bai
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Aicun Fu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China.
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26
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Pérez-Flores I, Macías-Murelaga B, Barrio-Barrio J. A multicenter Spanish study of atropine 0.01% in childhood myopia progression. Sci Rep 2021; 11:21748. [PMID: 34741059 PMCID: PMC8571279 DOI: 10.1038/s41598-021-00923-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
To evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective, multicenter study was designed. Children aged between 6 and 14 years, with myopia between - 2.00 D to - 6.00 D, astigmatism < 1.50 D and documented previous annual progression greater than - 0.5 D (cycloplegic spherical equivalent, SE) were included. Once nightly atropine 0.01% eye drops in each eye were prescribed to all participants for 12 months. Age, gender, ethnicity and iris color were registered. All patients underwent the same follow-up protocol in every center: baseline visit, telephone consultation 2 weeks later and office controls at 4, 8 and 12 months. At each visit, best-corrected visual acuity, and cycloplegic autorefraction were assessed. Axial length (AL), anterior chamber depth and pupil diameter were measured on an IOL Master (Carl Zeiss Meditec, Inc, Dublin, CA). Adverse effects were registered in a specific questionnaire. Mean changes in cycloplegic SE and AL in the 12 months follow-up were analyzed. SE progression during treatment was compared with the SE progression in the year before enrollment for each patient. Correlation between SE and AL, and annual progression distribution were evaluated. Progression risk factors were analyzed by multivariate logistic regression analyses. Of the 105 recruited children, 92 completed the treatment. Mean SE and AL changes were - 0.44 ± 0.41 D and 0.27 ± 0.20 mm respectively. Mean SE progression was lower than the year before treatment (- 0.44 ± 0.41 D versus - 1.01 ± 0.38 D; p < 0.0001). An inverse correlation between SE progression and AL progression (r: - 0.42; p < 0.0001) was found. Fifty-seven patients (62%) had a SE progression less than - 0.50 D. No risk factors associated with progression could be identified in multivariate analyses. Mean pupil diameter increment at 12-months visit was 0.74 ± 1.76 mm. The adverse effects were mild and infrequent, and decreased over the time. Atropine 0.01% is effective and safe for myopia progression control in a multicentric Spanish children cohort. We believe this efficacy might be extensible to the myopic pediatric population from Western countries with similar social and demographic features. More studies about myopia progression risk factors among atropine treated patients are needed.
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Affiliation(s)
| | | | - Jesús Barrio-Barrio
- Department of Ophthalmology, Navarra University Clinic Hospital, Navarra Institute for Health Research, IdiSNA, Pio XII, 36. Pamplona, 31008, Navarra, ES, Spain.
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27
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Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression Study: Continued Versus Washout: Phase 3 Report. Ophthalmology 2021; 129:308-321. [PMID: 34627809 DOI: 10.1016/j.ophtha.2021.10.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE (1) To compare the efficacy of continued and stopping treatment for 0.05%, 0.025%, and 0.01% atropine during the third year. (2) To evaluate the efficacy of continued treatment over 3 years. (3) To investigate the rebound phenomenon and its determinants after cessation of treatment. DESIGN A randomized, double-masked extended trial. PARTICIPANTS A total of 350 of 438 children aged 4 to 12 years originally recruited into the Low-Concentration Atropine for Myopia Progression (LAMP) study. METHODS At the beginning of the third year, children in each group were randomized at a 1:1 ratio to continued treatment and washout subgroups. Cycloplegic spherical equivalent (SE) refraction and axial length (AL) were measured at 4-month intervals. MAIN OUTCOME MEASURES Changes in SE and AL between groups. RESULTS A total of 326 children completed 3 years of follow-up. During the third year, SE progression and AL elongation were faster in the washout subgroups than in the continued treatment groups across all concentrations: -0.68 ± 0.49 diopters (D) versus -0.28 ± 0.42 D (P < 0.001) and 0.33 ± 0.17 mm versus 0.17 ± 0.14 mm (P < 0.001) for the 0.05%; -0.57 ± 0.38 D versus -0.35 ± 0.37 D (P = 0.004) and 0.29 ± 0.14 mm versus 0.20 ± 0.15 mm (P = 0.001) for the 0.025%; -0.56 ± 0.40 D versus -0.38 ± 0.49 D (P = 0.04) and 0.29 ± 0.15 mm versus 0.24 ± 0.18 mm (P = 0.13) for the 0.01%. Over the 3-year period, SE progressions were -0.73 ± 1.04 D, -1.31 ± 0.92 D, and -1.60 ± 1.32 D (P = 0.001) for the 0.05%, 0.025%, and 0.01% groups in the continued treatment subgroups, respectively, and -1.15 ± 1.13 D, -1.47 ± 0.77 D, and -1.81 ± 1.10 D (P = 0.03), respectively, in the washout subgroup. The respective AL elongations were 0.50 ± 0.40 mm, 0.74 ± 0.41 mm, and 0.89 ± 0.53 mm (P < 0.001) for the continued treatment subgroups and 0.70 ± 0.47 mm, 0.82 ± 0.37 mm, and 0.98 ± 0.48 mm (P = 0.04) for the washout subgroup. The rebound SE progressions during washout were concentration dependent, but their differences were clinically small (P = 0.15). Older age and lower concentration were associated with smaller rebound effects in both SE progression (P < 0.001) and AL elongation (P < 0.001). CONCLUSIONS During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. 0.05% atropine remained the optimal concentration over 3 years in Chinese children. The differences in rebound effects were clinically small across all 3 studied atropine concentrations. Stopping treatment at an older age and lower concentration are associated with a smaller rebound.
