Jan Roelof Polling1,2,3, Emily Tan1, Sjoerd Driessen3, Sjoukje E Loudon1, Hoi-Lam Wong1, Astrid van der Schans1, J Willem L Tideman1,3, Caroline C W Klaver4,5,6,7. 1. Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands. 2. Department Optometry & Orthoptics, Faculty of Health, University of Applied Sciences, Utrecht, The Netherlands. 3. Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. 4. Department Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands. c.c.w.klaver@erasmusmc.nl. 5. Department Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. c.c.w.klaver@erasmusmc.nl. 6. Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, Gelderland, The Netherlands. c.c.w.klaver@erasmusmc.nl. 7. Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland. c.c.w.klaver@erasmusmc.nl.
Abstract
BACKGROUND: Atropine is the most powerful treatment for progressive myopia in childhood. This study explores the 3-year effectiveness of atropine in a clinical setting. METHODS: In this prospective clinical effectiveness study, children with progressive myopia ≥ 1D/year or myopia ≤ -2.5D were prescribed atropine 0.5%. Examination, including cycloplegic refraction and axial length (AL), was performed at baseline, and follow-up. Outcome measures were spherical equivalent (SER) and AL; annual progression of SER on treatment was compared with that prior to treatment. Adjustments to the dose were made after 1 year in case of low (AL ≥ 0.3 mm/year) or high response (AL < 0.1 mm/year) of AL. RESULTS: A total of 124 patients were enrolled in the study (median age: 9.5, range: 5-16 years). At baseline, median SER was -5.03D (interquartile range (IQR): 3.08); median AL was 25.14 mm (IQR: 1.30). N = 89 (71.8%) children were persistent to therapy throughout the 3-year follow-up. Median annual progression of SER for these children was -0.25D (IQR: 0.44); of AL 0.11 mm (IQR: 0.18). Of these, N = 32 (36.0%) had insufficient response and were assigned to atropine 1%; N = 26 (29.2%) showed good response and underwent tapering in dose. Rebound of AL progression was not observed. Of the children who ceased therapy, N = 9 were lost to follow-up; N = 9 developed an allergic reaction; and N = 17 (19.1%) stopped due to adverse events. CONCLUSION: In children with or at risk of developing high myopia, a starting dose of atropine 0.5% was associated with decreased progression in European children during a 3-year treatment regimen. Our study supports high-dose atropine as a treatment option for children at risk of developing high myopia in adulthood.
BACKGROUND:Atropine is the most powerful treatment for progressive myopiain childhood. This study explores the 3-year effectiveness of atropinein a clinical setting. METHODS:In this prospective clinical effectiveness study, children with progressive myopia ≥ 1D/year or myopia ≤ -2.5D were prescribed atropine 0.5%. Examination, including cycloplegic refraction and axial length (AL), was performed at baseline, and follow-up. Outcome measures were spherical equivalent (SER) and AL; annual progression of SER on treatment was compared with that prior to treatment. Adjustments to the dose were made after 1 year in case of low (AL ≥ 0.3 mm/year) or high response (AL < 0.1 mm/year) of AL. RESULTS: A total of 124 patients were enrolled in the study (median age: 9.5, range: 5-16 years). At baseline, median SER was -5.03D (interquartile range (IQR): 3.08); median AL was 25.14 mm (IQR: 1.30). N = 89 (71.8%) children were persistent to therapy throughout the 3-year follow-up. Median annual progression of SER for these children was -0.25D (IQR: 0.44); of AL 0.11 mm (IQR: 0.18). Of these, N = 32 (36.0%) had insufficient response and were assigned to atropine 1%; N = 26 (29.2%) showed good response and underwent tapering in dose. Rebound of AL progression was not observed. Of the children who ceased therapy, N = 9 were lost to follow-up; N = 9 developed an allergic reaction; and N = 17 (19.1%) stopped due to adverse events. CONCLUSION:Inchildren with or at risk of developing high myopia, a starting dose of atropine 0.5% was associated with decreased progression in European children during a 3-year treatment regimen. Our study supports high-dose atropineas a treatment option for children at risk of developing high myopiain adulthood.