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Jethani J. Effect of defocus incorporated multiple segments lenses on halting myopia progression not responding to low-concentration atropine (0.01%) eye drops. Indian J Ophthalmol 2024; 72:S709-S711. [PMID: 38389263 DOI: 10.4103/ijo.ijo_2378_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/04/2023] [Indexed: 02/24/2024] Open
Abstract
To assess the effect of defocus incorporated multiple segments (DIMS) (Miyosmart) lenses on myopic progression in children not responding to low-concentration atropine (LCA) (0.01%) eye drops. A total of 10 children not responding to LCA (0.01%) eye drops were advised to start using the DIMS lens to halt the progression of myopia. The children were followed for a period of 1 year. Eight out of 10 children showed a reduction in the progression of myopia. Pre DIMS, the progression was -0.68 D ± 0.3 D sph, which reduced to -0.24 ± 0.2 diopter progression post DIMS lens in the eight children. The remaining two children still progressed by -0.57 ± 0.4 D sph over a year. The axial length growth reduced from 0.28 ± 0.3 mm to 0.16 ± 0.2 mm after using the DIMS lens in these non-responders. The DIMS lens shows initial promise in reducing the progression of myopia even in children not responding to LCA 0.01% eye drops.
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Affiliation(s)
- Jitendra Jethani
- Baroda Children Eyecare and Squint Clinic, Vadodara, Gujarat, India
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Lyu P, Hu J, Wang Y, Wang J, He X, Shi H. Impact of ophthalmic clinical service use in mitigating myopia onset and progression in preschool children: a retrospective cohort study. BMC Ophthalmol 2024; 24:221. [PMID: 38802768 PMCID: PMC11129446 DOI: 10.1186/s12886-024-03488-5] [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: 09/07/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Although school screenings identify children with vision problems and issue referrals for medical treatment at an ophthalmic hospital, the effectiveness of this approach remains unverified. OBJECTIVE To investigate the impact of ophthalmic clinical services on the onset and progression of myopia in preschool children identified with vision impairment. METHODS Using data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE), this retrospective cohort study evaluated the visual development of children from three districts-Jing'an, Minhang, and Pudong-which are representative of geographic diversity and economic disparity in Shanghai's 17 districts. Initially, in 2015, the study encompassed 14,572 children aged 4-6 years, of whom 5,917 needed a referral. Our cohort consisted of 5,511 children who had two or more vision screenings and complete personal information over the follow-up period from January 2015 to December 2020. We divided these children into two groups based on their initial spherical equivalent (SE): a High-risk group (SE > -0.5 D) and a Myopia group (SE ≤ -0.5 D). Within each of these groups, we further categorized children into Never, Tardily, and Timely groups based on their referral compliance to compare the differences in the occurrence and progression of myopia. Cox proportional models were applied to estimate hazard ratios (HRs) for myopia incidence per person-years of follow-up in High-risk group. Generalized additive models(GAM) was used to calculating the progression for annual spherical equivalent changes in all children. RESULTS Of the 5,511 preschool children (mean age, 5.25 years; 52.24% male) who received a referral recommendation, 1,327 (24.08%) sought clinical services at an ophthalmic hospital. After six years of follow-up, 65.53% of children developed myopia. The six-year cumulative incidence of myopia in the Never, Tardily, and Timely groups was 64.76%, 69.31%, and 57.14%, respectively. These percentages corresponded to hazard ratios (HRs) of 1.31 (95% CI, 1.10-1.55) for the Tardily group and 0.55 (95% CI, 0.33-0.93) for the Timely group, compared with the Never group. The HRs were adjusted for age, sex, and SE at study entry. Interestingly, the Timely group showed significantly less SE progression than the other groups (P < 0.001), and SE progression was higher in the High-risk group (-0.33 ± 0.37D/year) than in children with myopia (-0.08 ± 0.55D/year). CONCLUSION Timely utilization of ophthalmic clinical services among children aged 4 to 6 years who fail school vision screenings can significantly reduce the incidence of myopia and slow SE progression.
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Affiliation(s)
- Pingping Lyu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Jingwen Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Yujie Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China.
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Lee SH, Tseng BY, Wang JH, Chiu CJ. Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1506. [PMID: 38592670 PMCID: PMC10932201 DOI: 10.3390/jcm13051506] [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: 01/16/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Conclusions: Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.
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Affiliation(s)
- Ssu-Hsien Lee
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (S.-H.L.); (B.-Y.T.)
| | - Bor-Yuan Tseng
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (S.-H.L.); (B.-Y.T.)
