0.01% Atropine for Myopia Prevention in Pre-myopia (AMPP study).

Myopia usually commences during primary school and progresses until the mean age of 16 years. Topical low-dose (0.01%) atropine eye-drop appears to be safe and efficacious for myopia control in children. However, in some cases, a higher concentration of atropine is required in some cases because low-dose atropine treatment is not effective. This is a retrospective study among young myopic children between 5 and 15 years with myopia progression > 0.50 D/year. We selected patients treated with low-dose atropine (0.01%) eye-drops for 12 months and conducted a comparative analysis of the group with good responder and poor responder. Patients were classified as good responders if spherical equivalent refractive error (SE) progression was ⩽ 0.50 D after 12 months of treatment and poor responders if SE progression > 0.50 D. The prognostic factors before and after treatment were analyzed in two groups. A total of 68 eyes were included. Low-dose (0.01%) atropine eye-drops have a good treatment response in 54% of patients. In the good responder group (n = 37), the mean rate of myopia progression after 12 months of treatment (0.36 ± 0.17 D) was significantly slower compared with the baseline progression (p < 0.001). Good responders have smaller changes in axial length (AL) elongation and SE than poor responders (p < 0.001). The only adverse event was temporary near vision difficulty (10%), photophobia (10%), and mild pupil dilation (30%). The AL elongation is an important indicator for monitoring the treatment response. Children with a family history of myopia at a young age may not respond well to low-dose (0.01%) atropine eye-drops. In these cases, increasing the concentration of atropine eye-drops should be considered.

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.

Atropine for the Treatment of Childhood Myopia: Effect on Myopia Progression after Cessation of Atropine

Background: To evaluate the effect of the COVID-19 pandemic on myopic progression defined in terms of refractive change and axial length elongation in Korean children with myopia using 0.01% atropine eye drops. Methods: A retrospective review was performed on the medical records of 73 children aged 4 to 15 years with a baseline myopia of -0.50 diopters (D) or more who had used 0.01% atropine eye drops for more than 12 months before the onset of the COVID-19 pandemic in South Korea. The rate of myopic progression was compared between two periods: the pre- and post-pandemic eras, the latter of which was defined by the initiation of remote schooling in March 2020. At each visit, cycloplegic autorefraction and axial length were measured using a Zeiss IOL Master. Patients answered a questionnaire regarding their time spent on near work (computer, smartphone, reading, homework, after-school workbooks, drawing, etc.) and outdoors. Results: During the pandemic, in terms of refraction, myopia progressed at an average rate of -0.45 D/y, which was significantly faster than before the pandemic of -0.22D/y (p = 0.037). In contrast, axial length elongation was 0.22 mm/y and 0.19 mm/y before and after the pandemic, respectively, which was not significantly different (p = 0.546). Time spent on using computers, smartphones, and other near work significantly increased, while outdoor time had significantly decreased after the pandemic (paired t-test, all p < 0.001). The change in annual refractive myopic progression rate during the pandemic compared to the pre-pandemic period did not significantly correlate with changes in computer time, smartphone time, or other near work time (p = 0.134, 0.210, 0.863, respectively). However, the change in outdoor time showed a negative correlation with the change in annual myopic progression rate (r = -0.239, p = 0.041). Conclusions: Among Korean children aged 4 to 15 years receiving 0.01% atropine, the rate of myopic progression increased significantly in terms of refraction during the COVID-19 pandemic compared with the pre-pandemic period, whereas axial length progression did not change significantly.