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28
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Yum HR, Park SH, Shin SY. Influence of coronavirus disease 2019 on myopic progression in children treated with low-concentration atropine. PLoS One 2021; 16:e0257480. [PMID: 34520481 PMCID: PMC8439482 DOI: 10.1371/journal.pone.0257480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose The outbreak of coronavirus disease 2019 (COVID-19) has caused many children to stay indoors. Increased near work and insufficient outdoor activities are considered important risk factors for myopic progression. This study aimed to compare the changes in myopic progression before and after COVID-19 in children treated with low-concentration atropine. Methods The records of 103 eyes of 103 children who were treated with low-concentration atropine eye drops were retrospectively reviewed. We classified children according to the concentration of atropine eye drops and children’s age. The beginning of the pre-COVID-19 period was set from January 2019 to May 2019, and the endpoint was set in March 2020. The beginning of the post-COVID-19 period was set in March 2020, and the endpoint was set from January 2021 to March 2021. We evaluated the questionnaires administered to children’s parents. Results A significant myopic progression was observed in the post-COVID-19 period compared to the pre-COVID-19 period in the 0.05% and 0.025% atropine groups (P < 0.001 and P = 0.020, respectively). For children aged 5 to 7 and 8 to 10 years, the axial elongations were significantly faster in the post-COVID-19 period than in the pre-COVID-19 period (P = 0.022 and P = 0.005, respectively). However, the rates of axial elongation and myopic progression were not significantly different between pre- and post-COVID-19 in children aged 11 to 15 years (P = 0.065 and P = 0.792, respectively). The average time spent using computers and smartphones and reading time were significantly increased, and the times of physical and outdoor activity were significantly decreased in the post-COVID-19 period compared to the pre-COVID-19 period. Conclusions The rates of myopic progression have increased substantially after the spread of COVID-19 with an increase in the home confinement of children. Therefore, it is necessary to control the environmental risk factors for myopia, even in children undergoing treatment for the inhibition of myopic progression.
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Affiliation(s)
- Hae Ri Yum
- Department of Ophthalmology and Visual Science, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shin Hae Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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29
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Foo LL, Ng WY, Lim GYS, Tan TE, Ang M, Ting DSW. Artificial intelligence in myopia: current and future trends. Curr Opin Ophthalmol 2021; 32:413-424. [PMID: 34310401 DOI: 10.1097/icu.0000000000000791] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Myopia is one of the leading causes of visual impairment, with a projected increase in prevalence globally. One potential approach to address myopia and its complications is early detection and treatment. However, current healthcare systems may not be able to cope with the growing burden. Digital technological solutions such as artificial intelligence (AI) have emerged as a potential adjunct for myopia management. RECENT FINDINGS There are currently four significant domains of AI in myopia, including machine learning (ML), deep learning (DL), genetics and natural language processing (NLP). ML has been demonstrated to be a useful adjunctive for myopia prediction and biometry for cataract surgery in highly myopic individuals. DL techniques, particularly convoluted neural networks, have been applied to various image-related diagnostic and predictive solutions. Applications of AI in genomics and NLP appear to be at a nascent stage. SUMMARY Current AI research is mainly focused on disease classification and prediction in myopia. Through greater collaborative research, we envision AI will play an increasingly critical role in big data analysis by aggregating a greater variety of parameters including genomics and environmental factors. This may enable the development of generalizable adjunctive DL systems that could help realize predictive and individualized precision medicine for myopic patients.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Wei Yan Ng
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Tien-En Tan
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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30
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Tran HDM, Sankaridurg P, Naduvilath T, Ha TTX, Tran TD, Jong M, Coroneo M, Tran YH. A Meta-Analysis Assessing Change in Pupillary Diameter, Accommodative Amplitude, and Efficacy of Atropine for Myopia Control. Asia Pac J Ophthalmol (Phila) 2021; 10:450-460. [PMID: 34456234 DOI: 10.1097/apo.0000000000000414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the effect of atropine on pupillary diameter, accommodative amplitude as well as myopia progression. METHODS Medical databases and Cochrane Library were systematically searched for studies from 1980 until June 2020. The primary and secondary outcomes were: a) change in pupillary diameter (PD) and accommodative amplitude (AA) and b) annualized mean change in spherical equivalent and axial length with various concentrations of atropine compared to control. RESULTS Thirteen trials (6 RCTs, 7 observational studies) that studied 9 atropine concentrations (0.01-1.0%) were included. The relation between atropine and change in PD and AA was nonlinear; at < 0.10% atropine, the slope of the curve was steep but the change in PD (+0.7 mm; 95% CI: +0.1 to +1.4) and AA (-1.6D; 95% CI: -3.9 to +0.7) was smaller whereas at ≥0.10% atropine, the slope plateaued but change in PD (+3.2 mm, 95% CI: +2.8 to +3.5) and AA (-10.7D; 95% CI: -12.2 to -9.2) was high.Reduction in myopia progression with atropine at <0.10% and ≥0.10% as compared to controls was 0.37D (95% CI: 0.16 to 0.58) versus 0.75D (95% CI: 0.17 to 1.33) for spherical equivalent and -0.10 mm (95% CI: -0.24 to 0.05) versus -0.23 mm (95% CI: -0.34 to -0.13) for axial length. CONCLUSIONS A nonlinear dose-response relationship exists between atropine and PD and AA. Further work is warranted to determine the concentration that provides maximal efficacy with tolerable side effects.