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
- Department of Ophthalmology, Hualien Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
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Jawaid I, Saunders K, Hammond CJ, Dahlmann-Noor A, Bullimore MA. Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners. Eye (Lond) 2024; 38:434-441. [PMID: 37717107 PMCID: PMC10858250 DOI: 10.1038/s41433-023-02718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/18/2023] Open
Abstract
The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the benefits of slowing myopia progression are considered against the side-effects of near blur and photophobia. More recently, randomised trials have focused on determining the optimum concentration of atropine leading to low-concentration atropine being used to manage myopia progression by practitioners across the world. Currently, in the United Kingdom, there is no licensed pharmacological intervention for myopia management. The aim of this review is to interpret the available data to inform clinical practice. We conducted a narrative review of the literature and identified peer-reviewed randomised controlled trials using the search terms 'myopia' and 'atropine', limited to the English language. We identified two key studies, which were the Atropine in the Treatment Of Myopia (ATOM) and Low-concentration Atropine for Myopia Progression (LAMP). Further studies were identified using the above search terms and the references from the identified literature. Atropine 0.01% has a modest effect on controlling axial length progression. Atropine 0.05% appears to be superior to atropine 0.01% in managing myopia progression. There is a dose-dependent rebound effect when treatment is stopped. Atropine is a well-tolerated, safe, and effective intervention. Treatment would be needed for several years and into adolescence, until axial length progression is stable.
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Affiliation(s)
- Imran Jawaid
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
| | - Kathryn Saunders
- School of Biomedical Sciences, Ulster University, Northern Ireland, UK
| | - Christopher J Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, King's College London, London, UK
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Wang B, Watt K, Chen Z, Kang P. Predicting the child who will become myopic - can we prevent onset? Clin Exp Optom 2023; 106:815-824. [PMID: 37194117 DOI: 10.1080/08164622.2023.2202306] [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: 11/07/2022] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
Myopia has become a global epidemic with significant public health impacts. Identifying the child at risk of developing myopia, i.e. the pre-myopic child and implementing strategies to prevent the onset of myopia, could significantly reduce the burden of myopia on an individual and society. This paper is a review of publications that have identified ocular characteristics of children at risk of future myopia development including a lower than age normal amount of hyperopia and accelerated axial length elongation. Risk factors associated with increased risk of myopia development such as education exposure and reduced outdoor time, and strategies that could be implemented to prevent myopia onset in children are also explored. The strong causal role of education and outdoor time on myopia development suggests that lifestyle modifications could be implemented as preventative measures to at-risk children and may significantly impact the myopia epidemic by preventing or delaying myopia onset and its associated ocular health consequences.
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Affiliation(s)
- Bingjie Wang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Zhi Chen
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Shanghai, China
| | - Pauline Kang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Zhang G, Jiang J, Qu C. Myopia prevention and control in children: a systematic review and network meta-analysis. Eye (Lond) 2023; 37:3461-3469. [PMID: 37106147 PMCID: PMC10630522 DOI: 10.1038/s41433-023-02534-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To analyse and compare the efficacy of different interventions for myopia prevention and control in children. METHODS We searched CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Registry, PubMed, The Cochrane Library, Web of Science, Embase and ClinicalTrials.gov from inception to July 2022. We selected randomized controlled trials (RCTs) that included interventions to slow myopia progression in children. The main outcomes included mean annual change in axial length (AL) (millimetres/year) and in refraction (R) (dioptres/year). RESULTS A total of 80 RCTs (27103 eyes) were included. In comparison with control, orthokeratology (AL, -0.36 [-0.53, -0.20], P < 0.05; R, 0.56 [0.34, 0.77], P < 0.05), 1%Atropine (AL, -0.39 [-0.65, -0.13], P < 0.05; R, 0.54 [0.31, 0.77], P < 0.05), 0.01%Atropine + orthokeratology (AL, -0.47 [-0.80, -0.14], P < 0.05; R, 0.81 [0.43, 1.20], P < 0.05) could significantly slow the progression of myopia; in addition, progressive multi-focal spectacle lenses (PMSL) (0.42, [0.06, 0.79], P < 0.05), bifocal soft contact lenses (0.40, [0.03, 0.77], P < 0.05), 0.5%Atropine (0.67 [0.25, 1.10], P < 0.05), 0.1%Atropine (0.42 [0.15, 0.71], P < 0.05), 0.05%Atropine (0.57 [0.28, 0.86], P < 0.05), 0.01%Atropine (0.33 [0.15, 0.52], P < 0.05), 1%Atropine + bifocal spectacle lenses (BSL) (1.30 [0.54, 2.00], P < 0.05), 1%Atropine + PMSL (0.66 [0.23, 1.10], P < 0.05), 0.01%Atropine + single vision spectacle lenses (SVSL) (0.70 [0.23, 1.10], P < 0.05), 0.01%Atropine + orthokeratology (0.81 [0.43, 1.20], P < 0.05), BSL + Massage (0.85 [0.22, 1.50], P < 0.05), SVSL + Red light (0.59 [0.06, 0.79], P < 0.05) showed significant slowing effect on the increase in R. CONCLUSIONS This network meta-analysis suggests that the combined measures were most effective in AL and R, followed by Atropine.
