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Wang JD, Liu MR, Chen CX, Cao K, Zhang Y, Zhu XH, Wan XH. Effects of atropine eyedrops at ten different concentrations for myopia control in children: A systematic review on meta-analysis. Eur J Ophthalmol 2024; 34:1355-1364. [PMID: 38377951 DOI: 10.1177/11206721241229317] [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] [Indexed: 02/22/2024]
Abstract
PURPOSE To estimate the effect of atropine eyedrops at different concentrations for myopia control in children. METHODS We conducted a Bayesian random-effects network meta-analysis based on randomized controlled trials (RCT). Primary outcomes include changes in spherical equivalent error (SER) and changes in axial length (AL), mean difference (MD) together with 95% credible interval (CrI) were used to evaluate the efficacy. RESULTS 28 RCTs (6608 children) were included in this review. Comparing ten atropine eyedrops (0.0025%, 0.005%, 0.01%, 0.02%, 0.025%, 0.05%, 0.1%, 0.25%, 0.5% and 1% concentrations) with the placebo, the MDs and 95%CrIs of changes in SER are -0.006 (-0.269, 0.256) D, 0.216 (-0.078, 0.508) D, 0.146 (0.094, 0.199) D, 0.167 (0.039, 0.297) D, 0.201 (0.064, 0.341) D, 0.344 (0.251, 0.440) D, 0.255 (0.114, 0.396) D, 0.296 (0.140, 0.452) D, 0.331 (0.215, 0.447) D, and 0.286 (0.195, 0.337) D, respectively. The MDs and 95%CrIs of changes in AL are -0.048 (-0.182, 0.085) mm, -0.078 (-0.222, 0.066) mm, -0.095 (-0.130, -0.060) mm, -0.096 (-0.183, -0.009) mm, -0.083 (-0.164, -0.004) mm, -0.114 (-0.176, -0.056) mm, -0.134 (-0.198, -0.032) mm, -0.174 (-0.315, -0.061) mm, -0.184 (-0.291, -0.073) mm, and -0.171 (-0.203, -0.097) mm, respectively.Whether evaluated by SER or AL, 1% concentration ranks first in efficacy, but the risk of photophobia is 17 times higher than 0.01% concentration. CONCLUSIONS 0.01% or higher concentration atropine eyedrops are effective for myopia control, while 0.0025% and 0.005% concentrations may not. As the concentration increases, the effect tends to increase, 1% concentration may have the strongest effect.
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Affiliation(s)
- Jin-Da Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mei-Rui Liu
- School of Public Health, North China University of Science and Technology, Hebei, Beijing, China
| | - Chang-Xi Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun Zhang
- Jianguomen Community Health Service Center, Beijing, China
| | - Xiao-Hong Zhu
- Xicheng District Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Xiu-Hua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Moriche-Carretero M, Revilla-Amores R, Gutiérrez-Blanco A, Moreno-Morillo FJ, Martinez-Perez C, Sánchez-Tena MÁ, Alvarez-Peregrina C. Five-year results of atropine 0.01% efficacy in the myopia control in a European population. Br J Ophthalmol 2024; 108:715-719. [PMID: 37268328 DOI: 10.1136/bjo-2022-322808] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
AIMS To evaluate the efficacy and safety of 0.01% atropine eye-drops in controlling myopia progression over 5 years. METHODS Experimental, analytical, prospective, randomised and longitudinal study, in 361 right eyes from 361 children randomised into the control group (177 eyes without treatment) and treatment group (184 eyes with 0.01% atropine eye-drops). Children assigned to the treatment group used 0.01% atropine once a day every night and the control group's children did not use any treatment or placebo. All the subjects completed an eye examination every 6 months for the 5 years of follow-up. The examination included subjective and objective refraction with cycloplegia, axial length (AL), keratometry and anterior chamber depth (ACD) to evaluate the efficacy of the treatment. It also included the anterior and posterior pole examination to evaluate the safety of the treatment. RESULTS The SE increased -0.63±0.42D in children after 5 years of treatment with 0.01% atropine, while in the control group the increase was -0.92±0.56D. AL increased 0.26±0.28 mm in the treatment group compared with 0.49±0.34 mm in the control group. Atropine 0.01% showed an efficacy of 31.5% and 46.9% in the control of the SE and AL increase, respectively. ACD and keratometry did not have significant changes between groups. CONCLUSIONS Atropine 0.01% is effective in slowing myopia progression in a European population. There were no side effects after 5 years of 0.01% atropine.
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Affiliation(s)
- Manuel Moriche-Carretero
- Infanta Sofia University Hospital, San Sebastian de los Reyes (Madrid), Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | - Miguel Ángel Sánchez-Tena
- ISEC LISBOA - Instituto Superior de Educação e Ciências, Lisboa, Portugal
- Department of Optometry and Vision, Complutense University of Madrid. Faculty of Optics and Optometry, Madrid, Spain
| | - Cristina Alvarez-Peregrina
- Department of Optometry and Vision, Complutense University of Madrid. Faculty of Optics and Optometry, Madrid, Spain
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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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Salzano AD, Khanal S, Cheung NL, Weise KK, Jenewein EC, Horn DM, Mutti DO, Gawne TJ. Repeated Low-level Red-light Therapy: The Next Wave in Myopia Management? Optom Vis Sci 2023; 100:812-822. [PMID: 37890098 DOI: 10.1097/opx.0000000000002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Abstract
SIGNIFICANCE Exposure to long-wavelength light has been proposed as a potential intervention to slow myopia progression in children. This article provides an evidence-based review of the safety and myopia control efficacy of red light and discusses the potential mechanisms by which red light may work to slow childhood myopia progression.The spectral composition of the ambient light in the visual environment has powerful effects on eye growth and refractive development. Studies in mammalian and primate animal models (macaque monkeys and tree shrews) have shown that daily exposure to long-wavelength (red or amber) light promotes slower eye growth and hyperopia development and inhibits myopia induced by form deprivation or minus lens wear. Consistent with these results, several recent randomized controlled clinical trials in Chinese children have demonstrated that exposure to red light for 3 minutes twice a day significantly reduces myopia progression and axial elongation. These findings have collectively provided strong evidence for the potential of using red light as a myopia control intervention in clinical practice. However, several questions remain unanswered. In this article, we review the current evidence on the safety and efficacy of red light as a myopia control intervention, describe potential mechanisms, and discuss some key unresolved issues that require consideration before red light can be broadly translated into myopia control in children.
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Affiliation(s)
| | - Safal Khanal
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nathan L Cheung
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Katherine K Weise
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erin C Jenewein
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania
| | - Darryl M Horn
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania
| | - Donald O Mutti
- The Ohio State University College of Optometry, Columbus, Ohio
| | - Timothy J Gawne
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
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Saxena R, Gupta V, Dhiman R, Phuljhele S, Kumar P, Sharma N, Iribarren R, Rozema J. Effect of low-dose atropine (0.01%) on crystalline lens power among school-aged children with progressive myopia. Ophthalmic Physiol Opt 2023; 43:1406-1411. [PMID: 37350384 DOI: 10.1111/opo.13192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To evaluate the change in crystalline lens power (LP) in a cohort of Indian children with progressive myopia receiving atropine (0.01%) compared with an untreated control group. DESIGN Nonrandomised clinical trial. METHODS The study included 120 children (70 in the atropine group; 50 in the control group) with progressive myopia (≥0.5 D/year) with a 1-year follow-up. The atropine group received 0.01% atropine eye drops once daily in both eyes, whereas the control group received no treatment. Changes in cycloplegic spherical equivalent, axial length (AL), keratometry (KER), anterior chamber depth (ACD) and lens thickness (LT) were recorded. LP was calculated using the formula proposed by Bennett. RESULTS Mean myopia progression at year 1 was significantly less in the atropine group (-0.18 D [0.2]) than in the control group (-0.59 [0.21]; p < 0.001). The increase in AL was significantly different between the two groups (atropine: 0.21 mm [0.12]; control: 0.29 mm [0.11], p < 0.001). A significantly greater loss of LP was noted in the atropine group (-0.67 D [0.34]) than in the placebo group (-0.28 D [0.42]; p < 0.001). The change in LT was significantly different between the atropine and control groups (p = 0.02), whereas the change in ACD and KER was similar in the two groups. CONCLUSION The greater loss of LP could contribute to the anti-myopia effect of atropine and should therefore be evaluated in studies reporting the efficacy of atropine on myopia to assess its actual effect on myopic progression.
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Affiliation(s)
- Rohit Saxena
- Paediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Gupta
- Paediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rebika Dhiman
- Paediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele
- Paediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Kumar
- Paediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Paediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jos Rozema
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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Long H, Shi MH, Li X. Efficacy and safety of atropine in myopic children: A meta-analysis of randomized controlled trials. J Fr Ophtalmol 2023; 46:929-940. [PMID: 37147148 DOI: 10.1016/j.jfo.2023.01.030] [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: 11/30/2022] [Revised: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of atropine for childhood myopia and further explore the optimal concentration of atropine, so as to provide more reference for clinical application. METHODS PubMed, Embase, Cochrane Library and ClinicalTrials.gov were comprehensively searched for randomized controlled trials (RCTs) up to October 14, 2021. The efficacy outcomes were progression of spherical equivalent (SE) and axial length (AL). The safety outcomes included accommodation amplitude, pupil size and adverse effects. The meta-analysis was performed using Review Manager 5.3. RESULTS Eighteen RCTs involving 3002 eyes were included. The results showed that at 6-36 months of treatment, atropine was effective in slowing the progression of myopia in children. At 12 months, the WMD of SE and AL of low-dose atropine was 0.25 diopters (D) and 0.1 millimeter (mm), moderate-dose atropine was 0.44 D and 0.16mm, high-dose atropine was 1.21 D and 0.82mm, respectively, compared with the control group. Similarly, at 24 months, low-dose atropine was 0.22 D and 0.14mm, moderate-dose atropine was 0.60 D, high-dose atropine was 0.66 D and 0.24mm, respectively. Interestingly, we also found that there was no significant difference in the effects of low-dose atropine on accommodation amplitude and photopic pupil size compared with the control group, and the rate of photophobia, allergy, blurred vision and other side effects was similar between the low-dose atropine group and the control group. In addition, atropine appears to be more effective in myopic children in China than in other countries. CONCLUSIONS Atropine in various concentrations can effectively slow myopia progression in children, and its effect is dose-dependent, while low-dose atropine (0.01% atropine) appears to be safer.