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Affiliation(s)
- Huy D M Tran
- Brien Holden Vision Institute, Sydney, Australia
- Hai Yen Vision Institute, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Thomas Naduvilath
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Thao T X Ha
- Hai Yen Vision Institute, Ho Chi Minh City, Vietnam
| | - Tuan D Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Monica Jong
- Brien Holden Vision Institute, Sydney, Australia
- Discipline of Optometry and Vision Science, University of Canberra, Australia
| | - Minas Coroneo
- Department of Ophthalmology, University of New South Wales, Sydney, Australia
| | - Yen H Tran
- Hai Yen Vision Institute, Ho Chi Minh City, Vietnam
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Is 0.01% Atropine an Effective and Safe Treatment for Myopic Children? A Systemic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10173766. [PMID: 34501214 PMCID: PMC8432260 DOI: 10.3390/jcm10173766] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
Several conflicting results regarding the efficacy of 0.01% atropine in slowing axial elongation remain in doubt. To solve this issue and evaluate the safety of 0.01% atropine, we conducted a systematic review and meta-analysis with the latest evidence. The review included a total of 1178 participants (myopic children). The efficacy outcomes were the mean annual progression in standardized equivalent refraction (SER) and axial length (AL). The safety outcomes included mean annual change in accommodative amplitude, photopic and mesopic pupil diameter. The results demonstrated that 0.01% atropine significantly retarded SER progression compared with the controls (weighted mean difference [WMD], 0.28 diopter (D) per year; 95% confidence interval (CI) = 0.17, 0.38; p < 0.01), and axial elongation (WMD, −0.06 mm; 95% CI = −0.09, −0.03; p < 0.01) during the 1-year period. Patients receiving 0.01% atropine showed no significant changes in accommodative amplitude (WMD, −0.45 D; 95% CI = −1.80, 0.90; p = 0.51) but showed dilated photopic pupil diameter (WMD, 0.35 mm; 95% CI = 0.02, 0.68; p = 0.04) and mesopic pupil diameter (WMD, 0.20 mm; 95% CI = 0.08, 0.32; p < 0.01). In the subgroup analysis of SER progression, myopic children with lower baseline refraction (>−3 D) and older age (>10-year-old) obtained better responses with 0.01% atropine treatment. Furthermore, the European and multi-ethnicity groups showed greater effect than the Asian groups. In conclusion, 0.01% atropine had favorable efficacy and adequate safety for childhood myopia over a 1-year period.
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Jeon GS, Hong IH, Lee JH, Song TG, Lee TY, Han JR. Analysis of treatment response about low-dose (0.01%) atropine eye-drops in myopic children. Eur J Ophthalmol 2021; 32:2011-2017. [PMID: 34399596 DOI: 10.1177/11206721211038817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Myopia usually commences during primary school and progresses until the mean age of 16 years. Topical low-dose (0.01%) atropine eye-drop appears to be safe and efficacious for myopia control in children. However, in some cases, a higher concentration of atropine is required in some cases because low-dose atropine treatment is not effective. METHODS This is a retrospective study among young myopic children between 5 and 15 years with myopia progression > 0.50 D/year. We selected patients treated with low-dose atropine (0.01%) eye-drops for 12 months and conducted a comparative analysis of the group with good responder and poor responder. Patients were classified as good responders if spherical equivalent refractive error (SE) progression was ⩽ 0.50 D after 12 months of treatment and poor responders if SE progression > 0.50 D. The prognostic factors before and after treatment were analyzed in two groups. RESULTS A total of 68 eyes were included. Low-dose (0.01%) atropine eye-drops have a good treatment response in 54% of patients. In the good responder group (n = 37), the mean rate of myopia progression after 12 months of treatment (0.36 ± 0.17 D) was significantly slower compared with the baseline progression (p < 0.001). Good responders have smaller changes in axial length (AL) elongation and SE than poor responders (p < 0.001). The only adverse event was temporary near vision difficulty (10%), photophobia (10%), and mild pupil dilation (30%). DISCUSSION The AL elongation is an important indicator for monitoring the treatment response. Children with a family history of myopia at a young age may not respond well to low-dose (0.01%) atropine eye-drops. In these cases, increasing the concentration of atropine eye-drops should be considered.
