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Tapasztó B, Flitcroft DI, Aclimandos WA, Jonas JB, De Faber JTHN, Nagy ZZ, Kestelyn PG, Januleviciene I, Grzybowski A, Vidinova CN, Guggenheim JA, Polling JR, Wolffsohn JS, Tideman JWL, Allen PM, Baraas RC, Saunders KJ, McCullough SJ, Gray LS, Wahl S, Smirnova IY, Formenti M, Radhakrishnan H, Resnikoff S, Németh J. Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2024; 34:952-966. [PMID: 38087768 PMCID: PMC11295429 DOI: 10.1177/11206721231219532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024]
Abstract
Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.
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Affiliation(s)
- Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Daniel Ian Flitcroft
- Temple Street Children's Hospital, Dublin, Ireland
- Centre for Eye Research Ireland (CERI) Technological University, Dublin, Ireland
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | | | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Christina Nicolaeva Vidinova
- Department of Ophthalmology, Military Medical Academy, Sofia, Bulgaria
- Department of Optometry, Sofia University “St. Kliment Ohridski“, Sofia, Bulgaria
| | | | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, University of Applied Science, Utrecht, The Netherlands
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J Willem L Tideman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department Ophthalmology, Martini Hospital, Groningen, The Netherlands
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Centre for Optometry and Vision Science, Ulster University, Coleraine, UK
| | | | - Siegfried Wahl
- Institute for Ophthalmic Research, University Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Tübingen, Germany
| | | | - Marino Formenti
- Department of Physics, School of Science, University of Padova, Padova, Italy
| | - Hema Radhakrishnan
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, Australia
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Simonaviciute D, Grzybowski A, Gelzinis A, Zemaitiene R. Efficacy and Safety of 0.03% Atropine Eye Drops in Controlling Myopia Progression: A One-Year Prospective Clinical Study. J Clin Med 2024; 13:3218. [PMID: 38892929 PMCID: PMC11173064 DOI: 10.3390/jcm13113218] [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: 04/17/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Objective: To investigate the efficacy and safety of one-year treatment with 0.03% atropine eye drops for slowing myopia progression among children aged 6-12 years. Methods: Healthy Caucasian children aged 6-12 years with cycloplegic spherical equivalent (SE) from -1.0 D to -5.0 D and astigmatism and anisometropia ≤1.5 D were included. Changes in mean axial length (AL) and objective SE as well as changes in intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD) and lens thickness (LT) were assessed in the 0.03% atropine eye drops group and the control group from baseline through the 1-year follow-up. The proportion of participants showing myopia progression of <0.5 D from baseline in each group and any potential side effects in 0.03% atropine group were evaluated. Results: The study involved 31 patients in the 0.03% atropine eye drops group and 41 in the control group. Administration of 0.03% atropine for 1 year resulted in a mean change in SE of -0.34 (0.44) D/year, significantly lower than the -0.60 (0.50) D/year observed in the control group (p = 0.024). The change in AL was 0.19 (0.17) mm in the 0.03% atropine group, compared to 0.31 (0.20) mm in the control group (p = 0.015). There were no significant differences in changes of IOP, CCT and LT between the groups (all p ≥ 0.05). The 0.03% atropine group had a significantly greater increase in ACD compared to the control group (p = 0.015). In total, 64.5% of patients in the 0.03% atropine group showed progression <0.5 D/year, in contrast to 39.0% in the control group (p = 0.032). Adverse events were reported in 13 (35.0%) out of 37 patients in the treatment group, leading to discontinuation of the eye drops in six (16.0%) cases. None of the adverse events were severe. Conclusions: Despite a higher incidence of adverse events, 0.03% atropine eye drops effectively slowed the progression of myopia over 1-year.
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Affiliation(s)
- Dovile Simonaviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; (A.G.); (R.Z.)
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10-724 Olsztyn, Poland;
- Institute for Research in Ophthalmology, 60-554 Poznan, Poland
| | - Arvydas Gelzinis
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; (A.G.); (R.Z.)
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; (A.G.); (R.Z.)
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Pérez-Flores I, Macías-Murelaga B, Barrio-Barrio J. Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression. Sci Rep 2023; 13:16310. [PMID: 37770602 PMCID: PMC10539365 DOI: 10.1038/s41598-023-43569-x] [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: 01/29/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
To evaluate the age-related efficacy and safety of atropine 0.01% eye drops over 2 years for myopia control in a multicentric pediatric Spanish cohort. A non-controlled, interventional, prospective multicenter study was conducted as an extension of the Spanish Group of Atropine Treatment for Myopia Control Study (GTAM 1). Children aged 6-14 years with myopia from - 2.00 to - 6.00 D, astigmatism < 1.50 D and documented annual myopic progression of at least - 0.50 D under cycloplegic examination were recruited. From the original cohort of 105 participants, 92 children who had been receiving atropine 0.01% eye drops once nightly in each eye for 1 year continued their participation in this extended study (GTAM 2). All the patients underwent a standardized quarterly follow-up protocol, which included measurements of best-corrected visual acuity (BCVA), cycloplegic autorefraction, axial length (AL), anterior chamber depth (ACD), and pupil diameter. The study sample was divided into three age groups: 6-8, 9-11, and 12-14 years old. The mean change in cycloplegic spherical equivalent (SE) and axial length (AL) during the 24 months of follow-up was analyzed. Correlations between SE and AL, as well as the distribution of annual progression, were evaluated. Adverse effects were recorded using a specific questionnaire. Finally, 81 children completed the follow-up and were included in the analysis. Over the 2-year period, the mean changes in SE and AL were - 0.88 ± 0.60 D and 0.49 ± 0.25 mm, respectively. Additionally, 51 patients (63%) experienced SE annual progression lower than - 0.50 D. The correlation between the progression of SE and AL during the total period of treatment was mild (r = - 0.36; p < 0.001). There were no differences between the first and the second year of treatment in the progression of SE (- 0.42 ± 0.41 D versus - 0.45 ± 0.39 D; p = 0.69) or AL (0.25 ± 0.16 mm versus 0.23 ± 0.14 mm; p = 0.43). Older patients (12-14 years old) showed less AL progression than younger children (6-8 years old): 0.36 ± 0.18 mm versus 0.59 ± 0.30 mm; p = 0.01. Adverse effects were mild, infrequent, and decreased over time. On average, the myopia progression in control groups from other published biannual studies exceeded that observed in our study. Over 2 years, atropine 0.01% demonstrated a safe treatment for controlling myopia progression in a multicentric cohort of Spanish children. The effect remained stable during this period. Older patients exhibited a more favorable response in terms of AL enlargement. However, further studies are needed to investigate the age-related effect of low-dose atropine in the Caucasian population.
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Affiliation(s)
| | | | - Jesús Barrio-Barrio
- Department of Ophthalmology, Navarra University Clinic Hospital, Navarra Institute for Health Research, IdiSNA, Pio XII, 36. Pamplona, 31008, Navarra, Spain.
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