BackgroundMany efforts have been invested in slowing progression of myopia. Among the methods, atropine administration and orthokeratology (OK) are most widely used. This study analyzed the efficacy of atropine and OK lens in controlling myopia progression and elongation of axial length.MethodsThis retrospective study included 105 patients (210 eyes) who wore OK lenses and 105 patients (210 eyes) who applied 0.125% atropine every night during the 3 following period. Student t-test, linear regression analysis, repeated measure ANOVA, and Pearson’s correlation coefficient were used for statistical analysis.ResultsThe change in axial length per year was 0.28 ± 0.08 mm, 0.30 ± 0.09 mm, and 0.27 ± 0.10 mm in the OK lens group, and 0.38 ± 0.09 mm, 0.37 ± 0.12 mm, and 0.36 ± 0.08 mm in the atropine group for years 1, 2, and 3, respectively. Linear regression analysis revealed an increase in myopia of 0.28 D and 0.34 D per year, and an increase in axial length of 0.28 mm and 0.37 mm per year in the OK lens and atropine groups, respectively. Repeated measure ANOVA showed significant differences in myopia (p = 0.001) and axial length (p < 0.001) between the atropine and OK lens groups; in astigmatism, there was no significant difference in these parameters (p = 0.320). Comparison of increases in axial length in relation to baseline myopia showed significant correlations both in the OK lens group (Pearson’s correlation coefficient, r = 0.259; p < 0.001) and atropine group (r = 0.169; p = 0.014). High myopia patients benefited more from both OK lenses and atropine than did low myopia patients. The correlation of baseline myopia and myopia progression was stronger in the OK lens group then in the atropine group.ConclusionsOK lens is a useful method for controlling myopia progression even in high myopia patients.

The aim of this study is to investigate if baseline relative peripheral refraction (RPR) influences the myopia control effects in Chinese myopic children wearing Defocus Incorporated Multiple Segments (DIMS) lenses. Peripheral refraction at 10°, 20°, and 30° nasal (10 N, 20 N, 30 N) and temporal (10 T, 20 T, 30 T) retina were measured at six-month intervals for children who participated in a 2-year randomized controlled trial. The relationship between the baseline peripheral refractions and myopia progression and axial length changes were analysed. A total of 79 children and 81 children in the DIMS and single vision (SV) group were investigated, respectively. In the DIMS group, more baseline myopic RPR spherical equivalent (SE) was associated with more myopic progression (10 N: r = 0.36, p = 0.001; 20 N: r = 0.35, p = 0.001) and greater axial elongation (10 N: r = −0.34, p = 0.001; 20 N: r = −0.29, p = 0.006) after adjusting for co-factors. In the SV group, baseline RPR had association with only myopia progression (10 N: r = 0.37, p = 0.001; 20 N: r = 0.36, p = 0.001; 30 N: r = 0.35, p = 0.002) but not with axial elongation after Bonferroni correction (p > 0.008). No statistically significant relationship was found between temporal retina and myopia progression or axial elongation in both groups. Children with baseline myopic RPR had statistically significant more myopia progression (mean difference around −0.40 D) and more axial elongation (mean difference 0.15 mm) when compared with the children having baseline hyperopic RPR in the DIMS group but not in the SV group. In conclusion, the baseline RPR profile may not influence future myopia progression or axial elongation for the SV lens wearers. However, DIMS lenses slowed down myopia progression and was better in myopia control for the children with baseline hyperopic RPR than the children with myopic RPR. This may partially explain why myopia control effects vary among myopic children. Customised myopic defocus for individuals may optimise myopia control effects, and further research to determine the optimal dosage, with consideration of peripheral retinal profile, is warranted.

Purpose: We evaluated the efficacy of atropine eye drops diluted with artificial tears in different ratios for mitigating myopia progression in children.Methods: This retrospective study analyzed the children diagnosed with myopia who were treated with 0.125% atropine eye drops, followed immediately by artificial tears. Participants were divided into two groups based on the atropine dilution method. Group A received one drop of atropine followed by one drop of artificial tears (resulting in an approximate atropine concentration of 0.063%) for 1 year. Group B received one drop of atropine followed by three drops of artificial tears (approximately 0.031% atropine) for 6 months. Subsequently, the regimen transitioned to one drop of artificial tears (approximately 0.063% atropine) for an additional 6 months. Myopia progression was evaluated by measuring changes in axial length and spherical equivalents at baseline, 6 months, and 12 months.Results: We analyzed 58 children, including 30 in Group A (mean age: 8.7 ± 1.9 years) and 28 in Group B (mean age: 9.1 ± 1.5 years). Baseline axial lengths were 24.71 ± 1.05 mm in Group A and 24.90 ± 1.38 mm in Group B. At 6 months, mean axial length changes were 0.12 ± 0.15 mm in Group A and 0.17 ± 0.17 mm in Group B. Between 6 and 12 months, the respective changes were 0.17 ± 0.14 mm and 0.15 ± 0.12 mm. Both groups exhibited delayed myopia progression in axial length and spherical equivalents, with no statistically significant differences between them.Conclusions: Dilution of 0.125% atropine eye drops with artificial tears effectively slowed myopia progression in both groups. However, no statistically significant differences were observed between the two dilution methods. These findings emphasize the need for precise atropine formulations to optimize myopia control.