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Affiliation(s)
- H Long
- Aier Eye Hospital of Wuhan University, Wuhan, China
| | - M H Shi
- Aier Eye Hospital of Wuhan University, Wuhan, China
| | - X Li
- Aier Eye Hospital of Wuhan University, Wuhan, China.
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Chen ZR, Chen SC, Wan TY, Chuang LH, Chen HC, Yeh LK, Kuo YK, Wu PC, Chen YW, Lai IC, Hwang YS, Liu CF. Treatment of Myopia with Atropine 0.125% Once Every Night Compared with Atropine 0.125% Every Other Night: A Pilot Study. J Clin Med 2023; 12:5220. [PMID: 37629261 PMCID: PMC10456055 DOI: 10.3390/jcm12165220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/04/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Purpose: To investigate the efficacy of myopia treatment in children using atropine 0.125% once every two nights (QON) compared with atropine 0.125% once every night (HS). (2) Methods: This retrospective cohort study reviewed the medical records of two groups of children with myopia. Group 1 comprised children treated with atropine 0.125% QON, while group 2 included children treated with atropine 0.125% HS. The first 6 months of data of outcome measurements were subtracted as washout periods in those children undergoing both atropine QON and HS treatment. The independent t-test and Pearson's chi-square test were used to compare the baseline clinical characteristics between the two groups. A generalized estimating equations (GEE) model was used to determine the factors that influence treatment effects. (3) Results: The average baseline ages of group 1 (38 eyes from 19 patients) and group 2 (130 eyes from 65 patients) were 10.6 and 10.2 years, respectively. There were no significant differences in axial length (AL) or cycloplegic spherical equivalent (SEq) at baseline or changes of them after 16.9 months of follow-up. GEE showed that the frequency of atropine 0.125% use has no association with annual AL (QON vs. HS: 0.16 ± 0.10 vs. 0.18 ± 0.12) and SEq (QON vs. HS: -0.29 ± 0.44 vs. -0.34 ± 0.36) changes in all children with myopia. It also showed that older baseline age (B = -0.020, p < 0.001) was associated with lesser AL elongation. (4) Conclusion: The treatment effects of atropine 0.125% HS and QON were similar in this pilot study. The use of atropine 0.125% QON may be an alternative strategy for children who cannot tolerate the side effects of atropine 0.125% HS. This observation should be confirmed with further large-scale studies.
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Affiliation(s)
- Zi-Rong Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
| | - Shin-Chieh Chen
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100, Taiwan
| | - Tsung-Yao Wan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
| | - Lan-Hsin Chuang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Hung-Chi Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
- Center for Tissue Engineering, Chang Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Lung-Kun Yeh
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Yu-Kai Kuo
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Pei-Chang Wu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yun-Wen Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Ing-Chou Lai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi City 613, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi City 613, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen 361000, China
| | - Chun-Fu Liu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Z.-R.C.); (T.-Y.W.); (L.-H.C.); (H.-C.C.); (L.-K.Y.); (Y.-K.K.); (P.-C.W.); (Y.-W.C.); (I.-C.L.); (Y.-S.H.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Program in Molecular Medicine, National Yang Ming University, Taipei 112, Taiwan
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Yang Y, Jiang J. A Survey of Myopia Correction Pattern of Children and Parent's Attitudes in China. Optom Vis Sci 2023; 100:388-396. [PMID: 37200197 DOI: 10.1097/opx.0000000000002028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
SIGNIFICANCE This survey provides information about Chinese children's myopia correction status and parents' attitudes toward myopia correction. PURPOSE Under the background of a guideline of appropriate techniques for the prevention and control of children's myopia, this study aimed to investigate the current myopia correction pattern of children and parents' attitudes. METHODS Two self-administered questionnaires were distributed to 684 children with myopia corrections and 450 parents (384 mothers and 66 fathers) to explore children's myopia correction patterns and parental attitudes. The questionnaire investigated the pattern of children's myopia correction, prescribing of children's myopia correction, the incidence of high myopia, parental attitudes toward various myopia corrections methods, and preferred initial age for contact lens usage. RESULTS Single-vision spectacles (n = 600; 88.2 ± 7.4%) are widely used in China because of their comfort and affordability. More than 80% of children use single-vision spectacles prescribed by ophthalmologists and opticians. Children who used single-vision spectacles at an earlier age had more incidence of high myopia (18.4 ± 4.2%) than those who used single-vision spectacles at a later age (0.7 ± 0.9%). Effective myopia control was the primary reason parents preferred to choose different optical corrections, followed by safety, convenience, clarity, affordability, comfort, and other reasons. The survey indicated that 52.4% of parents whose children used orthokeratology lenses would have preferred safe and convenient options if available. In addition, 50% of the parents preferred delaying their children's use of orthokeratology lenses and other contact lenses to an older age. CONCLUSIONS Single-vision spectacles are still a popular option to correct myopia in children. There was a demonstrated increase in myopia in children who used single spectacles at an earlier age. Parents' attitudes were important factors for selecting myopia corrections in children.
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Affiliation(s)
| | - Jun Jiang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Xiao Y, Qian Y, Yang C, Zou H. Is myopia accelerated in type 1 diabetes mellitus children? Analyses from the ocular parameters. BMC Ophthalmol 2023; 23:147. [PMID: 37041512 PMCID: PMC10088217 DOI: 10.1186/s12886-023-02908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/05/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND This study compares the ocular biometry with or without myopia in children with type 1 diabetes mellitus (T1DM) and healthy children in China to analyse the difference between myopia in T1DM and healthy children. METHODS A case-control study was conducted at the Children's Hospital of Fudan University. The children were divided into four subgroups depending on myopia or non-myopia, T1DM or non-DM. The participants were evaluated for anterior chamber depth (ACD), lens thickness (LT), axial length (AL), average keratometry (K) and lens power (P). Furthermore, cycloplegic refraction was performed and the spherical equivalent (SE) was acquired. RESULTS One hundred and ten patients with T1DM and 102 healthy subjects were included in this study. In the age-sex adjusted analysis, the myopia T1DM subgroup showed thicker LT (p = 0.001), larger P (p = 0.003) and similar ACD, AL, K and SE (all p > 0.05) compared to the myopia control subgroup. Additionally, the myopia T1DM subgroup showed longer AL (p < 0.001) and similar ACD, LT, K and P (all p > 0.05) as the non-myopia T1DM subgroup. In the multivariate linear regression, for T1DM patients, eyes with longer AL, shallower ACD, and larger P were associated with a decrease in SE (p < 0.001, p = 0.01, and p < 0.001, respectively). Meanwhile, for healthy controls, eyes with longer AL and larger P were associated with a decrease in SE (all p < 0.001). CONCLUSIONS The ACD and LT of myopia T1DM children remained unchanged compared to non-myopia T1DM children. This means that the lens in the former group could not lose power as compensation for AL growth, thus providing evidence for the acceleration of myopia in T1DM children.
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Affiliation(s)
- Ying Xiao
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yu Qian
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
- Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
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10
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van der Sande E, Polling JR, Tideman JWL, Meester-Smoor MA, Thiadens AAHJ, Tan E, De Zeeuw CI, Hamelink R, Willuhn I, Verhoeven VJM, Winkelman BHJ, Klaver CCW. Myopia control in Mendelian forms of myopia. Ophthalmic Physiol Opt 2023; 43:494-504. [PMID: 36882953 DOI: 10.1111/opo.13115] [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: 10/14/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To study the effectiveness of high-dose atropine for reducing eye growth in Mendelian myopia in children and mice. METHODS We studied the effect of high-dose atropine in children with progressive myopia with and without a monogenetic cause. Children were matched for age and axial length (AL) in their first year of treatment. We considered annual AL progression rate as the outcome and compared rates with percentile charts of an untreated general population. We treated C57BL/6J mice featuring the myopic phenotype of Donnai-Barrow syndrome by selective inactivation of Lrp2 knock out (KO) and control mice (CTRL) daily with 1% atropine in the left eye and saline in the right eye, from postnatal days 30-56. Ocular biometry was measured using spectral-domain optical coherence tomography. Retinal dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) were measured using high-performance liquid chromatography. RESULTS Children with a Mendelian form of myopia had average baseline spherical equivalent (SE) -7.6 ± 2.5D and AL 25.8 ± 0.3 mm; children with non-Mendelian myopia had average SE -7.3 ± 2.9 D and AL 25.6 ± 0.9 mm. During atropine treatment, the annual AL progression rate was 0.37 ± 0.08 and 0.39 ± 0.05 mm in the Mendelian myopes and non-Mendelian myopes, respectively. Compared with progression rates of untreated general population (0.47 mm/year), atropine reduced AL progression with 27% in Mendelian myopes and 23% in non-Mendelian myopes. Atropine significantly reduced AL growth in both KO and CTRL mice (male, KO: -40 ± 15; CTRL: -42 ± 10; female, KO: -53 ± 15; CTRL: -62 ± 3 μm). The DA and DOPAC levels 2 and 24 h after atropine treatment were slightly, albeit non-significantly, elevated. CONCLUSIONS High-dose atropine had the same effect on AL in high myopic children with and without a known monogenetic cause. In mice featuring a severe form of Mendelian myopia, atropine reduced AL progression. This suggests that atropine can reduce myopia progression even in the presence of a strong monogenic driver.
