Atropine for the Treatment of Childhood Myopia: Changes after Stopping Atropine 0.01%, 0.1% and 0.5%

doi:10.1016/j.ajo.2013.09.020

American Journal of Ophthalmology

Volume 157, Issue 2, February 2014, Pages 451-457.e1

https://doi.org/10.1016/j.ajo.2013.09.020 Get rights and content

Purpose

To study the change in spherical equivalent and other ocular parameters 1 year after stopping the administration of atropine.

Design

Prospective randomized double-masked clinical trial.

Methods

We assigned 400 myopic children, 6 to 12 years of age, to receive atropine 0.5%, 0.1% or 0.01% for 24 months, after which medication was stopped. Parents and children gave informed consent to participate in the research. Children were reviewed at 26, 32 and 36 months, and changes in cycloplegic spherical equivalent (SE), axial length (AL), visual acuity, pupil size, and accommodation were assessed.

Results

Of the children, 356 (89%) entered into the washout phase. At entry, there was no significant difference in age, gender, SE, or AL among the children in the various atropine groups. Over the following 12 months, myopic progression was greater in the 0.5% eyes (−0.87 ± 0.52 D), compared to the 0.1% (−0.68 ± 0.45 D) and 0.01% eyes (−0.28 ± 0.33 D, P < 0.001). AL growth was also greater in the 0.5% (0.35 ± 0.20 mm) and 0.1% (0.33 ± 0.18 mm) eyes, compared to the 0.01% eyes (0.19 ± 0.13 mm, P < 0.001). Pupil size and near visual acuity returned to pre-atropine levels in all groups, but accommodation at 36 months was less in the 0.5% eyes (13.24 ± 2.72 D) compared to the 0.1% (14.45 ± 2.61 D) and 0.01% eyes (14.04 ± 2.90 D, P < 0.001). The overall increase in SE over the entire 36 months in the 0.5%, 0.1% and 0.01% groups was −1.15 ± 0.81 D, −1.04 ± 0.83 D and −0.72 ± 0.72 D, respectively (P < 0.001).

Conclusion

There was a myopic rebound after atropine was stopped, and it was greater in eyes that had received 0.5% and 0.1% atropine. The 0.01% atropine effect, however, was more modulated and sustained.

Section snippets

Methods

The results described are based on a 12-month washout period after the phase 1 stage of the ATOM2 study, a randomized double-masked control study. In phase 1 of this study, 400 children (aged 6 to 12 years) with myopia ≥2.0 D, astigmatism of <1.50 D and documented myopic progression of ≥0.50 D over the past year were randomized to daily 0.01%, 0.1% or 0.5% atropine in a 1:2:2 ratio in 6 gender and age strata to ensure an equal gender-age balance among the groups. Study investigators, parents

Results

We studied 356 children (89%) who entered into the phase 2 washout phase of the ATOM2 study, with 75, 141 and 140 children in the 0.01%, 0.1% and 0.5% atropine groups, respectively (Fig. 1). At the 24-month visit, there was no significant difference in age, gender, SE, or AL in the children in each group (Table 1).

Analysis showed that 44 children (11%) were lost to follow-up by the 24-month visit. These children were found to have similar ages (9.7 ± 1.5 vs 9.7 ± 1.9 years, P = 0.99); similar

Discussion

In this second phase of our ATOM2 study, when atropine was ceased after 2 years of treatment, there was an increase in myopia that was greater in eyes treated with higher dosages of atropine. This was associated with a corresponding increase in AL in the atropine 0.1% and 0.5% eyes. Pupil size, accommodation and near vision recovered after atropine was stopped, but recovery was quicker in eyes treated with lower doses of atropine.

These results support the trend seen in the ATOM1 study, in which

Audrey Chia is a pediatric ophthalmologist based at the Singapore National Eye Center, the Singapore Eye Research Institute and the Kandang Kerbau Women's and Children's Hospital. She graduated from the University of Sydney, did her ophthalmology training at the Sydney Eye Hospital and a pediatric ophthalmology fellowship at the Great Ormond Street Hospital, London. Besides being involved in clinical care, Dr Chia's research interests include strabismus, amblyopia, retinopathy of prematurity,

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Original articleAtropine for the Treatment of Childhood Myopia: Changes after Stopping Atropine 0.01%, 0.1% and 0.5%

Purpose

Design

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Complement Ther Med

Ophthalmology

Ophthalmology

The control of myopia with atropine

Can J Ophthalmol

Clinical assessment of the arrest of myopia

Br J Ophthalmol

The treatment of myopia with atropine and bifocals: a long-term prospective study

Ophthalmology

Further observations on use of atropine in the treatment of myopia

Ann Ophthalmol

The effectiveness of 0.5% atropine in controlling high myopia in children

J Ocul Pharmacol Ther

Management of progressive school myopia with topical atropine eyedrops and photochromic bifocal spectacles

Binocul Vis Strabismus Q

Reducing the progression of myopia with atropine: a long term cohort study of Olmsted County students

Binocul Vis Strabismus Q

Treatment of childhood myopia with atropine eyedrops and bifocal spectacles

Binocul Vis Strabismus Q

Original article
Atropine for the Treatment of Childhood Myopia: Changes after Stopping Atropine 0.01%, 0.1% and 0.5%