Purpose This study investigated the correlation between corneal biomechanical parameters and the speed of myopia progression. Methods This is a retrospective, multicenter study. Both Chinese and Caucasian children were involved. The follow-up time was at least 12 months. Ocular biometry data including the central corneal thickness (CCT), axial length (AL), corneal keratometry (K), anterior chamber depth (ACD), white-to-white (WTW) distance, and pupil size (PS) were measured. The age of onset, speed of progression of spherical equivalent (SE), and speed of AL elongation were calculated. Data were analyzed using the R programming language. Results This study comprised 306 eyes of 153 myopic children. 122 children were Chinese, and 31 children were Caucasian. The myopia progression was faster in Chinese children than that in the Caucasian group in both SE progression speed and AL elongation speed. The CCT was negatively correlated with the SE speed of progression (correlation coefficient, R = −0.65, and p=7.25 × 10−38) and AL speed (R = −0.47 and p=1.62 × 10−18). CCT was positively correlated with the age of onset (R = 0.35 and p=4.53 × 10−10). No significant correlation (R > 0.3 and p < 0.01) was found between other ocular biometries (K, ACD, WTW, and PS) and the onset and speed of the progression of myopia. The same trends were found in both Chinese and Caucasian children and in both the right eye and left eye. Conclusion CCT was negatively correlated with myopia (SE) progression speed and AL elongation speed. Thin CCT may be associated with faster myopia progression.

BackgroundAxial myopia is the most common type of myopia. However, due to the high incidence of myopia in Chinese children, few studies estimating the physiological elongation of the ocular axial length (AL), which does not cause myopia progression and differs from the non-physiological elongation of AL, have been conducted. The purpose of our study was to construct a machine learning (ML)-based model for estimating the physiological elongation of AL in a sample of Chinese school-aged myopic children.MethodsIn total, 1011 myopic children aged 6 to 18 years participated in this study. Cross-sectional datasets were used to optimize the ML algorithms. The input variables included age, sex, central corneal thickness (CCT), spherical equivalent refractive error (SER), mean K reading (K-mean), and white-to-white corneal diameter (WTW). The output variable was AL. A 5-fold cross-validation scheme was used to randomly divide all data into 5 groups, including 4 groups used as training data and one group used as validation data. Six types of ML algorithms were implemented in our models. The best-performing algorithm was applied to predict AL, and estimates of the physiological elongation of AL were obtained as the partial derivatives of ALpredicted-age curves based on an unchanged SER value with increasing age.ResultsAmong the six algorithms, the robust linear regression model was the best model for predicting AL, with a R2 value of 0.87 and relatively minimal averaged errors between the predicted AL and true AL. Based on the partial derivatives of the ALpredicted-age curves, the estimated physiological AL elongation varied from 0.010 to 0.116 mm/year in male subjects and 0.003 to 0.110 mm/year in female subjects and was influenced by age, SER and K-mean. According to the model, the physiological elongation of AL linearly decreased with increasing age and was negatively correlated with the SER and the K-mean.ConclusionsThe physiological elongation of the AL is rarely recorded in clinical data in China. In cases of unavailable clinical data, an ML algorithm could provide practitioners a reasonable model that can be used to estimate the physiological elongation of AL, which is especially useful when monitoring myopia progression in orthokeratology lens wearers.

