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Wu W, Yi L, Zhang K, Chen Z, Shi C, Chen C, Cai Y, Hu L, Chen X. Health-related quality of life measurements in children and adolescents with refractive errors: A scoping review. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:84-94. [PMID: 38623588 PMCID: PMC11016581 DOI: 10.1016/j.aopr.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
Background Refractive errors, particularly myopia, are the leading visual disorders worldwide, significantly affecting the quality of life (QOL) even after correction. This scoping review focuses on health-related quality of life (HRQOL) measurements for children and adolescents with refractive errors. Main text We explored generic and disease-specific HRQOL tools, examining their content, psychometric properties, and the impact of various interventions on QOL. Two English databases-PubMed, Embase, and one Chinese database, CNKI, were searched for relevant studies published from January 2001 to October 2023. Inclusion criteria encompassed studies using standardized instruments to assess the QOL of children aged 0-18 with refractive errors. The review compares prevalent HRQOL measurements, analyzes children's refractive error assessments, and discusses intervention effects on patient QOL. Conclusions The study underlines the necessity of developing disease-specific QOL instruments for very young children and serves as a practical guide for researchers in this field. The findings advocate for a targeted approach in HRQOL assessment among the pediatric population, identifying critical gaps in current methodologies.
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Affiliation(s)
- Wei Wu
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lisha Yi
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Biomedical Sciences, University of Queensland, St Lucia Campus, Brisbane, Australia
| | - Kai Zhang
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zipei Chen
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Caiping Shi
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chen Chen
- School of Biomedical Sciences, University of Queensland, St Lucia Campus, Brisbane, Australia
| | - Yilu Cai
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lidan Hu
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiangjun Chen
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
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Luo Y, Yin Z, Zhang J, Wang W, Huang Y, Li X, Chen H, Lu F, Bao J. Differential Impact of 0.01% and 0.05% Atropine Eyedrops on Ocular Surface in Young Adults. Transl Vis Sci Technol 2024; 13:22. [PMID: 38625083 PMCID: PMC11033597 DOI: 10.1167/tvst.13.4.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To evaluate the effect of low-concentration (0.01% and 0.05%) atropine eyedrops on ocular surface characteristics in young adults. Methods Twenty-six myopic students aged 18 to 30 years were randomly assigned to receive either 0.01% or 0.05% atropine once nightly for 14 days, followed by cessation, with a ≥14-day interval between each administration. Assessments were conducted one, two, seven, and 14 days after using atropine with corresponding timepoints after atropine cessation. Tear meniscus height and first and average noninvasive keratograph tear film breakup time (NIKBUT-first, NIKBUT-average) were measured using Keratograph 5M, whereas the objective scatter index (OSI) was measured by OQAS II devices; the ocular surface disease index (OSDI) score was also obtained. Results The mean OSI peaked after two days of administration of 0.05% atropine (β = 0.51, P = 0.001), accompanied by significant decreases in NIKBUT-first (β = -7.73, P < 0.001) and NIKBUT-average (β = -8.10, P < 0.001); the OSDI peaked after 14 days (β = 15.41, P < 0.001). The above parameters returned to baseline one week after atropine discontinuation (all P > 0.05). NIKBUT-first and NIKBUT-average reached their lowest points after 14 days of 0.01% atropine administration (NIKBUT-first: β = -4.46, P = 0.005; NIKBUT-average: β = -4.42, P = 0.001), but those significant changes were diminished once atropine treatment stopped. Conclusions Young adult myopes experienced a significant but temporary impact on the ocular surface with 0.05% atropine administration, whereas 0.01% atropine had a minimal effect. Translational Relevance The investigation of the ocular surface effects of different concentrations of atropine may inform evidence-based clinical decisions regarding myopia control in young adults.
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Affiliation(s)
- Yifan Luo
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ziang Yin
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jiali Zhang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weijia Wang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yingying Huang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xue Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jinhua Bao
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Sun H, Bu F, Xin X, Yan J. Incidence of Adverse Events Induced by Atropine in Myopic Children: A Meta-Analysis. J Clin Pharmacol 2023; 63:1377-1386. [PMID: 37492894 DOI: 10.1002/jcph.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/23/2023] [Indexed: 07/27/2023]
Abstract
A large number of studies have evaluated the efficacy of low-dose atropine in preventing or slowing myopic progression. However, it is challenging to evaluate the ocular safety from these studies. We aimed to evaluate the incidence of adverse events induced by atropine in children with myopia. We performed a systematic literature search in several databases for studies published until November 2022. The incidence of adverse events induced by atropine was pooled by a common-effect (fixed-effect) or random-effects model. Subgroup analyses were conducted according to drug doses, types of adverse events, and ethnicity. A total of 31 articles were ultimately included in the study. The overall incidence of adverse events for atropine was 5.9%, and the incidence of severe adverse events was 0.0%. The most commonly reported adverse events were photophobia (9.1%) and blurred near vision (2.9%). Other adverse events including eye irritation/discomfort, allergic reactions, headache, stye/chalazion, glare, and dizziness occurred in less than 1% of the patients. The incidence of atropine-induced adverse events varied depending on the drug doses. A lower dose of atropine was associated with a lower incidence of adverse events. There was no significant difference in the incidence of adverse events for low-dose atropine between Asian and White children. Our study suggests photophobia and blurred near vision are the most frequently reported adverse events induced by atropine. Low-dose atropine is safer than moderate- and high-dose atropine. Our study could provide a safe reference for ophthalmologists to prescribe atropine for myopic children.