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Affiliation(s)
- Guanghong Zhang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Sichuan Key Laboratory for Disease Gene Study, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, CN, 611731, China
| | - Jun Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Sichuan Key Laboratory for Disease Gene Study, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, CN, 611731, China
| | - Chao Qu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China.
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, CN, 611731, China.
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He X, Wang J, Zhu Z, Xiang K, Zhang X, Zhang B, Chen J, Yang J, Du L, Niu C, Leng M, Huang J, Liu K, Zou H, He M, Xu X. Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e239612. [PMID: 37099298 PMCID: PMC10134010 DOI: 10.1001/jamanetworkopen.2023.9612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/09/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Myopia is a global concern, but effective prevention measures remain limited. Premyopia is a refractive state in which children are at higher risk of myopia, meriting preventive interventions. Objective To assess the efficacy and safety of a repeated low-level red-light (RLRL) intervention in preventing incident myopia among children with premyopia. Design, Setting, and Participants This was a 12-month, parallel-group, school-based randomized clinical trial conducted in 10 primary schools in Shanghai, China. A total of 139 children with premyopia (defined as cycloplegic spherical equivalence refraction [SER] of -0.50 to 0.50 diopter [D] in the more myopic eye and having at least 1 parent with SER ≤-3.00 D) in grades 1 to 4 were enrolled between April 1, 2021, and June 30, 2021; the trial was completed August 31, 2022. Interventions Children were randomly assigned to 2 groups after grade stratification. Children in the intervention group received RLRL therapy twice per day, 5 days per week, with each session lasting 3 minutes. The intervention was conducted at school during semesters and at home during winter and summer vacations. Children in the control group continued usual activities. Main Outcomes and Measures The primary outcome was the 12-month incidence rate of myopia (defined as SER ≤-0.50 D). Secondary outcomes included the changes in SER, axial length, vision function, and optical coherence tomography scan results over 12 months. Data from the more myopic eyes were analyzed. Outcomes were analyzed by means of an intention-to-treat method and per-protocol method. The intention-to-treat analysis included participants in both groups at baseline, while the per-protocol analysis included participants in the control group and those in the intervention group who were able to continue the intervention without interruption by the COVID-19 pandemic. Results There were 139 children (mean [SD] age, 8.3 [1.1] years; 71 boys [51.1%]) in the intervention group and 139 children (mean [SD] age, 8.3 [1.1] years; 68 boys [48.9%]) in the control group. The 12-month incidence of myopia was 40.8% (49 of 120) in the intervention group and 61.3% (68 of 111) in the control group, a relative 33.4% reduction in incidence. For children in the intervention group who did not have treatment interruption secondary to the COVID-19 pandemic, the incidence was 28.1% (9 of 32), a relative 54.1% reduction in incidence. The RLRL intervention significantly reduced the myopic shifts in terms of axial length and SER compared with the control group (mean [SD] axial length, 0.30 [0.27] mm vs 0.47 [0.25] mm; difference, 0.17 mm [95% CI, 0.11-0.23 mm]; mean [SD] SER, -0.35 [0.54] D vs -0.76 [0.60] D; difference, -0.41 D [95% CI, -0.56 to -0.26 D]). No visual acuity or structural damage was noted on optical coherence tomography scans in the intervention group. Conclusions and Relevance In this randomized clinical trial, RLRL therapy was a novel and effective intervention for myopia prevention, with good user acceptability and up to 54.1% reduction in incident myopia within 12 months among children with premyopia. Trial Registration ClinicalTrials.gov Identifier: NCT04825769.