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Affiliation(s)
- Gang Seok Jeon
- Department of Ophthalmology, Dasan Samsung Bright Eye Clinic, Gyeonggi-do, Korea
| | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi, Korea
| | - Jang Hun Lee
- Department of Ophthalmology, Dasan Samsung Bright Eye Clinic, Gyeonggi-do, Korea
| | - Tae Geun Song
- Department of Ophthalmology, Dasan Samsung Bright Eye Clinic, Gyeonggi-do, Korea
| | - Tae Yeem Lee
- Department of Gynecology, Galmae Samsung Bright Clinic, Gyeonggi-do, Korea
| | - Jae Ryong Han
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi, Korea
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Ma M, Xiong S, Zhao S, Zheng Z, Sun T, Li C. COVID-19 Home Quarantine Accelerated the Progression of Myopia in Children Aged 7 to 12 Years in China. Invest Ophthalmol Vis Sci 2021; 62:37. [PMID: 34463719 PMCID: PMC8411864 DOI: 10.1167/iovs.62.10.37] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the effect of home quarantine during the COVID-19 pandemic on myopia progression in children and its associated factors. Methods Myopic children aged 7 to 12 years with regular follow-up visits every half a year from April 2019 to May 2020 were included. Cycloplegic refraction was measured at baseline and at two follow-up visits. The first follow-up visit (visit 1) was conducted before the COVID-19 home quarantine, whereas the second (visit 2) was four months after the home quarantine. Myopia progression at visits 1 and 2 were compared. Factors associated with changes in myopia progression were tested with a multiple regression analysis. Results In total, 201 myopic children were enrolled. There was a significantly greater change in spherical equivalent at visit 2 (−0.98 ± 0.52 D) than at visit 1 (−0.39 ± 0.58 D; P < 0.001). Students were reported to have spent more time on digital devices for online learning (P < 0.001) and less time on outdoor activities (P < 0.001) at visit 2 than at visit 1. Children using television and projectors had significantly less myopic shift than those using tablets and mobile phones (P < 0.001). More time spent on digital screens (β = 0.211, P < 0.001), but not less time on outdoor activities (β = −0.106, P = 0.110), was associated with greater myopia progression at visit 2. Conclusions Changes in behavior and myopic progression were found during the COVID-19 home quarantine. Myopic progression was associated with digital screen use for online learning, but not time spent on outdoor activities. The projector and television could be better choices for online learning.
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Affiliation(s)
- Mingming Ma
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Shuyu Xiong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Shuzhi Zhao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Tao Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Chunxia Li
- Department of Ophthalmology, Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai, China
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Progression of myopia in a natural cohort of Chinese children during COVID-19 pandemic. Graefes Arch Clin Exp Ophthalmol 2021; 259:2813-2820. [PMID: 34287693 PMCID: PMC8294263 DOI: 10.1007/s00417-021-05305-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To determine myopia progression in children during the COVID-19 and the related factors associated with myopia. Methods All subjects underwent three-timepoint ocular examinations that were measured in July 2019, January, and August 2020. We compared the changes in uncorrected visual acuity (UCVA), mydriatic spherical equivalent (SE), and axial length (AL) between two periods (before and during COVID-19). A questionnaire was performed to investigate risk factors for myopia. Results Compared with before the COVID-19, the mean (S.D.) myopia progression during the COVID-19 was significantly higher in right eyes (− 0.93 (0.65) vs. − 0.33 (0.47) D; p < 0.001). However, the differences in UCVA changes and the axial elongation between two periods were clinically insignificant. Through logistic regressive analysis, we found the difference of the SE changes was associated with the baseline AL (P = 0.028; 95% confidence interval [CI], 1.058, 2.632), online education (P = 0.02; 95% CI, 1.587, 8.665), and time of digital screen (p < 0.005; 95% CI, 1.587, 4.450). Conclusions Children were at higher risk of myopia progression during COVID-19, which was associated with the baseline AL, the longtime online learning, and digital screen reading.