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Affiliation(s)
- Emilie van der Sande
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Jan Roelof Polling
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Departments Orthoptics and Optometry, Hogeschool Utrecht, Utrecht, The Netherlands
| | - J Willem L Tideman
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Ophthalmology, Martini Hospital, Groningen, The Netherlands
| | - Magda A Meester-Smoor
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Emily Tan
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Chris I De Zeeuw
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Department Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ralph Hamelink
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Department Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ingo Willuhn
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Department Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Virginie J M Verhoeven
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Beerend H J Winkelman
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Department Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Ophthalmology, Radboud Medical Center, Nijmegen, The Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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11
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Yam JC, Zhang XJ, Kam KW, Chen LJ, Tham CC, Pang CP. Myopia control and prevention: From lifestyle to low-concentration atropine. The 2022 Josh Wallman Memorial Lecture. Ophthalmic Physiol Opt 2023; 43:299-310. [PMID: 36857025 DOI: 10.1111/opo.13118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
The purpose of this study was to explore the findings from the Hong Kong Children Eye Study and the Low Concentration Atropine for Myopia Progression (LAMP-1) Study. The incidence of myopia among schoolchildren in Hong Kong more than doubled during the COVID-19 pandemic, with outdoor time decreased significantly and screen time increased. The change in lifestyle during the COVID-19 pandemic aggravated myopia development. Low-concentration atropine (0.05%, 0.025% and 0.01%) is effective in reducing myopia progression with a concentration-related response. This concentration-dependent response was maintained throughout a 3-year follow-up period, and all low concentrations were well tolerated. An age-dependent effect was observed in each treatment group with 0.05%, 0.025% and 0.01% atropine. Younger age was associated with a poor treatment response to low-concentration atropine. Additionally, low-concentration atropine induced choroidal thickening along a concentration-dependent response throughout the treatment period. During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. Stopping treatment at an older age and receiving lower concentration were associated with a smaller rebound effect. However, differences in the rebound effect were clinically small across all the three concentrations studied.
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Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong 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.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong 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.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
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12
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Hvid-Hansen A, Jacobsen N, Hjortdal J, Møller F, Ozenne B, Kessel L. Low-Dose Atropine Induces Changes in Ocular Biometrics in Myopic Children: Exploring Temporal Changes by Linear Mixed Models and Contribution to Treatment Effect by Mediation Analyses. J Clin Med 2023; 12:jcm12041605. [PMID: 36836139 PMCID: PMC9966043 DOI: 10.3390/jcm12041605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
This study aimed to investigate changes in non-cycloplegic ocular biometrics during the initial six months of treatment with a 0.1% atropine loading dose and 0.01% atropine compared with a placebo and analyze their contribution to the treatment effect on cycloplegic spherical equivalent (SE) progression. The study was based on a randomized, double-masked, placebo-controlled, multicenter trial evaluating a 0.1% atropine six-month loading dose and 0.01% atropine in reducing myopic progression in Danish children. The treatment phase was 24 months, and the washout phase was 12 months. Parameters measured included changes in axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and choroidal thickness (ChT), while cycloplegic SE and lens power were calculated. Longitudinal changes and contributions to treatment effects were analyzed using constrained linear mixed models and mediation analyses, respectively. After six months, AL was 0.13 mm shorter (95% confidence interval [CI], -0.18 to -0.07 [adjusted p < 0.001]) and 0.06 mm shorter (95% CI, -0.11 to -0.01 [adjusted p = 0.060]) with a 0.1% atropine loading dose and 0.01% atropine, respectively, compared to the placebo group. Similar concentration-dependent changes were found with ACD, LT, VCD, ChT, and cycloplegic SE. Although the treatment effects trended toward concentration-dependent responses, only the treatment effect mediated by AL at three months differed significantly between 0.01% atropine and a 0.1% atropine loading dose (adjusted p = 0.023). Several ocular biometrics, including AL, ACD, and LT, changed dose-dependently during low-dose atropine treatment. Moreover, the treatment effect of atropine on SE progression was mediated by a subset of ocular biometrics, mainly AL, with trends toward concentration dependency and distributional shifts over time.
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Affiliation(s)
- Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Correspondence:
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark—Vejle Hospital, DK-7100 Vejle, Denmark
| | - Brice Ozenne
- Department of Public Health, Section of Biostatistics, University of Copenhagen, DK-1014 København K, Denmark
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, DK-2200 København N, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
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13
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Lawrenson JG, Shah R, Huntjens B, Downie LE, Virgili G, Dhakal R, Verkicharla PK, Li D, Mavi S, Kernohan A, Li T, Walline JJ. Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 2:CD014758. [PMID: 36809645 PMCID: PMC9933422 DOI: 10.1002/14651858.cd014758.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Myopia is a common refractive error, where elongation of the eyeball causes distant objects to appear blurred. The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Since myopia is usually detected in children before 10 years of age and can progress rapidly, interventions to slow its progression need to be delivered in childhood. OBJECTIVES To assess the comparative efficacy of optical, pharmacological and environmental interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of myopia control interventions according to their efficacy. To produce a brief economic commentary, summarising the economic evaluations assessing myopia control interventions in children. To maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE; Embase; and three trials registers. The search date was 26 February 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of optical, pharmacological and environmental interventions for slowing myopia progression in children aged 18 years or younger. Critical outcomes were progression of myopia (defined as the difference in the change in spherical equivalent refraction (SER, dioptres (D)) and axial length (mm) in the intervention and control groups at one year or longer) and difference in the change in SER and axial length following cessation of treatment ('rebound'). DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. We assessed bias using RoB 2 for parallel RCTs. We rated the certainty of evidence using the GRADE approach for the outcomes: change in SER and axial length at one and two years. Most comparisons were with inactive controls. MAIN RESULTS We included 64 studies that randomised 11,617 children, aged 4 to 18 years. Studies were mostly conducted in China or other Asian countries (39 studies, 60.9%) and North America (13 studies, 20.3%). Fifty-seven studies (89%) compared myopia control interventions (multifocal spectacles, peripheral plus spectacles (PPSL), undercorrected single vision spectacles (SVLs), multifocal soft contact lenses (MFSCL), orthokeratology, rigid gas-permeable contact lenses (RGP); or pharmacological interventions (including high- (HDA), moderate- (MDA) and low-dose (LDA) atropine, pirenzipine or 7-methylxanthine) against an inactive control. Study duration was 12 to 36 months. The overall certainty of the evidence ranged from very low to moderate. Since the networks in the NMA were poorly connected, most estimates versus control were as, or more, imprecise than the corresponding direct estimates. Consequently, we mostly report estimates based on direct (pairwise) comparisons below. At one year, in 38 studies (6525 participants analysed), the median change in SER for controls was -0.65 D. The following interventions may reduce SER progression compared to controls: HDA (mean difference (MD) 0.90 D, 95% confidence interval (CI) 0.62 to 1.18), MDA (MD 0.65 D, 95% CI 0.27 to 1.03), LDA (MD 0.38 D, 95% CI 0.10 to 0.66), pirenzipine (MD 0.32 D, 95% CI 0.15 to 0.49), MFSCL (MD 0.26 D, 95% CI 0.17 to 0.35), PPSLs (MD 0.51 D, 95% CI 0.19 to 0.82), and multifocal spectacles (MD 0.14 D, 95% CI 0.08 to 0.21). By contrast, there was little or no evidence that RGP (MD 0.02 D, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.07 D, 95% CI -0.09 to 0.24) or undercorrected SVLs (MD -0.15 D, 95% CI -0.29 to 0.00) reduce progression. At two years, in 26 studies (4949 participants), the median change in SER for controls was -1.02 D. The following interventions may reduce SER progression compared to controls: HDA (MD 1.26 D, 95% CI 1.17 to 1.36), MDA (MD 0.45 D, 95% CI 0.08 to 0.83), LDA (MD 0.24 D, 95% CI 0.17 to 0.31), pirenzipine (MD 0.41 D, 95% CI 0.13 to 0.69), MFSCL (MD 0.30 D, 95% CI 0.19 to 0.41), and multifocal spectacles (MD 0.19 D, 95% CI 0.08 to 0.30). PPSLs (MD 0.34 D, 95% CI -0.08 to 0.76) may also reduce progression, but the results were inconsistent. For RGP, one study found a benefit and another found no difference with control. We found no difference in SER change for undercorrected SVLs (MD 0.02 D, 95% CI -0.05 to 0.09). At one year, in 36 studies (6263 participants), the median change in axial length for controls was 0.31 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.33 mm, 95% CI -0.35 to 0.30), MDA (MD -0.28 mm, 95% CI -0.38 to -0.17), LDA (MD -0.13 mm, 95% CI -0.21 to -0.05), orthokeratology (MD -0.19 mm, 95% CI -0.23 to -0.15), MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09), pirenzipine (MD -0.10 mm, 95% CI -0.18 to -0.02), PPSLs (MD -0.13 mm, 95% CI -0.24 to -0.03), and multifocal spectacles (MD -0.06 mm, 95% CI -0.09 to -0.04). We found little or no evidence that RGP (MD 0.02 mm, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.03 mm, 95% CI -0.10 to 0.03) or undercorrected SVLs (MD 0.05 mm, 95% CI -0.01 to 0.11) reduce axial length. At two years, in 21 studies (4169 participants), the median change in axial length for controls was 0.56 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.47mm, 95% CI -0.61 to -0.34), MDA (MD -0.33 mm, 95% CI -0.46 to -0.20), orthokeratology (MD -0.28 mm, (95% CI -0.38 to -0.19), LDA (MD -0.16 mm, 95% CI -0.20 to -0.12), MFSCL (MD -0.15 mm, 95% CI -0.19 to -0.12), and multifocal spectacles (MD -0.07 mm, 95% CI -0.12 to -0.03). PPSL may reduce progression (MD -0.20 mm, 95% CI -0.45 to 0.05) but results were inconsistent. We found little or no evidence that undercorrected SVLs (MD -0.01 mm, 95% CI -0.06 to 0.03) or RGP (MD 0.03 mm, 95% CI -0.05 to 0.12) reduce axial length. There was inconclusive evidence on whether treatment cessation increases myopia progression. Adverse events and treatment adherence were not consistently reported, and only one study reported quality of life. No studies reported environmental interventions reporting progression in children with myopia, and no economic evaluations assessed interventions for myopia control in children. AUTHORS' CONCLUSIONS Studies mostly compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. Effects at one year provided evidence that these interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. A smaller body of evidence is available at two or three years, and uncertainty remains about the sustained effect of these interventions. Longer-term and better-quality studies comparing myopia control interventions used alone or in combination are needed, and improved methods for monitoring and reporting adverse effects.