To evaluate the efficacy and safety of three different concentrations of diluted atropine for the control of myopia in Korean children, and to assess the risk factors associated with rapid myopia progression. A total of 285 children, with refractive errors within the range of -6 diopters (D) between 5 and 14 years of age were included. After using 0.01%, or 0.025%, or 0.05% atropine, for about 1y, changes in refraction, axial lengths and frequency of adverse events were analyzed. Logistic regression analyses were performed to evaluate the risk factors associated with rapid myopia progression. The changes in the mean spherical equivalent values were -0.134 D/mo in the before atropine group, -0.070 D/mo in the 0.01% atropine group, -0.047 D/mo in the 0.025% atropine group, and -0.019 D/mo in the 0.05% atropine group, with significant differences between the groups (P<0.001). The axial elongation was 0.046 mm/mo, 0.037 mm/mo, 0.025 mm/mo, and 0.019 mm/mo respectively, with significant differences between the groups (P=0.003). The incidence of photophobia and near vision difficulty was not different among the three atropine groups (P=0.425 and P=0.356, respectively). Multivariate logistic regression analyses showed that only highly myopic parents were a significant predictive factor of rapid myopia progression in Korean children (odds ratio, 8.155; 95% confidence interval, 3.626-18.342; P<0.001). Treatment with 0.01%, 0.025% and 0.05% atropine solution inhibits myopia progression in Korean children in a dose-dependent manner. Children with highly myopic parents preferentially shows a rapid myopia progression rate.

Background: Myopia, the most common refractive error, is becoming a significant public health challenge due to its rising incidence and associated risks of vision impairment and ocular complications. Low-dose atropine (0.01%) is a promising intervention hypothesized to slow myopia progression by modulating retinal and scleral signaling and reducing axial elongation. Unlike higher concentrations, it has fewer side effects, making it suitable for long-term use in children. Methods: This prospective comparative study was conducted at the National Institute of Ophthalmology and Hospital in Dhaka, Bangladesh, from June 2023 to July 2024. Fifty-six myopic children aged 6–14 years were divided into two equal groups: one received atropine 0.01% eye drops (Atropine group), while the other received no atropine (Control group). Refractive status (RS) and axial length (AL) were assessed over 12 months using SPSS 26 for data analysis. Results: Forty-six participants (92 eyes) completed the study. Children aged 6–10 years in the atropine group showed significantly less myopia progression (-0.04±0.09 D vs. -0.38±0.23 D, p&lt;0.0001) and axial length elongation (0.03±0.02 mm vs. 0.21±0.05 mm, p&lt;0.0001). In the 11–14 years subgroup, axial length growth was significantly slower in the atropine group (0.04±0.05 mm vs. 0.20±0.05 mm, p&lt;0.0001), though refractive error differences were not statistically significant. Temporary photophobia was reported in 4.5% of atropine users, with no other adverse effects. Conclusions: Atropine 0.01% eye drops effectively slow the progression of myopia and axial length growth in children aged 6–14 years.