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Rose LVT, Schulz AM, Graham SL. Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01. PLoS One 2021; 16:e0254061. [PMID: 34264970 PMCID: PMC8282033 DOI: 10.1371/journal.pone.0254061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Identifying axial length growth rate as an indicator of fast progression before initiating atropine 0.01% for myopia progression in children. METHOD From baseline, axial length growth over six months was measured prospectively. Subjects were then initiated on atropine 0.01% if axial length growth was greater than 0.1mm per 6 months (fast progressors), axial length and spherical equivalent change measurements recorded every six months. The rate of change was compared to the baseline pre-treatment rate. If axial length change was below the threshold, subjects received monitoring only. RESULTS 73 subjects were identified as fast progressors and commenced atropine 0.01%, (mean baseline refraction of OD -2.9±1.6, OS -2.9±1.8 and a mean baseline axial length OD 24.62 ± 1.00 mm, OS 24.53 ± 0.99 mm). At six months, the mean paired difference of axial length growth rate was significantly reduced by 50% of baseline (all 73 subjects, p<0.05). 53 subjects followed to 12 months, and 12 to 24 months maintained a reduced growth rate. Change in mean spherical equivalent was significantly reduced compared to pre-treatment refractive error (mean paired difference p<0.05) and at each subsequent visit. 91 children were slow progressors and remained untreated. Their axial length growth rate did not change significantly out to 24 months. Spherical equivalent changed less than -0.5D annually in this group. CONCLUSION Identifying fast progressors before treatment initiation demonstrated a strong treatment effect with atropine 0.01% reducing their individual rate of myopia progression by 50%. Another large group of myopic children, slow progressors, continued without medical intervention. A baseline axial length growth rate is proposed as a guideline to identify fast progressors who are more likely to benefit from atropine 0.01%.
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Affiliation(s)
- Loreto V. T. Rose
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park NSW, Australia
| | - Angela M. Schulz
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park NSW, Australia
| | - Stuart L. Graham
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park NSW, Australia
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Kaymak H, Graff B, Schaeffel F, Langenbucher A, Seitz B, Schwahn H. A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting. Graefes Arch Clin Exp Ophthalmol 2021; 259:3083-3092. [PMID: 34142186 PMCID: PMC8478763 DOI: 10.1007/s00417-021-05254-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Several randomized controlled studies have demonstrated the beneficial effects of 0.01% atropine eye drops on myopia progression in children. However, treatment effects may be different in a routine clinical setting. We performed a retrospective analysis of our clinical data from children to investigate the effect of 0.01% atropine eye drops on myopia progression in a routine clinical setting. METHODS Atropine-treated children were asked to instill one drop of 0.01% atropine in each eye every evening at 5 days a week. Myopic children who did not undergo atropine treatment served as controls. Objective refraction and ocular biometry of 80 atropine-treated and 103 untreated children at initial visit and 1 year later were retrospectively analyzed. RESULTS Myopic refractions in the treated and untreated children at initial visit ranged from -0.625 to -15.25 D (-4.21 ± 2.90 D) and from -0.125 to -9.375 D (-2.92 ± 1.77 D), respectively. Ages at initial visit ranged from 3.2 to 15.5 years (10.1 ± 2.7 years) in the treated and from 3.4 to 15.5 years (11.2 ± 3.0 years) in untreated children. Two-factor ANOVA for age and atropine effects on axial length growth confirmed that axial length growth rates declined with age (p<0.0001) and revealed a significant inhibitory effect of atropine on axial length growth (p<0.0015). The atropine effect on axial length growth averaged to 0.08 mm (28%) inhibition per year. Effects on refraction were not statistically significant. CONCLUSION The observed atropine effects were not very distinctive: Statistical analysis confirmed that atropine reduced axial length growth, but to an extent of minor clinical relevance. It was also shown that beneficial effects of 0.01% atropine may not be obvious in each single case, which should be communicated with parents and resident ophthalmologists.
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Affiliation(s)
- Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie GbR c/o Breyer Kaymak and Klabe Augenchirurgie, Duesseldorf, Germany. .,Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany.
| | - Birte Graff
- Internationale Innovative Ophthalmochirurgie GbR c/o Breyer Kaymak and Klabe Augenchirurgie, Duesseldorf, Germany.,Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Frank Schaeffel
- Section of Neurobiology of the Eye, Ophthalmic Research Institute, University of Tuebingen, Tuebingen, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Germany
| | - Hartmut Schwahn
- Internationale Innovative Ophthalmochirurgie GbR c/o Breyer Kaymak and Klabe Augenchirurgie, Duesseldorf, Germany
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Risk factors for rapid axial length elongation with low concentration atropine for myopia control. Sci Rep 2021; 11:11729. [PMID: 34083576 PMCID: PMC8175344 DOI: 10.1038/s41598-021-88719-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
Three hundred and twenty-eight myopic children, randomized to use either 0.01% (N = 166) or 0.02% (N = 162) atropine were enrolled in this study. Gender, age, body mass index(BMI), parental myopia status, atropine concentration used, pupil diameter, amplitude of accommodation, spherical equivalent refractive error (SER), anterior chamber depth (ACD) and axial length (AL) were collected at baseline and 1 year after using atropine. Rapid AL elongation was defined as > 0.36 mm growth per year. Univariate analyses showed that children with rapid AL elongation tend to be younger, have a smaller BMI, use of 0.01% atropine, narrow ACD, lower SER, shorter AL, smaller change in pupil diameter between 1 year and baseline (all P < 0.05). Multivariate logistic regression analyses confirmed that rapid AL elongation was associated with children that were younger at baseline (P < 0.0001), use of 0.01% atropine (P = 0.04), a shorter baseline AL (P = 0.03) and a smaller change in pupil diameter between 1 year and baseline (P = 0.04). Younger children with shorter AL at baseline, less change in their pupil diameter with atropine treatment and using the lower of the two atropine concentrations may undergo rapid AL elongation over a 12 months myopia control treatment period.