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Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Rakhee Shah
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Dongfeng Li
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Walline
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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14
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Cheng X, Xu J, Brennan NA. Randomized Trial of Soft Contact Lenses with Novel Ring Focus for Controlling Myopia Progression. OPHTHALMOLOGY SCIENCE 2022; 3:100232. [PMID: 36545264 PMCID: PMC9762188 DOI: 10.1016/j.xops.2022.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022]
Abstract
Purpose To evaluate efficacy and vision with 2 prototype myopia control soft contact lenses with noncoaxial ring-focus designs (for enhancing efficacy [EE] and enhancing vision [EV]) compared with dual-focus (DF) and single-vision (SV) designs. Design Multicenter, 6-month, randomized, controlled, double-masked clinical trial. Participants One hundred ninety-nine myopic (-0.75 diopters [D] to -4.50 D) children aged 7 to 12 years. Methods Participants were randomized with stratification into myopia control (EE, EV, or DF) or SV arms at 9 clinical sites in 3 countries. Postcycloplegia axial length (AL) and spherical equivalent autorefraction (SECAR) were measured at baseline and 26 weeks. Axial length was also measured without cycloplegia at baseline, 1, 4, 13, and 26 weeks. Progression was analyzed using linear mixed models by intention-to-treat population. Visual acuity (VA) and vision quality were monitored. Main Outcome Measures Axial elongation, change in SECAR. Results A total of 185 subjects completed the study (n = 44, 49, 45, and 47 for EE, EV, DF, and SV, respectively). There were no serious/significant ocular adverse events. After 26 weeks, EE, EV, and DF all had statistically significantly less axial elongation than SV (unadjusted mean [standard deviation]: EE, 0.079 [0.125]; EV, 0.119 [0.101]; DF, 0.135 [0.117]; SV; 0.189 [0.121] mm). The estimated least-square mean (LSM) differences (adjusted 95% confidence interval) compared with SV were -0.105 (-0.149, -0.062), -0.063 (-0.106, -0.020), and -0.056 (-0.100, -0.013) mm for EE, EV, and DF, respectively. Enhancing efficacy alone had statistically significantly less progression of SECAR than SV (EE: -0.12 [0.27] D vs. SV: -0.35 [0.33] D; LSM difference: 0.22 D [0.09, 0.35]). Enhancing efficacy also had statistically significantly less axial elongation than DF (-0.049 mm [-0.093, -0.004]). Changes in AL and SECAR of EV and DF were not statistically different. All 3 myopia control lenses had mean VA close to 0.00 logarithm of the minimum angle of resolution (logMAR) with estimated 95% upper confidence limits <0.10 logMAR. Enhancing efficacy and DF produced similar reports of halos but more than EV and SV. Conclusions The prototype contact lenses met the design intent; EE was more efficacious in slowing axial elongation than DF with comparable vision performance, whereas EV produced comparable efficacy to DF with similar vision performance to SV.
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Key Words
- AL, axial length
- Axial length, Myopia control, Pediatric, Soft contact lenses, Vision
- B2B, bottom-2-boxes
- CI, confidence interval
- D, diopter
- DF, dual-focus
- EE, enhanced efficacy
- EV, enhanced vision
- LSM, least-square mean
- MMRM, mixed models with repeated measures
- SD, standard deviation
- SE, standard error
- SECAR, spherical equivalent cycloplegic autorefraction
- SV, single-vision
- VA, visual acuity
- logMAR, logarithm of the minimum angle of resolution
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Affiliation(s)
- Xu Cheng
- Correspondence: Xu Cheng, MD, PhD, 7500 Centurion Pkwy, W-2A, Jacksonville, FL 32256.
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15
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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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16
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Efficacy and Adverse Effects of Atropine for Myopia Control in Children: A Meta-Analysis of Randomised Controlled Trials. J Ophthalmol 2021; 2021:4274572. [PMID: 34925913 PMCID: PMC8683246 DOI: 10.1155/2021/4274572] [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: 09/26/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore the rebound effects and safety of atropine on accommodation amplitude in slowing myopia progression. Methods We conducted a meta-analysis to testify proper dosage of atropine in children with myopia. We searched in PubMed, EMBASE, Ovid, and the Cochrane Library up to March 30, 2021. We selected randomised controlled trials (RCTs) that evaluated the efficacy of atropine for controlling myopia progression in children. We performed the inverse variance random-effects model to pool the data using mean difference (MD) for continuous variables. Statistical heterogeneity was assessed using the I2 test. Additionally, we conducted subgroup analyses and sensitivity analyses. Results Seventeen RCTs involving 2955 participants were included. Myopia progression was significantly less in the atropine group than that of the control group, with MD = 0.38 D per year (95% confidence interval, 0.20 to 0.56). Less axial elongation was shown with MD = −0.19 mm per year (95% CI, −0.25 to −0.12). There was a statistically difference among various doses (p=0.00001). In addition, 1.0% atropine showed the rebound effect with MD = −0.54 D per year (95% CI, −0.81 to −0.26) and was more effective in the latter six months than in the former one. Less accommodation amplitude was shown in 0.01% atropine. Conclusion The efficacy of atropine is dose dependent, and 0.01% atropine may be the optimal dose in slowing myopia progression in children with no accommodation dysfunction. A rebound effect is more prominent in high-dose atropine in the former cessation after discontinuation.
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17
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Kao PH, Chuang LH, Lai CC, Chen SY, Lin KK, Lee JS, Hou CH, Chen CT, Kuo YK, Sun CC, Liu CF. Evaluation of axial length to identify the effects of monocular 0.125% atropine treatment for pediatric anisometropia. Sci Rep 2021; 11:21511. [PMID: 34728777 PMCID: PMC8563952 DOI: 10.1038/s41598-021-96414-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
The aim of the study is to determine the effects of monocular 0.125% atropine daily treatment on the longer axial length (AL) eyes in children with pediatric anisometropia. This was a retrospective cohort study. The charts of children with anisometropia (aged 6–15 years) who had a > 0.2-mm difference in AL between the two eyes were reviewed. Children who received monocular treatment of 0.125% atropine in the eye with longer AL were included for final analysis. The main outcome measure was the difference in AL between the two eyes after treatment. Regression analysis was used to model the changes in AL according to the time of treatment in both eyes. Finally, forty eyes in 20 patients (mean age 10.2 years) were included in the analyses. During the treatment period, AL was controlled in the treated eyes (p = 0.389) but elongated significantly in the untreated eyes (p < 0.001). The difference in AL between the treated and untreated eyes decreased from 0.57 to 0.22 mm (p < 0.001) after the 1-year treatment period. In the regression model, the best fit for the relationship between changes in AL and time during the treatment period in the treated eyes was the quadratic regression model with a concave function. In conclusion, these data suggest that 0.125% atropine daily is an effective treatment to reduce the interocular difference of AL in eyes with axial anisometropia. This pilot study provides useful information for future prospective and larger studies of atropine for the treatment of pediatric axial anisometropia.
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Affiliation(s)
- Po-Hsiang Kao
- Department of Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Yi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ken-Kuo Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jiahn-Shing Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chiun-Ho Hou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chueh-Tan Chen
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Kai Kuo
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Fu Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Program in Molecular Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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18
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Cheng Z, Mei J, Cao S, Zhang R, Zhou J, Wang Y. The Effects of 0.01% Atropine on Adult Myopes' Contrast Sensitivity. Front Neurosci 2021; 15:624472. [PMID: 33679306 PMCID: PMC7933202 DOI: 10.3389/fnins.2021.624472] [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: 10/31/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Atropine at a low concentration is considered a safe and effective treatment to mitigate myopia progression. However, the potential unwanted side effects of administering atropine at a low dose on visual functions other than best corrected visual acuity has not been investigated. In this study, we investigate the short-term (12,16, and 20 h) and long-term (1, 2, and 4 weeks) effects of 0.01% atropine (i.e., 0.1 mg/ml) on contrast sensitivity (CS) in patients with myopia. METHODS Thirty adults (23.33 ± 2.93 years old) with myopia between -1.00 and -6.00 diopters (D), astigmatism of -1.50 D or less, and anisometropia of 1.00 D or less, participated in this prospective, masked, placebo-controlled, randomized study. The participants were randomly assigned to receive 0.01% atropine or polyvinyl alcohol eye drops once nightly to both eyes for four weeks. CS was measured binocularly at baseline and 12, 16, 20 h, 1, 2, and 4 weeks after the first use of the eye drops. RESULTS There was no statistically significant differences of CS found between atropine and placebo-controlled groups in both short-term and long-term. There was no statistically significant interaction effect found between the time and group. CONCLUSION We demonstrated no significant deleterious effect of 0.01% atropine on adult myopes' CS.