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Affiliation(s)
- Xiangui He
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jingjing Wang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Kaidi Xiang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xinzi Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Bo Zhang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Jun Chen
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Jinliuxing Yang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Linlin Du
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Chunjin Niu
- Department of Ophthalmology Prevention, Changning Center for Disease Control and Prevention, Shanghai, China
| | - Mei Leng
- Department of Teaching and Research, Changning Institute of Education, Shanghai, China
| | - Jiannan Huang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Haidong Zou
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Xun Xu
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Wang W, Zhang F, Yu S, Ma N, Huang C, Wang M, Wei L, Zhang J, Fu A. Prevention of myopia shift and myopia onset using 0.01% atropine in premyopic children - a prospective, randomized, double-masked, and crossover trial. Eur J Pediatr 2023:10.1007/s00431-023-04921-5. [PMID: 36944782 DOI: 10.1007/s00431-023-04921-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
This study aims to evaluate the efficacy of 0.01% atropine eye drops in preventing myopia shift and myopia onset in premyopic children. A prospective, randomized, double-masked, placebo-controlled, and crossover trial was conducted over 13 months. Sixty premyopic children aged 6-12 years with cycloplegic spherical equivalent refraction (SER) > - 0.75 D and ≤ + 0.50 D in both eyes were assigned in a 1:1 ratio to receive one drop of 0.01% atropine or placebo once nightly for 6 months (period 1), followed by a 1-month recovery period. Then, the 0.01% atropine group was crossed over to the placebo group, and the latter was crossed over to the 0.01% atropine group for another 6 months (period 2). The primary outcomes were changes in SER and axial length (AL), and the secondary outcomes were the proportion of myopia onset (SER ≤ - 0.75D) and fast myopic shift (change in SER ≤ - 0.25D) in the two periods. Generalized estimating equation (GEE) model performed a statistically significant treatment effect of 0.01% atropine compared with placebo (pSER = 0.02, pAL < 0.001), with a mean SER and AL difference of 0.20D (- 0.15 ± 0.26D vs. - 0.34 ± 0.34D) and 0.11 mm (0.17 ± 0.11 mm vs. 0.28 ± 0.14 mm) in period 1, and 0.17D (- 0.18 ± 0.24D vs. - 0.34 ± 0.31D) and 0.10 mm (0.15 ± 0.15 mm vs. 0.24 ± 0.11 mm) in period 2. The GEE model showed that the proportion of myopia onset (p = 0.004) and fast myopic shift (p = 0.009) was significantly lower in the 0.01% atropine group than that in the placebo group. The period effect was not statistically significant (all p > 0.05). A total of 0.01% atropine significantly prevented myopic shift, axial elongation, and myopia onset in premyopic schoolchildren in central Mainland China. CONCLUSION Within the limits of only two consecutive 6-month observation period, 0.01% atropine eye drops effectively prevented myopic shift, axial elongation, and myopia onset in premyopic children. TRIAL REGISTRATION This trial was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000034760). Registered 18 July 2020. WHAT IS KNOWN • Minimal studies on interventions for pre-myopia, despite the International Myopia Institute stating that preventing myopia is an "even more valuable target" for science and practice than reducing progression after onset. WHAT IS NEW • A total of 0.01% atropine eye drops may safely and effectively reduce the proportion of myopia onset and fast myopic shift in premyopic schoolchildren.
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Affiliation(s)
- Weiqun Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Fengyan Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Shiao Yu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Nana Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Congcong Huang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Ming Wang
- Beijing Aier Intech Eye Hospital, Beijing, 100021, China
| | - Li Wei
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Junjie Zhang
- Henan Eye Institute, Henan Provincial People's Hospital, Zhengzhou, 450000, China
| | - Aicun Fu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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9
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Berntsen DA, Walline JJ. Delaying the Onset of Nearsightedness. JAMA 2023; 329:465-466. [PMID: 36786802 DOI: 10.1001/jama.2022.24386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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10
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Shi Y. Effect of Atropine Eye Drops Combined with VR-Based Binocular Visual Function Balance Training for Prevention and Control of Juvenile Myopia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4159996. [PMID: 36147642 PMCID: PMC9489366 DOI: 10.1155/2022/4159996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
Purpose This study mainly analyzes the efficacy of 0.01% atropine eye drops (low-dose atropine (LDA)) combined with virtual reality (VR)-based binocular visual function (BVF) balance training in the prevention and control of juvenile myopia. Methods One hundred and thirty-six juvenile myopia patients admitted between November 2018 to November 2021 were selected, including 76 cases (research group) receiving LDA + VR-based BVF balance training and 60 cases (control group) treated by LDA intervention alone. Visual acuity (VA; naked vision), ocular parameters (pupil diameter (PD), axial length (AXL), and diopter), intraocular pressure (IOP), accommodation facility, clinical efficacy, and incidence of adverse reactions were observed, compared, and analyzed in both groups. Results After analysis, it was found that the research group showed significantly higher naked vision and PD while statistically lower D after intervention than the corresponding preinterventional parameters than the control group. While AXL showed no statistical difference between the groups and within groups. The IOP also differed insignificantly between groups, but the post-treatment accommodation facility was better in the research group compared with the baseline (before treatment) and control group. In terms of curative effects, an obviously higher total effective rate was determined in the research group. In addition, the two groups showed no significant difference in the incidence of adverse reactions. Conclusions LDA + VR-based BVF balance training deserves clinical popularization, as it can prevent and control myopia among teenagers, with better adjusting effects on eye function and certain safety.
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Affiliation(s)
- Yuping Shi
- Chengdu Aier Eye Hospital, Chengdu 610041, Sichuan, China
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