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Myles W, Dunlop C, McFadden SA. The Effect of Long-Term Low-Dose Atropine on Refractive Progression in Myopic Australian School Children. J Clin Med 2021; 10:jcm10071444. [PMID: 33916204 PMCID: PMC8036859 DOI: 10.3390/jcm10071444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/27/2022] Open
Abstract
Myopia will affect half the global population by 2050 and is a leading cause of vision impairment. High-dose atropine slows myopia progression but with undesirable side-effects. Low-dose atropine is an alternative. We report the effects of 0.01% or 0.005% atropine eye drops on myopia progression in 13 Australian children aged between 2 and 18 years and observed for 2 years without and up to 5 years (mean 2.8 years) with treatment. Prior to treatment, myopia progression was either ‘slow’ (more positive than −0.5 D/year; mean −0.19 D/year) or ‘fast’ (more negative than −0.5 D/year; mean −1.01 D/year). Atropine reduced myopic progression rates (slow: −0.07 D/year, fast: −0.25 D/year, combined: before: −0.74, during: −0.18 D/year, p = 0.03). Rebound occurred in 3/4 eyes that ceased atropine. Atropine halved axial growth in the ‘Slow’ group relative to an age-matched model of untreated myopes (0.098 vs. 0.196 mm/year, p < 0.001) but was double that in emmetropes (0.051 mm/year, p < 0.01). Atropine did not slow axial growth in ‘fast’ progressors compared to the age-matched untreated myope model (0.265 vs. 0.245 mm/year, p = 0.754, Power = 0.8). Adverse effects (69% of patients) included dilated pupils (6/13) more common in children with blue eyes (5/7, p = 0.04). Low-dose atropine could not remove initial myopia offsets suggesting treatment should commence in at-risk children as young as possible.
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Foo LL, Ang M, Wong CW, Ohno-Matsui K, Saw SM, Wong TY, Ting DS. Is artificial intelligence a solution to the myopia pandemic? Br J Ophthalmol 2021; 105:741-744. [PMID: 33712483 DOI: 10.1136/bjophthalmol-2021-319129] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Kyoko Ohno-Matsui
- Ophthalmology and Visual Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | | | - Tien Yin Wong
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Daniel S Ting
- Singapore National Eye Centre, Singapore .,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
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40
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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: 10] [Impact Index Per Article: 3.3] [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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41
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Joachimsen L, Farassat N, Bleul T, Böhringer D, Lagrèze WA, Reich M. Side effects of topical atropine 0.05% compared to 0.01% for myopia control in German school children: a pilot study. Int Ophthalmol 2021; 41:2001-2008. [PMID: 33634343 PMCID: PMC8172502 DOI: 10.1007/s10792-021-01755-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/06/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE Based on findings of the Asian low-concentration atropine for myopia progression study, a concentration of 0.05% has been proposed as a good compromise between safety and efficacy for myopia control. However, no data on side effects have been published so far in Caucasian children receiving this dose. METHODS Prior to commencement of bilateral atropine treatment with 0.05% atropine, 19 myopic children aged 5 to 15 years were treated in only one eye at bedtime leaving the other eye as a control. Pupil size, accommodation amplitude and near visual acuity were measured at 10:00 a.m. the next day and compared to the untreated contralateral control eye. The results were then compared to a cohort of 18 children whose treatment with 0.01% atropine commenced in a similar fashion. RESULTS Twelve children (63%) reported visual impairment or reading difficulties. Anisocoria was 2.9 ± 1.1 mm. In comparison, 0.01% atropine led to a significantly less anisocoria of 0.8 ± 0.7 mm (p < 0.0001). Accommodation was decreased by - 4.2 ± 3.8 D in 0.05% atropine treated eyes, whereas 0.01% atropine induced hypoaccommodation of - 0.05 ± 2.5 D (p < 0.01). Near visual acuity was not significantly reduced in eyes treated with 0.05% atropine compared to 0.01% atropine (p = 0.26). CONCLUSION Compared to 0.01%, our data indicate stronger more relevant side effects of 0.05% topical atropine in young Caucasian children with progressive myopia as recently reported in Asian children, potentially compromising acceptance and compliance.
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Affiliation(s)
- Lutz Joachimsen
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau, Germany
| | - Navid Farassat
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau, Germany
| | - Tim Bleul
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau, Germany.