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Affiliation(s)
| | | | | | | | - Jiawei Zhou
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology and Optometry, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yuwen Wang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology and Optometry, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, China
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19
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Wang WY, Chen C, Chang J, Chien L, Shih YF, Lin LLK, Pang CP, Wang IJ. Pharmacotherapeutic candidates for myopia: A review. Biomed Pharmacother 2021; 133:111092. [PMID: 33378986 DOI: 10.1016/j.biopha.2020.111092] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/11/2023] Open
Abstract
This review provides insights into the mechanism underlying the pathogenesis of myopia and potential targets for clinical intervention. Although the etiology of myopia involves both environmental and genetic factors, recent evidence has suggested that the prevalence and severity of myopia appears to be affected more by environmental factors. Current pharmacotherapeutics are aimed at inhibiting environmentally induced changes in visual input and subsequent changes in signaling pathways during myopia pathogenesis and progression. Recent studies on animal models of myopia have revealed specific molecules potentially involved in the regulation of eye development. Among them, the dopamine receptor plays a critical role in controlling myopia. Subsequent studies have reported pharmacotherapeutic treatments to control myopia progression. In particular, atropine treatment yielded favorable outcomes and has been extensively used; however, current studies are aimed at optimizing its efficacy and confirming its safety. Furthermore, future studies are required to assess the efficacy of combinatorial use of low-dose atropine and contact lenses or orthokeratology.
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Affiliation(s)
- Wen-Yi Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Camille Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Justine Chang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lillian Chien
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Feng Shih
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Luke L K Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, KLN, Hong Kong, China.
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.
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20
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Zhao C, Cai C, Ding Q, Dai H. Efficacy and safety of atropine to control myopia progression: a systematic review and meta-analysis. BMC Ophthalmol 2020; 20:478. [PMID: 33287746 PMCID: PMC7720573 DOI: 10.1186/s12886-020-01746-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background The effect and safety of atropine on delaying the progression of myopia has been extensively studied, but its optimal dose is still unclear. Therefore, the purpose of this meta-analysis is to systematically evaluate the safety and effectiveness of atropine in controlling the progression of myopia, and to explore the relationship between the dose of atropine and the effectiveness of controlling the progression of myopia. Methods This work was done through the data searched from PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The Cochrane Handbook was also used to evaluate the quality of the included studies. In addition, a meta-analysis was performed using Revman5.3 software. Results A total of 10 randomized controlled trials (RCTs) were included. Myopia progression was mitigated greater in the atropine treatment group than that in the control group, with MD = − 0.80, 95% CI (− 0.94, − 0.66) during the whole observation period. There was a statistical difference among 0.05, 0.5, and 1.0% atropine (P = 0.004). In addition, less axial elongation was shown, with MD = − 0.26, 95% CI (− 0.33, − 0.18) during the whole observation period. Conclusion The effectiveness of atropine in controlling the progression of myopia was dose related. A 0.05% atropine was likely to be the optimal dose.
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Affiliation(s)
- Congling Zhao
- Aier Eye Hospital of Wuhan university, Wuhan, Hubei Province, China
| | - Chunyan Cai
- Aier Eye Hospital of Wuhan university, Wuhan, Hubei Province, China
| | - Qiang Ding
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hongbin Dai
- Aier Eye Hospital of Wuhan university, Wuhan, Hubei Province, China.
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21
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Comparative Study of the Effects of 1% Atropine on the Anterior Segment. J Ophthalmol 2020; 2020:5125243. [PMID: 33062312 PMCID: PMC7539084 DOI: 10.1155/2020/5125243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/15/2020] [Accepted: 07/21/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the influences of atropine on changes in anterior segment geometry, as measured by ultrasound biomicroscopy in children. Methods A prospective observational study was performed. Anterior segment parameters were obtained by UBM before and after the instillation of 1% atropine. Univariate linear regression was performed to identify the variables contributing to the changes in the trabecular meshwork-iris angle (TIA). Results The study included 21 boys and 37 girls with a mean age of 10.79 ± 2.53 years. Anterior chamber parameters including the central anterior chamber depth, TIA, angle opening distance at 500 μm from the scleral spur, iris thickness 750 μm and 1500 μm from the scleral spur, trabecular-ciliary angle (TCA), trabecular-ciliary process distance, sclera-iris angle (SIA), and sclera-ciliary process angle significantly increased after cycloplegia (P < 0.05). In contrast, the lens vault, iris cross-sectional area, and maximum ciliary muscle thickness significantly decreased after cycloplegia. Univariate analysis identified the change in TCA and the change in SIA and the TIA before mydriasis as determinants of the change in TIA. Conclusions Atropine causes statistically significant changes in various anterior segment parameters in children. The change in anterior chamber angle is associated with the change in TCA and the change in SIA and the TIA before mydriasis.
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22
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Polling JR, Tan E, Driessen S, Loudon SE, Wong HL, van der Schans A, Tideman JWL, Klaver CCW. A 3-year follow-up study of atropine treatment for progressive myopia in Europeans. Eye (Lond) 2020; 34:2020-2028. [PMID: 32958872 PMCID: PMC7785025 DOI: 10.1038/s41433-020-1122-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/04/2020] [Accepted: 07/29/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Atropine is the most powerful treatment for progressive myopia in childhood. This study explores the 3-year effectiveness of atropine in a clinical setting. METHODS In this prospective clinical effectiveness study, children with progressive myopia ≥ 1D/year or myopia ≤ -2.5D were prescribed atropine 0.5%. Examination, including cycloplegic refraction and axial length (AL), was performed at baseline, and follow-up. Outcome measures were spherical equivalent (SER) and AL; annual progression of SER on treatment was compared with that prior to treatment. Adjustments to the dose were made after 1 year in case of low (AL ≥ 0.3 mm/year) or high response (AL < 0.1 mm/year) of AL. RESULTS A total of 124 patients were enrolled in the study (median age: 9.5, range: 5-16 years). At baseline, median SER was -5.03D (interquartile range (IQR): 3.08); median AL was 25.14 mm (IQR: 1.30). N = 89 (71.8%) children were persistent to therapy throughout the 3-year follow-up. Median annual progression of SER for these children was -0.25D (IQR: 0.44); of AL 0.11 mm (IQR: 0.18). Of these, N = 32 (36.0%) had insufficient response and were assigned to atropine 1%; N = 26 (29.2%) showed good response and underwent tapering in dose. Rebound of AL progression was not observed. Of the children who ceased therapy, N = 9 were lost to follow-up; N = 9 developed an allergic reaction; and N = 17 (19.1%) stopped due to adverse events. CONCLUSION In children with or at risk of developing high myopia, a starting dose of atropine 0.5% was associated with decreased progression in European children during a 3-year treatment regimen. Our study supports high-dose atropine as a treatment option for children at risk of developing high myopia in adulthood.
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Affiliation(s)
- Jan Roelof Polling
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Optometry & Orthoptics, Faculty of Health, University of Applied Sciences, Utrecht, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emily Tan
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sjoerd Driessen
- Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sjoukje E Loudon
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hoi-Lam Wong
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - J Willem L Tideman
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, Gelderland, The Netherlands. .,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
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23
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Li FF, Kam KW, Zhang Y, Tang SM, Young AL, Chen LJ, Tham CC, Pang CP, Yam JC. Differential Effects on Ocular Biometrics by 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study. Ophthalmology 2020; 127:1603-1611. [PMID: 32525048 DOI: 10.1016/j.ophtha.2020.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate changes in ocular biometrics in groups receiving 0.05%, 0.025%, and 0.01% atropine compared with placebo over 1 year based on the Low-Concentration Atropine for Myopia Progression (LAMP) study. DESIGN Double-blinded, randomized, placebo-controlled trial. PARTICIPANTS Three hundred eighty-three children aged 4 to 12 years who were assigned randomly to receive 0.05%, 0.025%, 0.01% atropine, or placebo once daily in both eyes and completed the first year of the LAMP study. METHODS Cycloplegic spherical equivalent (SE), axial length (AL), corneal curvature (K), and anterior chamber depth (ACD) were measured by IOLMaster. Corneal astigmatism and lens power were calculated. The ocular biometric parameter changes were compared among groups. Contributions to SE progression from ocular parameters were determined and compared among groups. MAIN OUTCOME MEASURES Changes in ocular biometrics and their associations with the changes in SE. RESULTS Over 1 year, changes in AL were 0.20 ± 0.25 mm, 0.29 ± 0.20 mm, 0.36 ± 0.29 mm, and 0.41 ± 0.22 mm in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P < 0.001), with a concentration-dependent response. Corneal power remained stable, and its changes were similar across all atropine concentrations: -0.02 ± 0.14 diopter (D), -0.01 ± 0.14 D, -0.01 ± 0.12 D, and 0.01 ± 0.14 D in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P = 0.10). Lens power decreased over time in each concentration, but its changes also were similar across all concentrations: -0.31 ± 0.43 D, -0.38 ± 0.47 D, -0.40 ± 0.43 D, and -0.41 ± 0.43 D in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P = 0.24). Changes in ACD remained similar across all concentrations (P = 0.41). The contributions to SE progression from the ocular biometric changes after adjusting for age and gender in each concentration were similar across all groups (P > 0.05). CONCLUSIONS Low-concentrations of atropine (0.05%, 0.025%, and 0.01%) have no clinical effect on corneal or lens power. Antimyopic effects of low-concentration atropine act mainly on reducing AL elongation, and therefore could reduce the risk of subsequent myopia complications.
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Affiliation(s)
- Fen Fen Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China.
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24
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Cristaldi M, Olivieri M, Pezzino S, Spampinato G, Lupo G, Anfuso CD, Rusciano D. Atropine Differentially Modulates ECM Production by Ocular Fibroblasts, and Its Ocular Surface Toxicity Is Blunted by Colostrum. Biomedicines 2020; 8:biomedicines8040078. [PMID: 32260532 PMCID: PMC7236597 DOI: 10.3390/biomedicines8040078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/15/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The etiology and the mechanism behind atropine treatment of progressive myopia are still poorly understood. Our study addressed the role of scleral and choroidal fibroblasts in myopia development and atropine function. Methods: Fibroblasts treated in vitro with atropine or 7-methylxanthine were tested for ECM production by Western blotting. Corneal epithelial cells were treated with atropine in the presence or absence of colostrum or fucosyl-lactose, and cell survival was evaluated by the MTT metabolic test. Results: Atropine and 7-methyl-xanthine stimulated collagen I and fibronectin production in scleral fibroblasts, while they inhibited their production in choroidal fibroblasts. Four days of treatment with atropine of corneal epithelial cells significantly decreased cell viability, which could be prevented by the presence of colostrum or fucosyl-lactose. Conclusions: Our results show that atropine may function in different ways in different eye districts, strengthening the scleral ECM and increasing permeability in the choroid. The finding that colostrum or fucosyl-lactose attenuate the corneal epithelial toxicity after long-term atropine treatment suggests the possibility that both compounds can efficiently blunt its toxicity in children subjected to chronic atropine treatment.