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Affiliation(s)
- Hong Sun
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Fengjiao Bu
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiu Xin
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jingchao Yan
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
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García Del Valle I, Alvarez-Lorenzo C. Atropine in topical formulations for the management of anterior and posterior segment ocular diseases. Expert Opin Drug Deliv 2021; 18:1245-1260. [PMID: 33787441 DOI: 10.1080/17425247.2021.1909568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atropine is an old-known drug which is gaining increasing attention due to the myriad of therapeutic effects it may trigger on eye structures. Nevertheless, novel applications may require more adequate topical formulations. AREAS COVERED This review aims to gather the existing knowledge about atropine and its clinical applications in the ophthalmological field when administered topically. Atropine ocular pharmacokinetics is paid a special attention, including recent evidences of the capability of the drug to access to the posterior segment. Ocular bioavailability and systemic bioavailability are counterbalanced. Finally, limitations of traditional dosage forms and potential advantages of under investigation delivery systems are analyzed. EXPERT OPINION Mydriasis and cyclopegia have been widely exploited for eye examination, management of anterior segment diseases, and more recently as antidotes of chemical weapons. Improved knowledge on drug receptors and related pathways explains atropine repositioning as an outstanding tool to prevent myopia. The ease with which atropine penetrates ocular tissues is a double edged sword, that is, while it ensures therapeutic levels in the posterior segment, the unspecific distribution causes a wide variety of untoward effects. The design of formulations that can selectively deliver atropine to the target tissue for each specific application is an urgent unmet need.
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Affiliation(s)
- Ines García Del Valle
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
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Yang N, Bai J, Liu L. Low concentration atropine combined with orthokeratology in the treatment of axial elongation in children with myopia: A meta-analysis. Eur J Ophthalmol 2021; 32:221-228. [PMID: 33678055 DOI: 10.1177/1120672121998903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the effect of low concentration atropine combined with Orthokeratology (OK) lens compared with the OK lens on the changes of axial length in children with moderate and low myopia by meta-analysis. METHODS Databases such as PubMed, Web of Science, Embase, and Cochrane Library were comprehensively searched to collect related studies on atropine combined with the OK lens in the treatment of children with moderate and low myopia. The retrieval time was from the establishment of the database to December 2020. The standardized mean difference (SMD) and its 95% confidence interval (CI) were selected as the effect to analyze the changes of the axial length of the eye axis in children with low and moderate myopia treated with low concentration atropine combined with OK lens. RESULTS A total of eight articles were included in this study. Compared with OK lens treatment, low concentration atropine combined with the OK lens significantly slowed down the axial elongation of low and moderate myopia, SMD = -0.68(95% CI: -0.86--0.50, p < 0.05). According to the subgroup analysis of treatment time, when the treatment time was less than or equal to 6 months, SMD = -0.63(95% CI: -0.88--0.37, p < 0.05), when the treatment time was 1 year, SMD = -0.76(95% CI: -1.08--0.43, p < 0.05), and when the treatment time was 2 years, SMD = -0.69(95% CI: -1.07--0.31, p < 0.05). CONCLUSION Low concentration atropine combined with the OK lens is more effective than the OK lens in the treatment of children with low to moderate myopia in reducing axial elongation.
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Affiliation(s)
- Ning Yang
- Your Bright Eye Clinic of Chengdu Hi-tech Zone, Chengdu, Sichuan, China
| | | | - Li Liu
- Your Bright Eye Clinic of Chengdu Hi-tech Zone, Chengdu, Sichuan, China
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Corneal Penetration of Low-Dose Atropine Eye Drops. J Clin Med 2021; 10:jcm10040588. [PMID: 33557281 PMCID: PMC7914535 DOI: 10.3390/jcm10040588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/28/2022] Open
Abstract
Major studies demonstrating the inhibition of myopia in children and juveniles by low-dose atropine eye drops provide little information on the manufacturing process and the exact composition of the atropine dilutions. However, corneal penetration might significantly vary depending on preservatives, such as benzalkonium chloride (BAC), and the atropine concentration. Since there is a trade-off between side effects, stability, and optimal effects of atropine on myopia, it is important to gain better knowledge about intraocular atropine concentrations. We performed an ex vivo study to determine corneal penetration for different formulations. Atropine drops (0.01%) of different formulations were obtained from pharmacies and applied to the cornea of freshly enucleated pig eyes. After 10 min, a sample of aqueous humor was taken and atropine concentrations were determined after liquid–liquid extraction followed by high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS). The variability that originated from variations in applied drop size exceeded the differences between preserved and preservative-free formulations. The atropine concentration in the anterior chamber measured after 10 min was only 3.8 × 10−8 of its concentration in the applied eye drops, corresponding to 502.4 pM. Obviously, the preservative did not facilitate corneal penetration, at least ex vivo. In the aqueous humor of children’s eyes, similar concentrations, including higher variability, may be expected in the lower therapeutic window of pharmacodynamic action.
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