Background: The progression of myopia in children is mainly caused by near-work activities and diminishing time outdoors. These increase the risk of high myopia, resulting in retinal detachment or macular degeneration. There are several alternative interventions to slow myopia progression, such as Orthokeratology (Ortho-K) and Atropine Eyedrop. Objectives: Systematically compile current evidence from relevant peer-reviewed publications to assess children’s myopia progression efficacy between Atropine Eyedrop and Orthokeratology. Method: A literature search was conducted on Cochrane®, Pubmed®, and ProQuest® then selected based on inclusion (randomized controlled trial, cohort, myopic children under 18 years old, cycloplegic refraction, publication year between 2010 - 2022) and exclusion (conference abstracts, case reports, duplicate publications) criteria. Primary outcomes are mean changes of axial elongation and spherical equivalent refraction in diopters. The secondary outcome is the mean changes in the sub-foveal choroidal thickness. Furthermore, critical appraisal will be done on selected articles. Results: Two prospective RCTs (187 subjects) revealed: axial elongation and spherical equivalent refraction significantly reduced in both treatment groups. However, axial length reduction was better in the Atropine Eyedrop compared to the Ortho-K group (0.20?±?0.03 mm vs. 0.28?±?0.03 mm). Another study also revealed that AL increased in Atropine compared to the Ortho-K group (0.24 ± 0.06 mm vs. 0.32 ± 0.07 mm). Moreover, spherical equivalent refraction reduction was better in Atropine compared to the Ortho-K group (?0.30 ± 0.07 D vs. ?0.41 ± 0.08 D). Nevertheless, sub-foveal choroidal thickness was greater in Ortho-K compared to the Atropine group (19.33?±?2.63 ?m vs. 8.09?±?1.47 ?m). Conclusion: Atropine Eyedrop is potentially a better option in controlling myopia progression in children than Orthokeratology with minimal changes in sub-foveal choroidal thickness.

Crystalline lens thickness change is associated with axial length elongation and myopia progression in orthokeratology

Relationships between intraocular pressure (IOP) and baseline characteristics are explored in a subgroup of children participating in the Correction of Myopia Evaluation Trial. The 5-year follow-up also provides information on the relationship between IOP, myopic progression, and change in axial length. Right eye IOP, cycloplegic autorefraction, and axial length were measured at baseline and annually in 104/118 children at one of the Correction of Myopia Evaluation Trial centers. At baseline, IOP for the cohort was 15.92 +/- 4.16 mm Hg. IOP decreased (0.125 mm Hg/year) over the follow-up (p = 0.05). IOP of Blacks (n = 17; 19.88 +/- 4.24 mm Hg) was higher than Hispanics (n = 50; 15.77 +/- 2.44 mm Hg, p = 0.006), Whites (n = 25; 14.51 +/- 1.75 mm Hg, p = 0.0001) and all non-Blacks combined (n = 87; 15.38 +/- 2.26 mm Hg, p = 0.0006). IOP averaged over the six visits did not differ by gender (mean difference = 0.66 mm Hg). There was no significant association between baseline IOP and baseline myopia or myopic progression, and no significant relationship between IOP the year prior to myopic progression measured over the following year. The same results were found for IOP and axial length. Small but significant ethnic differences were noted in the IOP of myopic children, with Blacks having higher values. IOP was not associated with gender, baseline refractive error, baseline axial length, myopic progression, or change in axial length over the 5-year observation period.

PurposeThe aim of this study is to evaluate the myopic control effect between defocus-incorporated multiple segments (DIMS) spectacle lenses plus 0.01% atropine (ATR), and 0.125% ATR, for patients with fast myopia progression.MethodsA retrospective cohort study was conducted, and patients who had experienced myopic progression of more than -1.00 diopter (D) within a one-year period were enrolled. Then, the patients were divided according to the management they received. A total of 53 and 46 eyes were assigned to the ATR and DIMS groups, respectively. The primary outcomes were the progression of spherical equivalent refraction (SER) and axial length (AXL). The independent t-test and generalized linear model were used for statistical analysis.ResultsAfter the one-year follow-up period, the progression of SER was significantly greater in the ATR group (0.31 ± 0.11 D) than in the DIMS group (0.10 ± 0.07 D) (p < 0.001). On the other hand, the elongation of AXL was significantly larger in the ATR group (0.12 ± 0.06 mm) than in the DIMS group (0.03 ± 0.02 mm) (p < 0.001) at the final visit. In addition, the ATR group with low- or moderate-baseline myopia revealed more significant SER and AXL progression than the DIMS group (all p < 0.001). A young age at onset was correlated with greater SER and AXL progression in the ATR group (both p < 0.05). Still, no pre-treatment parameter was associated with increased SER or AXL progression in the DIMS group (all p > 0.05).ConclusionsDIMS spectacle lenses plus 0.01% ATR management showed greater efficacy for SER and AXL control than 0.125% ATR management in the fast myopia progression population.