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Affiliation(s)
- Martina Cristaldi
- Research Center, Sooft Italia SpA c/o Biologic Tower, University of Catania, 95123 Catania, Italy; (M.C.); (M.O.); (S.P.); (G.S.)
| | - Melania Olivieri
- Research Center, Sooft Italia SpA c/o Biologic Tower, University of Catania, 95123 Catania, Italy; (M.C.); (M.O.); (S.P.); (G.S.)
| | - Salvatore Pezzino
- Research Center, Sooft Italia SpA c/o Biologic Tower, University of Catania, 95123 Catania, Italy; (M.C.); (M.O.); (S.P.); (G.S.)
| | - Giorgia Spampinato
- Research Center, Sooft Italia SpA c/o Biologic Tower, University of Catania, 95123 Catania, Italy; (M.C.); (M.O.); (S.P.); (G.S.)
| | - Gabriella Lupo
- Department of Biomedical and Biotechnological Sciences, Biologic Tower, University of Catania, 95123 Catania, Italy;
| | - Carmelina Daniela Anfuso
- Department of Biomedical and Biotechnological Sciences, Biologic Tower, University of Catania, 95123 Catania, Italy;
- Correspondence: (C.D.A.); (D.R.)
| | - Dario Rusciano
- Research Center, Sooft Italia SpA c/o Biologic Tower, University of Catania, 95123 Catania, Italy; (M.C.); (M.O.); (S.P.); (G.S.)
- Correspondence: (C.D.A.); (D.R.)
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Pugazhendhi S, Ambati B, Hunter AA. Pathogenesis and Prevention of Worsening Axial Elongation in Pathological Myopia. Clin Ophthalmol 2020; 14:853-873. [PMID: 32256044 PMCID: PMC7092688 DOI: 10.2147/opth.s241435] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This review discusses the etiology and pathogenesis of myopia, prevention of disease progression and worsening axial elongation, and emerging myopia treatment modalities. INTRODUCTION Pediatric myopia is a public health concern that impacts young children worldwide and is associated with numerous future ocular diseases such as cataract, glaucoma, retinal detachment and other chorioretinal abnormalities. While the exact mechanism of myopia of the human eye remains obscure, several studies have reported on the role of environmental and genetic factors in the disease development. METHODS A review of literature was conducted. PubMed and Medline were searched for combinations and derivatives of the keywords including, but not limited to, "pediatric myopia", "axial elongation", "scleral remodeling" or "atropine." The PubMed and Medline database search were performed for randomized control trials, systematic reviews and meta-analyses using the same keyword combinations. RESULTS Studies have reported that detection of genetic correlations and modification of environmental influences may have a significant impact in myopia progression, axial elongation and future myopic ocular complications. The conventional pharmacotherapy of pediatric myopia addresses the improvement in visual acuity and prevention of amblyopia but does not affect axial elongation or myopia progression. Several studies have published varying treatments, including optical, pharmacological and surgical management, which show great promise for a more precise control of myopia and preservation of ocular health. DISCUSSION Understanding the role of factors influencing the onset and progression of pediatric myopia will facilitate the development of successful treatments, reduction of disease burden, arrest of progression and improvement in future of the management of myopia.
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Hagen LA, Gilson SJ, Akram MN, Baraas RC. Emmetropia Is Maintained Despite Continued Eye Growth From 16 to 18 Years of Age. Invest Ophthalmol Vis Sci 2020; 60:4178-4186. [PMID: 31596926 DOI: 10.1167/iovs.19-27289] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine, in Norwegian adolescents, to what degree emmetropia and low hyperopia were maintained from 16 to 18 years of age, and if this was the case, whether it was associated with continued coordinated ocular growth. Methods Cycloplegic autorefraction and ocular biometry, including crystalline lens thickness, were measured in 93 Norwegian adolescents (mean age: 16.7 ± 0.3 years; 63.4% females) and repeated after 2 years. Crystalline lens power was determined by ray tracing over a 1-mm pupil, based on the Gullstrand-Emsley model. Serum vitamin D3 concentration was measured at follow-up. Results Emmetropia and low hyperopia (-0.50 diopters [D] < spherical equivalent refractive error [SER] < +2.00 D) were present in 91.4% at baseline and 89.2% at follow-up. The emmetropes and low hyperopes who maintained their refractive error exhibited continued ocular axial growth (+0.059 ± 0.070 mm) together with a decrease in crystalline lens power (-0.064 ± 0.291 D) and a deepening of the anterior chamber (+0.028 ± 0.040 mm). Thinning of the crystalline lens was found in 24%. Overall, the negative change in SER was larger in those with the most negative SER at baseline (R2 = 0.178, P < 0.001), and was associated with increases in vitreous chamber depth and in crystalline lens power (R2 = 0.752, P < 0.001), when adjusted for sex. There was no difference in vitamin D3 level between those who exhibited negative versus positive changes in refractive error. Conclusions The results show that emmetropic and low hyperopic eyes were still growing in late adolescence, with refractive errors being maintained through a coordinated decrease in crystalline lens power.
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Affiliation(s)
- Lene A Hagen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Stuart J Gilson
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Muhammad Nadeem Akram
- Department of Microsystems, Faculty of Technology, Natural Sciences and Maritime Sciences, University of South-Eastern Norway, Borre, Norway
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO, Ng SM, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev 2020; 1:CD004916. [PMID: 31930781 PMCID: PMC6984636 DOI: 10.1002/14651858.cd004916.pub4] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. OBJECTIVES To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. SEARCH METHODS We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. MAIN RESULTS We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). AUTHORS' CONCLUSIONS Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.
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Affiliation(s)
- Jeffrey J Walline
- The Ohio State University, College of Optometry, 338 West Tenth Avenue, Columbus, Ohio, USA, 43210-1240
| | - Kristina B Lindsley
- IBM Watson Health, Life Sciences, Oncology, & Genomics, Baltimore, Maryland, USA
| | - S Swaroop Vedula
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, USA, 21218
| | - Susan A Cotter
- Southern California College of Optometry, 2575 Yorba Linda Boulevard, Fullerton, California, USA, 92831
| | - Donald O Mutti
- The Ohio State University, College of Optometry, 338 West Tenth Avenue, Columbus, Ohio, USA, 43210-1240
| | - Sueko M Ng
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, W5010, c/o Cochrane Eyes and Vision Group, Baltimore, Maryland, USA, 21205
| | - J Daniel Twelker
- University of Arizona, Department of Ophthalmology, 655 North Alvernon Way Suite 108, Tucson, Arizona, USA, 85711
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Whatham AR, Lunn D, Judge SJ. Effects of Monocular Atropinization on Refractive Error and Eye Growth in Infant New World Monkeys. Invest Ophthalmol Vis Sci 2019; 60:2623-2630. [PMID: 31226711 DOI: 10.1167/iovs.18-24490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the effect of topical atropine on axial eye growth and emmetropization in infant marmosets. Methods Atropine was applied to one eye from the age of 7 to 56 days in two dose regimens, High (0.1-1% twice daily, increasing with age) or moderate (Mod) (0.1% once daily). Both eyes of the marmosets were refracted, and axial dimensions were measured ultrasonically, at 14, 28, 42, 49, 56, 70, 105, 168, and 279 days of age. The time course of each measured variable was analyzed using multilevel mixed-effects modeling realized in R. Results The logistic growth curves fitted to anterior segment depth (ASD) did not differ significantly between the dose regimens, but xmid, the age at which growth was half-maximal, and scal, the time constant of the exponential term in the logistic growth curve equation, differed significantly between the ASD of atropinized and untreated eyes (P = 0.03 and P < 0.0001, respectively), with the ASD of atropinized eyes shorter than that of untreated eyes. The splines fitted to lens thickness did not vary significantly with dose, but differed significantly (P < 0.0001) between the atropinized and untreated eyes, with the atropinized lenses thicker. Vitreous chamber depth (VCD) was not significantly different, but the variance of VCD was significantly greater (P < 0.001) in the atropinized compared with the untreated eyes. Refractive error (RE) became relatively myopic in atropinized eyes. The variance of RE in atropinized eyes was significantly greater (P < 0.0001) than in untreated eyes. Conclusions Atropine caused the infant marmoset lens to move forward and thicken, a relative myopia, and increases in the between-animals variance in VCD, which could be considered a failure of emmetropization.
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McCrann S, Flitcroft I, Strang NC, Saunders KJ, Logan NS, Lee SS, Mackey DA, Butler JS, Loughman J. Myopia Outcome Study of Atropine in Children (MOSAIC): an investigator-led, double-masked, placebo-controlled, randomised clinical trial protocol. HRB Open Res 2019. [DOI: 10.12688/hrbopenres.12914.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy, safety and mechanisms of action of 0.01% atropine for managing progression of myopia. During Phase 1 of the trial, 250 children aged 6-16 years with progressive myopia instil eye drops once nightly in both eyes from randomisation to month 24. From month 24 to 36 participants are re-randomised in Phase 2 of the trial, into continued 0.01% atropine, and washout, at 1:1 ratio for those participants initially randomised to the intervention arm (n=167), during which any potential rebound effects on cessation of treatment will be monitored. All participants initially assigned to the placebo (n=83) crossover to the intervention arm of the study for Phase 2, and from month 24 to 36, instil 0.01% atropine eye drops in both eyes once nightly. Further treatment and monitoring beyond 36 months is planned (Phase 3) and will be designed dependent on the outcomes of Phase 1. Results: The primary outcome measure is cycloplegic spherical equivalent refractive error progression at 24 months. Secondary outcome measures include axial length change as well as the rebound, safety and acceptability profile of 0.01% atropine. Additional analyses will include the mechanisms of action of 0.01% atropine for myopia control. Conclusions: The generalisability of results from previous clinical trials investigating atropine for myopia control is limited by the predominantly Asian ethnicity of previous study populations. MOSAIC is the first RCT to explore the efficacy, safety and mechanisms of action of unpreserved 0.01% atropine in a predominantly White population.