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Corneal Penetration of Low-Dose Atropine Eye Drops. J Clin Med 2021; 10:jcm10040588. [PMID: 33557281 PMCID: PMC7914535 DOI: 10.3390/jcm10040588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/28/2022] Open
Abstract
Major studies demonstrating the inhibition of myopia in children and juveniles by low-dose atropine eye drops provide little information on the manufacturing process and the exact composition of the atropine dilutions. However, corneal penetration might significantly vary depending on preservatives, such as benzalkonium chloride (BAC), and the atropine concentration. Since there is a trade-off between side effects, stability, and optimal effects of atropine on myopia, it is important to gain better knowledge about intraocular atropine concentrations. We performed an ex vivo study to determine corneal penetration for different formulations. Atropine drops (0.01%) of different formulations were obtained from pharmacies and applied to the cornea of freshly enucleated pig eyes. After 10 min, a sample of aqueous humor was taken and atropine concentrations were determined after liquid–liquid extraction followed by high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS). The variability that originated from variations in applied drop size exceeded the differences between preserved and preservative-free formulations. The atropine concentration in the anterior chamber measured after 10 min was only 3.8 × 10−8 of its concentration in the applied eye drops, corresponding to 502.4 pM. Obviously, the preservative did not facilitate corneal penetration, at least ex vivo. In the aqueous humor of children’s eyes, similar concentrations, including higher variability, may be expected in the lower therapeutic window of pharmacodynamic action.
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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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Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res 2020; 83:100923. [PMID: 33253901 DOI: 10.1016/j.preteyeres.2020.100923] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
There is rapidly expanding interest in interventions to slow myopia progression in children and teenagers, with the intent of reducing risk of myopia-associated complications later in life. Despite many publications dedicated to the topic, little attention has been devoted to understanding 'efficacy' in myopia control and its application. Treatment effect has been expressed in multiple ways, making comparison between therapies and prognosis for an individual patient difficult. Available efficacy data are generally limited to two to three years making long-term treatment effect uncertain. From an evidence-based perspective, efficacy projection should be conservative and not extend beyond that which has been empirically established. Using this principle, review of the literature, data from our own clinical studies, assessment of demonstrated myopia control treatments and allowance for the limitations and context of available data, we arrive at the following important interpretations: (i) axial elongation is the preferred endpoint for assessing myopic progression; (ii) there is insufficient evidence to suggest that faster progressors, or younger myopes, derive greater benefit from treatment; (iii) the initial rate of reduction of axial elongation by myopia control treatments is not sustained; (iv) consequently, using percentage reduction in progression as an index to describe treatment effect can be very misleading and (v) cumulative absolute reduction in axial elongation (CARE) emerges as a preferred efficacy metric; (vi) maximum CARE that has been measured for existing myopia control treatments is 0.44 mm (which equates to about 1 D); (vii) there is no apparent superior method of treatment, although commonly prescribed therapies such as 0.01% atropine and progressive addition spectacles lenses have not consistently provided clinically important effects; (viii) while different treatments have shown divergent efficacy in the first year, they have shown only small differences after this; (ix) rebound should be assumed until proven otherwise; (x) an illusion of inflated efficacy is created by measurement error in refraction, sample bias in only treating 'measured' fast progressors and regression to the mean; (xi) decision to treat should be based on age of onset (or refraction at a given age), not past progression; (xii) the decreased risk of complications later in life provided by even modest reductions in progression suggest treatment is advised for all young myopes and, because of limitations of available interventions, should be aggressive.
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Affiliation(s)
- Noel A Brennan
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA.
| | - Youssef M Toubouti
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA
| | - Xu Cheng
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA
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Zhang X, Wang Y, Zhou X, Qu X. Analysis of Factors That May Affect the Effect of Atropine 0.01% on Myopia Control. Front Pharmacol 2020; 11:01081. [PMID: 33013354 PMCID: PMC7509411 DOI: 10.3389/fphar.2020.01081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/02/2020] [Indexed: 01/01/2023] Open
Abstract
Children respond differently to atropine treatment, and predicting patient factors associated with better myopia control is important. Therefore, we aimed to evaluate factors related to myopia progression in Chinese children treated with atropine 0.01%. This retrospective study included 133 children who were administered atropine 0.01% eyedrops every night for 1 year. Enrolled children were examined at follow-up visits at 3 and 6 months, and 1 year. The primary outcome was clinically significant myopia progression (over a -0.75 diopter (D) increase in spherical equivalent (SE)). Multivariate logistic analysis was used to identify predictive factors for myopia progression. The mean baseline SE was -3.92 ± 2.76D, and the average increase in SE and axial length at 1 year from baseline were -0.55 ± 0.57D and 0.43 ± 0.52 mm, respectively. The risk of myopia progression significantly increased in children whose mothers had moderate myopia of less than -6D compared to that in children whose mothers had no history of myopia (odd ratio [OR] = 2.76, 95% confidence interval [CI]: 1.06 to 7.19, P = 0.0382). Birth by cesarean section was also a risk factor for myopia progression (odd ratio [OR] = 2.35, 95% CI: 1.30 to 4.27, P = 0.0048). The correlation between SE and treatment efficiency was linear, and the risk of myopia progression significantly decreased with increasing SE. Atropine 0.01% controlled myopia more effectively in children with higher myopia, who were delivered naturally, and whose mothers had no genetic background of myopia.
