JR Polling and team reported on the one-year results of their study investigating the effect of different strengths of atropine on refraction and axial length. Their results, presented virtually at ARVO, 2020, provide further evidence of the dose-dependent response of this form of treatment.
Jan Roelof (JR) Polling; Emily Tan; Willem Tideman; Caroline Klaver. Atropine for myopia progression: high dose vs low dose in a real-world setting. Invest Ophthalmol & Vis Sci June 2020, Vol.61, 1134
Abstract
Purpose: Many eye care providers prefer low dose atropine (0.01%) over high dose (0.5% or 1%) for myopia control because of the lower risk of side effects. Nevertheless, the effectiveness of this concentration on reduction of axial length progression has not been proven. This study explores the one year effectiveness of high versus low dose atropine on spherical equivalent refraction (SER) and axial length (AL) progression in a myopia control clinic.
Methods: Study participants were derived from the Erasmus MC Myopia Control Clinic, and consisted of children aged 6-13 years with bilateral progressive myopia and a SER of -0.5D to -6.0 using 0.5% or 0.01% atropine for myopia control at baseline. Children with syndromic myopia were excluded. SER and AL were measured at 6 months and 1 year, and progression was calculated. Baseline and progression of SER and AL were compared between treatment regimens with the Mann-Whitney U test.
Results: At baseline, 128 children (mean age 9.2±1.7) with 0.5% and 37 children (mean age 10.0±1.9) with 0.01% atropine started treatment. (p=0.51) Ethnicity was predominately white (68%) and only 9% of the study population was from East Asian descent. Median SER was -4.19D (IQR 1.7) for atropine 0.5% and -3.75D (IQR 2.7) for atropine 0.01% (p=0.04); median AL’s were 24.66 (IQR 1.13) and 24.59mm (IQR 0.73), respectively (p=0.14). At 6 months, 9/128 children (7%) who were on atropine 0.5%, and 2/37 children (5%) who were on atropine 0.01% stopped therapy. At one year, another 2 children had stopped therapy in the 0.5% group.(p= 0.53) At 6 months, median SER and AL progression was +0.19D and 0.00mm, respectively, for atropine 0.5% , and -0.03D and 0.15mm for 0.01%. (p<0.001; p<0.001) At 12 months, median SER and AL progression was +0.12D and 0.07mm, respectively, for atropine 0.5%; -0.25D and 0.19mm for 0.01%. (p=0.01; p=0.05)
Conclusions: One year progression of SER and AL was more in favor of high dose atropine (0.5%) than low dose (0.01%). Dropout rates were somewhat higher at high dose, but the vast majority managed to adhere to this therapy. High dose atropine should have a place in myopia control when strict control is needed to lower the risk of progression to high myopia.