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McCrann S, Flitcroft I, Strang NC, Saunders KJ, Logan NS, Lee SS, Mackey DA, Butler JS, Loughman J. Myopia Outcome Study of Atropine in Children (MOSAIC): an investigator-led, double-masked, placebo-controlled, randomised clinical trial protocol. HRB Open Res 2019; 2:15. [PMID: 32002514 PMCID: PMC6973533 DOI: 10.12688/hrbopenres.12914.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy, safety and mechanisms of action of 0.01% atropine for managing progression of myopia. During Phase 1 of the trial, 250 children aged 6-16 years with progressive myopia instil eye drops once nightly in both eyes from randomisation to month 24. No treatment is given during Phase 2 from month 24 to 36 (washout period) for those participants initially randomised to the intervention arm (n=167), during which any potential rebound effects on cessation of treatment will be monitored. All participants initially assigned to the placebo (n=83) crossover to the intervention arm of the study for Phase 2, and from month 24 to 36, instil 0.01% atropine eye drops in both eyes once nightly. Further treatment and monitoring beyond 36 months is planned (Phase 3) and will be designed dependent on the outcomes of Phase 1. Results: The primary outcome measure is cycloplegic spherical equivalent refractive error progression at 24 months. Secondary outcome measures include axial length change as well as the rebound, safety and acceptability profile of 0.01% atropine. Additional analyses will include the mechanisms of action of 0.01% atropine for myopia control. Conclusions: The generalisability of results from previous clinical trials investigating atropine for myopia control is limited by the predominantly Asian ethnicity of previous study populations. MOSAIC is the first RCT to explore the efficacy, safety and mechanisms of action of unpreserved 0.01% atropine in a predominantly White population. Trial registration: ISRCTN:
ISRCTN36732601 (04/10/2017), EudraCTdatabase
2016-003340-37 (03/07/2018).
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Affiliation(s)
- Saoirse McCrann
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Ireland, Dublin, Ireland
| | | | - Niall C Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Nicola S Logan
- Optometry & Vision Science Research Group, Aston Optometry School, Aston University, Birmingham, UK
| | - Samantha Szeyee Lee
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, WA, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, WA, Australia
| | - John S Butler
- School of Mathematical Sciences, Technological University Dublin, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Ireland, Dublin, Ireland
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Vutipongsatorn K, Yokoi T, Ohno-Matsui K. Current and emerging pharmaceutical interventions for myopia. Br J Ophthalmol 2019; 103:1539-1548. [DOI: 10.1136/bjophthalmol-2018-313798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 01/09/2023]
Abstract
Myopia is a major cause of visual impairment. Its prevalence is growing steadily, especially in East Asia. Despite the immense disease and economic burden, there are currently no Food and Drug Administration-approved drugs for myopia. This review aims to summarise pharmaceutical interventions of myopia at clinical and preclinical stages in the last decade and discuss challenges for preclinical myopia drugs to progress to clinical trials. Atropine and oral 7-methylxanthine are shown to reduce myopia progression in human studies. The former has been extensively studied and is arguably the most successful medication. However, it has side effects and trials on low-dose atropine are ongoing. Other pharmaceutical agents being investigated at a clinical trial level include ketorolac tromethamine, oral riboflavin and BHVI2 (an experimental drug). Since the pathophysiology of myopia is not fully elucidated, numerous drugs have been tested at the preclinical stage and can be broadly categorised based on the proposed mechanisms of myopisation, namely antimuscarinic, dopaminergic, anti-inflammatory and more. However, several agents were injected intravitreally or subconjunctivally, hindering their progress to human trials. Furthermore, with atropine being the most successful medication available, future preclinical interventions should be studied in combination with atropine to optimise the treatment of myopia.
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Wang LZ, Syn N, Li S, Barathi VA, Tong L, Neo J, Beuerman RW, Zhou L. The penetration and distribution of topical atropine in animal ocular tissues. Acta Ophthalmol 2019; 97:e238-e247. [PMID: 30259687 DOI: 10.1111/aos.13889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To conduct a multi-tissue investigation on the penetration and distribution of topical atropine in myopia treatment, and determine if atropine is detectable in the untreated contralateral eye after uniocular instillation. METHODS Nine mature New Zealand white rabbits were evenly divided into three groups. Each group was killed at 5, 24 and 72 hr, respectively, following uniocular instillation of 0.05 ml of 1% atropine. Tissues were sampled after enucleation: conjunctiva, sclera, cornea, iris, ciliary body, lens, retina, aqueous, and vitreous humors. The assay for atropine was performed using liquid chromatography-mass spectrometry (LC-MS), and molecular tissue distribution was illustrated using matrix-assisted laser desorption ionization-imaging mass spectrometry (MALDI-IMS) via an independent experiment on murine eyes. RESULTS At 5 hr, the highest (mean ± SEM) concentration of atropine was detected in the conjunctiva (19.05 ± 5.57 ng/mg, p < 0.05) with a concentration gradient established anteriorly to posteriorly, as supported by MALDI-IMS. At 24 hr, preferential binding of atropine to posterior ocular tissues occurred, demonstrating a reversal of the initial concentration gradient. Atropine has good ocular bioavailability with concentrations of two magnitudes higher than its binding affinity in most tissues at 3 days. Crossing-over of atropine to the untreated eye occurred within 5 hr post-administration. CONCLUSION Both transcorneal and transconjunctival-scleral routes are key in atropine absorption. Posterior ocular tissues could be important sites of action by atropine in myopic reduction. In uniocular atropine trials, cross-over effects on the placebo eye should be adjusted to enhance results reliability. Combining the use of LC-MS and MALDI-IMS can be a viable approach in the study of the ocular pharmacokinetics of atropine.
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Affiliation(s)
- Louis Zizhao Wang
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
| | - Shiya Li
- Dyson School of Design Engineering Imperial College London London UK
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
| | - Louis Tong
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
- Singapore National Eye Centre Singapore city Singapore
| | | | - Roger W. Beuerman
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
| | - Lei Zhou
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
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Ho MC, Hsieh YT, Shen EP, Hsu WC, Cheng HC. Short-term refractive and ocular parameter changes after topical atropine. Taiwan J Ophthalmol 2019; 10:111-115. [PMID: 32874839 PMCID: PMC7442094 DOI: 10.4103/tjo.tjo_110_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/08/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE: The purpose of this study is to explore short-term refractive and ocular parameter changes and their correlations after cycloplegia with atropine. METERIALS AND METHODS: This is a prospective clinical trial that enrolled 96 eyes of 96 participants (mean age, 8.5 ± 2.1 years). Spherical equivalent refractive error (SER), axial length (AL), mean keratometric value (mean-K), anterior chamber depth (ACD), and intraocular pressure (IOP) were measured at baseline and 1 week after topical use of 0.125% atropine. Postcycloplegic changes of refractive error and ocular parameters were evaluated, and their correlations were analyzed with multiple linear regression models. RESULTS: After topical atropine use, the mean AL decreased by 0.016 mm (P = 0.008), and the mean ACD increased by 0.58 mm (P < 0.0001). There was no significant change in the Mean-K or IOP. Eighty-two eyes (85%) had an emmetropic or hyperopic shift, and 14 (15%) had a myopic shift. Those with an emmetropic or hyperopic shift had their mean AL shortened by 0.023 mm, whereas the eyes with myopic shifts had their mean AL lengthened by 0.026 mm (P = 0.003). Change in SER was negatively correlated with change in AL (−2.57 D for an increase of 1 mm in AL, P < 0.001) and positively correlated with change in ACD (+0.96 D for an increase of 1 mm in ACD, P = 0.013). CONCLUSION: Most eyes had emmetropic or hyperopic changes after short-term topical atropine use, and AL shortening and anterior chamber deepening both contributed to the hyperopic changes. Meanwhile, myopic change may be observed in some eyes (15%), which were related to transient AL elongation but not invalid myopic control. This encouraged clinicians to sustain the atropine treatment for a longer period before switching to other modalities for myopic control in clinical practice. The clinical trial registration number NCT03839888 (clinicaltrials.gov).