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Affiliation(s)
- Xiaoyu Zhang
- Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yuliang Wang
- Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaomei Qu
- Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Berton B, Chennell P, Yessaad M, Bouattour Y, Jouannet M, Wasiak M, Sautou V. Stability of Ophthalmic Atropine Solutions for Child Myopia Control. Pharmaceutics 2020; 12:pharmaceutics12080781. [PMID: 32824572 PMCID: PMC7465901 DOI: 10.3390/pharmaceutics12080781] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022] Open
Abstract
Myopia is an ophthalmic condition affecting more than 1/5th of the world population, especially children. Low-dose atropine eyedrops have been shown to limit myopia evolution during treatment. However, there are currently no commercial industrial forms available and there is little data published concerning the stability of medications prepared by compounding pharmacies. The objective of this study was to evaluate the stability of two 0.1 mg/mL atropine formulations (with and without antimicrobiobial preservatives) for 6 months in two different low-density polyethylene (LDPE) multidose eyedroppers. Analyses used were the following: visual inspection, turbidity, chromaticity measurements, osmolality and pH measurements, atropine quantification by a stability-indicating liquid chromatography method, breakdown product research, and sterility assay. In an in-use study, atropine quantification was also performed on the drops emitted from the multidose eyedroppers. All tested parameters remained stable during the 6 months period, with atropine concentrations above 94.7% of initial concentration. A breakdown product (tropic acid) did increase slowly over time but remained well below usually admitted concentrations. Atropine concentrations remained stable during the in-use study. Both formulations of 0.1 mg/mL of atropine (with and without antimicrobial preservative) were proved to be physicochemically stable for 6 months at 25 °C when stored in LDPE bottles, with an identical microbial shelf-life.
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Affiliation(s)
- Baptiste Berton
- CHU Clermont-Ferrand, Pôle Pharmacie, F-63003 Clermont-Ferrand, France; (B.B.); (M.Y.); (M.J.); (M.W.)
| | - Philip Chennell
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA, ICCF, 63000 Clermont-Ferrand, France; (Y.B.); (V.S.)
- Correspondence:
| | - Mouloud Yessaad
- CHU Clermont-Ferrand, Pôle Pharmacie, F-63003 Clermont-Ferrand, France; (B.B.); (M.Y.); (M.J.); (M.W.)
| | - Yassine Bouattour
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA, ICCF, 63000 Clermont-Ferrand, France; (Y.B.); (V.S.)
| | - Mireille Jouannet
- CHU Clermont-Ferrand, Pôle Pharmacie, F-63003 Clermont-Ferrand, France; (B.B.); (M.Y.); (M.J.); (M.W.)
| | - Mathieu Wasiak
- CHU Clermont-Ferrand, Pôle Pharmacie, F-63003 Clermont-Ferrand, France; (B.B.); (M.Y.); (M.J.); (M.W.)
| | - Valérie Sautou
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA, ICCF, 63000 Clermont-Ferrand, France; (Y.B.); (V.S.)
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Part-time use of 1% atropine eye drops for prevention of myopia progression in children. Int Ophthalmol 2020; 40:1857-1862. [PMID: 32266643 DOI: 10.1007/s10792-020-01356-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To determine the effectiveness of atropine 1% administered once, twice and thrice per week. METHODS Retrospective review of 166 cases in a tertiary eye hospital. RESULTS In total, 166 patients started atropine 1% at different frequencies (once, twice and thrice per week) between January 2003 and August 2013 were identified. All patients had at least 15 months of follow-up. There was no significant difference in mean spherical equivalent (SE) (p = 0.341), age (p = 0.699), gender (p = 0.815) and ethnicity (p = 0.922) among the three groups at baseline. Patients were reviewed at 3, 9 and 15 months. Over a 15-month period, the mean change in SE was 0.26 ± 0.70 D, 0.51 ± 0.70 D and 0.46 ± 0.76 D in the patients started on once, twice and thrice per week, respectively (p = 0.342). Further analysis was performed by dividing patients into three groups of different changes in SE at the 15-month mark-≤ 0.5 D, between 0.5 D and 1.0 D and > 1.0 D. Groups with less myopic progression at the 15-month mark (< 0.5 and 0.5 to 1.0 D groups) were more myopic, - 5.32 D ± 1.88 and - 5.21 D ± 1.76, respectively, compared to - 4.13 D ± 2.05 in the > 1.0 D group. Multivariate linear regression analysis confirmed this relationship (p = 0.005), after adjusting for age, gender, ethnicity and frequency of dose. CONCLUSIONS Part-time use of atropine 1% provides an alternative regimen of treating patients with myopia and can have a lower side effect profile compared to daily doses of atropine.
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