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Affiliation(s)
- Min-Chieh Ho
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Elizabeth P Shen
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Cherng Hsu
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Han-Chih Cheng
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Avetisov SE, Fisenko VP, Zhuravlev AS, Avetisov KS. [Atropine use for the prevention of myopia progression]. Vestn Oftalmol 2018; 134:84-90. [PMID: 30166516 DOI: 10.17116/oftalma201813404184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Given the prevalence of myopic refraction (from 50 to 84% in Asian countries and 35 to 49% in European countries and the United States in young people), the development of methods for monitoring and preventing myopia continues to be an urgent task. One of the directions of pharmacological intervention on the progression of myopia is associated with the use of a non-selective M-cholinoreceptors antagonist - atropine. The review presents the results of studies on various aspects of the potential for topical application of atropine to control the progression of myopia (experimental and clinical data on the mechanism of action, the effectiveness of clinical use, the possible side effects of various concentrations of the drug).The heterogeneity of the data presented does not yet lead to the conclusion that the long-term instillations of atropine are effective in prevention of progressive myopia. In addition, the wide application of this method, for example, in the territory of the Russian Federation, is limited by approved official instruction for the local application of the atropine solution in ophthalmology.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021; Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, 2-4 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - V P Fisenko
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, 2-4 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - A S Zhuravlev
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, 2-4 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - K S Avetisov
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021
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Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology 2018; 126:113-124. [PMID: 30514630 DOI: 10.1016/j.ophtha.2018.05.029] [Citation(s) in RCA: 344] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Low-concentration atropine is an emerging therapy for myopia progression, but its efficacy and optimal concentration remain uncertain. Our study aimed to evaluate the efficacy and safety of low-concentration atropine eye drops at 0.05%, 0.025%, and 0.01% compared with placebo over a 1-year period. DESIGN Randomized, placebo-controlled, double-masked trial. PARTICIPANTS A total of 438 children aged 4 to 12 years with myopia of at least -1.0 diopter (D) and astigmatism of -2.5 D or less. METHODS Participants were randomly assigned in a 1:1:1:1 ratio to receive 0.05%, 0.025%, and 0.01% atropine eye drops, or placebo eye drop, respectively, once nightly to both eyes for 1 year. Cycloplegic refraction, axial length (AL), accommodation amplitude, pupil diameter, and best-corrected visual acuity were measured at baseline, 2 weeks, 4 months, 8 months, and 12 months. Visual Function Questionnaire was administered at the 1-year visit. MAIN OUTCOME MEASURES Changes in spherical equivalent (SE) and AL were measured, and their differences among groups were compared using generalized estimating equation. RESULTS After 1 year, the mean SE change was -0.27±0.61 D, -0.46±0.45 D, -0.59±0.61 D, and -0.81±0.53 D in the 0.05%, 0.025%, and 0.01% atropine groups, and placebo groups, respectively (P < 0.001), with a respective mean increase in AL of 0.20±0.25 mm, 0.29±0.20 mm, 0.36±0.29 mm, and 0.41±0.22 mm (P < 0.001). The accommodation amplitude was reduced by 1.98±2.82 D, 1.61±2.61 D, 0.26±3.04 D, and 0.32±2.91 D, respectively (P < 0.001). The pupil sizes under photopic and mesopic conditions were increased respectively by 1.03±1.02 mm and 0.58±0.63 mm in the 0.05% atropine group, 0.76±0.90 mm and 0.43±0.61 mm in the 0.025% atropine group, 0.49±0.80 mm and 0.23±0.46 mm in the 0.01% atropine group, and 0.13±1.07 mm and 0.02±0.55 mm in the placebo group (P < 0.001). Visual acuity and vision-related quality of life were not affected in each group. CONCLUSIONS The 0.05%, 0.025%, and 0.01% atropine eye drops reduced myopia progression along a concentration-dependent response. All concentrations were well tolerated without an adverse effect on vision-related quality of life. Of the 3 concentrations used, 0.05% atropine was most effective in controlling SE progression and AL elongation over a period of 1 year.
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Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - Yuning Jiang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Antony K P Law
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Joyce J Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Emily Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Simon T Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, 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
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, 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
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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Wu PC, Chuang MN, Choi J, Chen H, Wu G, Ohno-Matsui K, Jonas JB, Cheung CMG. Update in myopia and treatment strategy of atropine use in myopia control. Eye (Lond) 2018; 33:3-13. [PMID: 29891900 PMCID: PMC6328548 DOI: 10.1038/s41433-018-0139-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of myopia is increasing globally. Complications of myopia are associated with huge economic and social costs. It is believed that high myopia in adulthood can be traced back to school age onset myopia. Therefore, it is crucial and urgent to implement effective measures of myopia control, which may include preventing myopia onset as well as retarding myopia progression in school age children. The mechanism of myopia is still poorly understood. There are some evidences to suggest excessive expansion of Bruch’s membrane, possibly in response to peripheral hyperopic defocus, and it may be one of the mechanisms leading to the uncontrolled axial elongation of the globe. Atropine is currently the most effective therapy for myopia control. Recent clinical trials demonstrated low-dose atropine eye drops such as 0.01% resulted in retardation of myopia progression, with significantly less side effects compared to higher concentration preparation. However, there remain a proportion of patients who are poor responders, in whom the optimal management remains unclear. Proposed strategies include stepwise increase of atropine dosing, and a combination of low-dose atropine with increase outdoor time. This review will focus on the current understanding of epidemiology, pathophysiology in myopia and highlight recent clinical trials using atropine in the school-aged children, as well as the treatment strategy in clinical implementation in hyperopic, pre-myopic and myopic children.
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Affiliation(s)
- Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Meng-Ni Chuang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jessy Choi
- Department of Ophthalmology, Sheffield Children Hospital NHS Foundation Trust and Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Grace Wu
- Singapore Eye Research Institutes, National University of Singapore, Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institutes, National University of Singapore, Singapore, Singapore
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Pineles SL, Kraker RT, VanderVeen DK, Hutchinson AK, Galvin JA, Wilson LB, Lambert SR. Atropine for the Prevention of Myopia Progression in Children. Ophthalmology 2017; 124:1857-1866. [DOI: 10.1016/j.ophtha.2017.05.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022] Open
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Gong Q, Janowski M, Luo M, Wei H, Chen B, Yang G, Liu L. Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis. JAMA Ophthalmol 2017; 135:624-630. [PMID: 28494063 DOI: 10.1001/jamaophthalmol.2017.1091] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Some uncertainty about the clinical value and dosing of atropine for the treatment of myopia in children remains. Objective To evaluate the efficacy vs the adverse effects of various doses of atropine in the therapy for myopia in children. Data Sources Data were obtained from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from inception to April 30, 2016. The reference lists of published reviews and clinicaltrials.gov were searched for additional relevant studies. Key search terms included myopia, refractive errors, and atropine. Only studies published in English were included. Study Selection Randomized clinical trials and cohort studies that enrolled patients younger than 18 years with myopia who received atropine in at least 1 treatment arm and that reported the annual rate of myopia progression and/or any adverse effects of atropine therapy were included in the analysis. Data Extraction and Synthesis Two reviewers independently abstracted the data. Heterogeneity was statistically quantified by Q, H, and I2 statistics, and a meta-analysis was performed using the random-effects model. The Cochrane Collaboration 6 aspects of bias and the Newcastle-Ottawa Scale were used to assess the risk for bias. Main Outcomes and Measures The primary outcome was a difference in efficacy and the presence of adverse effects at different doses of atropine vs control conditions. The secondary outcomes included the differences in adverse effects between Asian and white patients. Results Nineteen unique studies involving 3137 unique children were included in the analysis. The weighted mean differences between the atropine and control groups in myopia progression were 0.50 diopters (D) per year (95% CI, 0.24-0.76 D per year) for low-dose atropine, 0.57 D per year (95% CI, 0.43-0.71 D per year) for moderate-dose atropine, and 0.62 D per year (95% CI, 0.45-0.79 D per year) for high-dose atropine (P < .001), which translated to a high effect size (Cohen d, 0.97, 1.76, and 1.94, respectively). All doses of atropine, therefore, were equally beneficial with respect to myopia progression (P = .15). High-dose atropine were associated with more adverse effects, such as the 43.1% incidence of photophobia compared with 6.3% for low-dose atropine and 17.8% for moderate-dose atropine (χ22 = 7.05; P = .03). In addition, differences in the incidence of adverse effects between Asian and white patients were not identified (χ21 = 0.81; P = .37 for photophobia). Conclusions and Relevance This meta-analysis suggests that the efficacy of atropine is dose independent within this range, whereas the adverse effects are dose dependent.
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Affiliation(s)
- Qianwen Gong
- Department of Optometry and Visual Science, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Miroslaw Janowski
- Institute for Cell Engineering, Division of Magnetic Resonance Research, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland3NeuroRepair Department, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Mi Luo
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Wei
- Department of Optometry and Visual Science, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China4Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Bingjie Chen
- Department of Optometry and Visual Science, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China4Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Guoyuan Yang
- Department of Optometry and Visual Science, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China4Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China4Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Goldberg LA, Rucker FJ. Opposing effects of atropine and timolol on the color and luminance emmetropization mechanisms in chicks. Vision Res 2016; 122:1-11. [PMID: 26971621 PMCID: PMC4861675 DOI: 10.1016/j.visres.2016.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 11/29/2022]
Abstract
This study analyzed the luminance and color emmetropization response in chicks treated with the nonselective parasympathetic antagonist atropine and the sympathetic β-receptor blocker timolol. Chicks were binocularly exposed (8h/day) for 4days to one of three illumination conditions: 2Hz sinusoidal luminance flicker, 2Hz sinusoidal blue/yellow color flicker, or steady light (mean 680lux). Atropine experiments involved monocular daily injections of either 20μl of atropine (18nmol) or 20μl of phosphate-buffered saline. Timolol experiments involved monocular daily applications of 2 drops of 0.5% timolol or 2 drops of distilled H2O. Changes in the experimental eye were compared with those in the fellow eye after correction for the effects of saline/water treatments. Atropine caused a reduction in axial length with both luminance flicker (-0.078±0.021mm) and color flicker (-0.054±0.017mm), and a reduction in vitreous chamber depth with luminance flicker (-0.095±0.023mm), evoking a hyperopic shift in refraction (3.40±1.77D). Timolol produced an increase in axial length with luminance flicker (0.045±0.030mm) and a myopic shift in refraction (-4.07±0.92D), while color flicker caused a significant decrease in axial length (-0.046±0.017mm) that was associated with choroidal thinning (-0.046±0.015mm). The opposing effects on growth and refraction seen with atropine and timolol suggest a balancing mechanism between the parasympathetic and β-receptor mediated sympathetic system through stimulation of the retina with luminance and color contrast.
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Affiliation(s)
- Laura A Goldberg
- New England College of Optometry, 424 Beacon Street, Boston, MA 02115, United States.
| | - Frances J Rucker
- New England College of Optometry, 424 Beacon Street, Boston, MA 02115, United States
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